Objectives:

• Identify the clinical presentation of allergic bronchopulmonary aspergillosis
• Diagnose and treat a patient with allergic bronchopulmonary aspergillosis

1		A 42-year-old female comes to your office with a history of asthma that has been difficult to control. She relates symptoms that have been worsening over the last 4–6 weeks. She received two courses of oral corticosteroids during that time. Her symptoms improved with this therapy but quickly returned after completing the steroids. She denies fever, chills, and night sweats, but complains of a chronic cough productive of brownish-colored sputum. Her review of systems is otherwise negative. She is a homemaker in a suburban area and has no pets. Physical examination reveals wheezing throughout all lung fields, but is otherwise within normal limits. Spirometry values are decreased from her baseline. Laboratory evaluation includes normal CBC (aside from a very few eosinophils), normal C-reactive protein, and an elevated IgE level of 1,250 ng/ml. A high-resolution CT scan of the chest reveals central bronchiectasis. What is the most likely diagnosis?
			A)	Hypersensitivity pneumonitis.
			B)	Acute eosinophilic pneumonia.
			C)	Allergic bronchopulmonary aspergillosis.
			D)	Bacterial pneumonia.
			E)	Churg-Strauss vasculitis.
2		Which of the following would be the next best step in confirming the diagnosis?
			A)	Sputum cultures.
			B)	Transbronchial biopsy.
			C)	Methacholine challenge.
			D)	Allergy skin testing for Aspergillus species.
			E)	p-ANCA.
3		The most appropriate treatment would include which of the following?
			A)	Antibiotics.
			B)	Oral corticosteroids.
			C)	Leukotriene receptor antagonist.
			D)	Levalbuterol.
			E)	Inhaled ipratropium bromide.