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-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.