17th January 2024

A 35-year-old patient with a background of severe asthma and eczema was diagnosed with ABPA after attending a respiratory clinic last year with recurrent asthma exacerbations, productive cough and shortness of breath despite optimal asthma treatment.

A 35-year-old patient with a background of severe asthma and eczema was diagnosed with ABPA after attending a respiratory clinic last year with recurrent asthma exacerbations, productive cough and shortness of breath despite optimal asthma treatment. Serum IgE was raised, and skin prick test was positive for ABPA. Imaging showed mucus plugging and bronchial wall thickening. They were successfully treated with steroids and had been weaned off steroids eight months ago. The patient has re-attended the clinic as they are having problems with productive cough, shortness of breath, and malaise again. They have taken over an allotment in the last few months but now find they are struggling to manage it. Based on this limited information, which of the below options would be the most appropriate medical management?

Select the SINGLE most appropriate option from the list below. Select ONE option only.