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

Answered by
Dr. Amit Jauhari
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 18, 2020

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 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 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 AEC is also elevated 612.



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) HsCRP.

2) 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.

Thank you doctor,

I will get the above tests done. Is there a chance of malignancy, and how often do I have to get a CT to follow the nodule? I understood that the last two tests are for TB. Can you throw some light on Hs CRP? If this test comes out positive, what does it signify, and how does it change the treatment plan?



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 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.

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