A 43-year-old woman with a longstanding history of sinus problems, allergies and chest problems has been treated long-term for asthma. She is experiencing frequent respiratory infections that have been managed as exacerbations of asthma.
- Recurrent respiratory infections are not a normal occurrence in patients with asthma, and an explanation must always be sought.
- High-dose fluticasone is associated with systemic effects and can rarely be clinically justified.
- Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome of asthma with bronchiectasis which is caused by sensitisation to fungi. Most people with asthma do not have ABPA.
- This patient’s symptoms and radiography results more typically indicate the development of bronchiectasis.
- Before treating for bronchiectasis, consider gastro-oesophageal reflux disease and any history of childhood infections, tuberculosis exposure and swallowing dysfunction. Test for treatable pathogens, especially Pseudomonas aeruginosa.
- Managing bronchiectasis requires daily airway clearance, influenza and pneumococcal vaccination and treating infection flares and immune deficiency if present.
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