A 52-yr old man visited for a 4-yr history of cough, dyspnea, sneezing, rhinorrhea, and wheezing on 25th June 2010. Initial FEV1 was 1.74 L (54.4%), FVC was 2.40 L (61.3%), and FEV1/FVC was 72.5%. BD response was positive (FEV1 increased 20.6%, 270 mL). CXR showed multiple nodules in both lungs. A sinus CT showed bilateral maxillary sinusitis. A chest CT showed a tree-in-bud appearance and air trapping in both lower lungs. Induced sputum showed neutrophilia. He showed a poor response to inhaled budesonide combined with formoterol and montelukast. As AFB studies were negative, we administered clarithromycin. The patient took clarithromycin 250 mg twice a day for 9 months, after which FEV1 improved from 54.4% to 95.3%, FVC improved from 61.3% to 92.8%, and FEV1/FVC also improved. Cough and sputum disappeared. He now takes montelukast and clarithromycin without respiratory symptoms.
A 25-year old male with uncontrolled asthma. Initial FEV1 was 2.51 L (62.6%) and severe sputum eosinophilia. His CT scan shows diffuse bronchitis with tree bud sign and then treated with clarithromycin for 9 months. FEV1was improved from 62.6% to 88.4%. He reduced daily amount of inhaled corticosteroid.