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.
A 69-yr-old man came with a 3-yr history of cough, sputum, and dyspnea on 11th July 2012. His initial FEV1 was 1.88 L (79.2%), FVC was 2.34 L (76.8%), and FEV1/FVC ratio was 80.3%. FEV1 increased 13.2% (250 mL) after bronchodilator inhalation. Induced sputum showed neutrophilia without eosinophils. CXR showed tiny nodules and bronchial wall thickening in both lower lungs (). Water's view showed left maxillary sinusitis (). A chest CT showed severe and diffuse centrilobular nodules and branching linear opacities in both lungs (). The AFB studies were negative. He was prescribed fluticasone combined with salmeterol, pranlukast, myrtol, and clarithromycin. After the patient took clarithromycin 250 mg twice a day for 40 days, his cough and sputum decreased. A follow-up CT showed a slight decrease in bronchial wall thickening and multiple nodules throughout both lungs (). After 8 months of clarithromycin, he was able to use only fluticasone and salmeterol inhaler with clarithromycin. His FEV1 increased from 79.2% to 127.0%, and FVC increased from 76.8% to 118.9%.\nThe study occurred in the allergy clinic of a tertiary teaching hospital in Korea. We collected 5 patients who visited as severe asthma but treated well with DPB treatment. Institutional review board reviewed and approved this study (4-2014-0362).