Interview long-term ABPA patient who coughed up large sputum plugs

Video Interview with long-term ABPA patient who coughed up large sputum plugs. This patient had several episodes of pneumonia and developed bronchiectasis after diagnosis for a collapsed left lung. She was treated with inhaled corticosteroids and bronchodilators and progressed well. She was later diagnosed with possible ABPA (aspergillus precipitins were negative), after producing a large sputum plug which was positive for aspergillus hyphae. Her main symptoms were severe coughing with production of clear sputum. In December 04 her coughing became very severe and she coughed badly for 7 months. Her treatment was modified to include itraconazole (400mg/day solution- she required a higher dose than normal as she was taking other medication which reduced it’s absorption). 8 weeks later she started very severe bouts of coughing over 3 days – which produced a large number of small mucous plugs, finally a very large plug (resembling a piece of grey chewing gum) was coughed up. After this, the coughing subsided and the patient felt well and a chest X-ray at this time showed a significant improvement with clearing of shadows from the right lower lobe. Itraconazole levels have been reduced to 300mg per day and steroid intake reduced. The patient remained well in July 2007. We thank the patient for kindly providing this interview.