ABSTRACT
A 42-year-old woman; never-smoker; with allergies to grass, cats, and ragweed; rhinosinusitis and nasal polyposis; and a recently identified aspirin sensitivity, who was on treatment with 1,000 mcg equivalent of an inhaled corticosteroid (ICS) and a long-acting β2-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and a leukotriene receptor antagonist (LTRA), had three exacerbations in the previous year that required treatment with short courses of prednisone. Her specialist decides to maintain her on a low dose of prednisone (7.5 mg daily) to avoid the frequent courses of prednisone. Her forced expiratory volume in one second (FEV1) and vital capacity (VC) prebronchodilator are 1.6 L (62% predicted) and 3.2 L (78% predicted) respectively, with a ratio of 50%. The FEV1 and VC improve to 1.9 L and 3.4 L after inhaling 200 μg of salbutamol. Her high-resolution thoracic CT scan does not show emphysema or bronchiectasis. Her total serum IgE is 480 IU/L. Other measurements include blood eosinophil count of 0.6/μL, sputum eosinophil count of 8% with moderate free granules, and an exhaled nitric oxide (NO) of 48 ppb.
