ASIA-PACIFIC SURVEY OF PHYSICIANS ON ASTHMA AND ALLERGIC RHINITIS (ASPAIR) - INDIA RESULTS

and presented with similar CT and bronchoscopic features. Methods: Patient A: a 70-year-old male had a tracheostomy during treatment for pneumonia but had its closure following recovery. Four months later, he developed fever, cough, and wheeze and the CT scan showed tracheobronchial wall thickening. Intravenous corticosteroids promptly eased the symptoms, but recurred after stopping the steroids. Oral prednisolone 20 mg daily was initiated before referral to us. Patient B: a 60-year-old male who underwent emergency surgery for intracranial haemorrhage was complicated by aspiration pneumonia and had a tracheostomy. Following recovery and tracheostomy closure, several months later he developed wheeziness which responded well to oral prednisolone 20 mg daily. CT scan showed thickening of the tracheobronchial walls. Results: Both patients did not have the characteristic CT findings at the time of tracheostomy procedures. They were referred to our department for further investigation, with clinical suspicion of RP. Bronchoscopy was performed and we found striking resemblance upon airway observation with tracheobronchial wall swelling leading to loss of cartilaginous ridges and fish scale-like appearances. Confirmation of cartilaginous inflammation proved difficult by bronchoscopic biopsy though non-specific inflammatory changes were observed. Conclusion: Up to 50% of RP cases involve the airways and impose risk of respiratory failure and death. Reports of preceding tracheostomy with subsequent onset of RP is scarce, and the bronchoscopic appearance of the airways in our cases were unique and have not been described previously. Obstructive symptoms after intubation or tracheostomy may be a sign of development of RP. Accumulation of case reports is warranted for prompt recognition and treatment of this potentially life threatening and poorly understood disease.