A 60-yr-old woman referred for a 5-yr history of severe asthma on 18th August 2010. Cough and dyspnea were her main symptoms. Her initial FEV1 was 0.88 L (42.9%), FVC was 1.10 L (44.9%), and FEV1/FVC was 73.4% without a BD response. A crackling sound was heard in both lungs. A chest CT showed diffuse bronchial wall thickening and centrilobular nodules with a tree-in-bud appearance in both lower lungs (). Induced sputum showed 2% eosinophils. A MBPT could not be performed. Water's view showed bilateral maxillary sinusitis. She had been using inhaled budesonide combined with formoterol, a tiotropium inhaler, montelukast, and theophylline for a month. After a month, she complained of continuous cough and sputum. The crackling sound was consistently heard. The AFB studies were negative, and clarithromycin was introduced. The patient took clarithromycin 250 mg twice a day for 5.5 months with asthma medication, after which her FEV1 improved from 0.88 L (42.9%) to 1.96 L (97.1%), and FVC improved from 44.9% to 98.8%. Follow-up chest CT after a year showed improved centrilobular nodules in both lungs. She was able to discontinue budesonide and formoterol.
A 25-yr-old man had a 5-yr history of cough and dyspnea on 28th March 2007. Initial FEV1 was 2.51 L (62.6%), FVC was 3.65 L (77.8%), and FEV1/FVC was 68.8%. BD response was negative. The results of a MBPT were positive (PC20 4.36 mg/mL). A CXR showed miliary nodules in both lungs, but he didn't have sinusitis. A chest CT showed bronchiolectasis and centrilobular nodules on both lungs (). Induced sputum showed severe eosinophilia (42%). The AFB studies were negative. He took inhaled fluticasone combined with salmeterol, montelukast, and theophylline, and he intermittently used 30 mg of prednisolone (PL) for asthma attacks. After the patient took clarithromycin 250 mg twice a day for 9 months, his FEV1 improved from 62.6% to 88.4%, and he could reduce the amount of PL. Before the patient had started taking clarithromycin, he had taken 720 mg of PL per year. After he treated with clarithromycin, he was able to reduce use of oral steroids by about 80%, such that he took 150 mg per year.