I have bronchial asthma with lower lobe granuloma with elevated AEC. Kindly help.

Question

Hi doctor,

I had a cough with mild expectoration for the past six months, for which I had consulted a pulmonologist before the COVID-19 lockdown. Subsequently, I got an x-ray and pulmonary function test (PFT) done, and I was told that I have mild early bronchial asthma. I took Formoterol, and symptoms subsided. But my main concern is I feel something stuck in the right side of my chest, which is causing discomfort. Whenever I cough hard (voluntarily), it makes me feel better. For the same, I consulted one of your colleagues on the same platform who suggested high resolution computed tomography (HRCT). I got the HRCT done, which shows a small soft tissue nodule (6 mm) in the left lower lobe granuloma's apical segment. And my absolute eosinophil count (AEC) is also elevated 612.

Answer 1

Hi,

Welcome to icliniq.com. Your AEC (absolute eosinophil count) is on the higher side, which means allergic levels are high. Your need to cough is due to the fibrosis seen in the left lung lower lobe - a sign of change in normal lung tissue. There is a small granuloma issue. Also, this can be due to inflammation or due to infection. It would help if you had the following tests for further advice: 1) High sensitivity C-reactive protein (HsCRP). 2) Tuberculosis polymerase chain reaction (TB PCR) / TB Gold. 3) Sputum for grams stain and fungus. These tests will solve the diagnosis issue and give a treatment plan also. It would help if you continued with Formeterol inhaler one puff three times a day + tablet Montair FX (Montelukast and Fexofenadine) once daily in the meantime.

Answer 2

Hello,

Welcome back to icliniq.com. For ruling out malignancy, you can do the following: 1) Add atypical cells to the sputum test. 2) Get a repeat HRCT (high resolution computed tomography) after three months and get a radiological comparison. The high-sensitivity C-reactive protein (hs-CRP) test is for inflammation levels. It is high in cases of uncontrolled systemic diseases (diabetes, arthritis, connective tissue disease). High inflammation levels do not allow asthma or any other conditions to subside to the remission stage.