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 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).