Chest tightness and SOB

43 female.having seasonal cough dyspnea,fever lasts for 2to3 months,on bronchodilators,takes regular influenza vaccine yearly. h/o PTB in 2015,taken complete AKT. routine lab is normal,ct &serial cxrays displayed.sputum AFB negative. plz discuss management.

51 yr k/c/o bronchial asthma fever for 7 days hemoptysis 1 episode tlc 12000 E 7% xray and CT attached

66yrs/M presented with 3 days of dyspnea.Known Diabetic and Asthmatic on budesonide inhaler.He has never smoked.No H/o fever,dry cough or travel.COVID 19 ÑEGATIVE,LAB REPORTS ENCLOSED.ANY THOUGHTS?

Dear doctors on this platform, sharing new updates on ABPA Allergic bronchopulmonary aspergillosis (ABPA) NEW diagnostic criteria and staging to be followed Aspergillus fumigatus colonizes the tracheobronchial tree of patients with asthma (and cystic fibrosis), with little or no tissue invasion by the organism . . . i.e. immunological response to antigens released from the fungus New diagnostic criteria for ABPA 1)Predisposing conditions • Bronchial asthma, cystic fibrosis 2)Obligatory criteria (both should be present) • Type I Af skin test positive or elevated Af IgE (>0.35 kUA/L) • Elevated total IgE levels (>1000 IU/mL) 3)Other criteria (at least two of three) • Presence of Af precipitating (or IgG) antibodies in serum • Radiographic pulmonary opacities consistent with ABPA • Eosinophil count >500 cells/µL (may be historical) fumigatus-specific IgE levels • MOST SENSITIVE INVESTIGATION IN DIAGNOSIS OF ABPA • Cutoff value: Af IgE >0.35 kUA/L • Sensitivity: 100%, Specificity: 69% • Preferred test for screening asthmatic patients for ABPA YOU WILL NOT MISS ANY CASE of ABPA, if the A. fumigatus-specific IgE antibodies <0.35 KUA/L Aspergillus skin test o Previously advocated as the screening test for AS o Sensitivity: 95%, Specificity: 80% o NO LONGER the preferred test for ABPA screening Total serum IgE levels • A normal serum IgE excludes active ABPA • Sensitivity: 97%, Specificity: 38% • Not a good screening test • BUT Important tool in follow-up of patients, and an increase in IgE levels may signify an impending exacerbation Serum precipitins (or specific IgG) against A. fumigatus • Precipitins (double diffusion method): sensitivity, 27% • A. fumigatus-specific IgG (cutoff 27 mgA/L): sensitivity, 89%; specificity, 100% PLEASE DO NOT USE serum precipitins, USE A. fumigatus-specific IgG Serum galactomannan • No utility in ABPA. Sensitivity: 26%; Specificity: 82% Total eosinophil count • Eosinophil count >1000 cells/µL has been a major criterion • In India, eosinophil count is used to screen asthmatic patients for ABPA and is one important cause for missed diagnosis PLEASE DO NOT USE eosinophil count as a screening test for ABPA Remember to obtain an HRCT not a NCCT/CECT chest • Bronchiectasis most common (70-95%) abnormality along with bronchial wall thickening (95%) • Forget about CENTRAL BRONCHIECTASIS (medial half or two-thirds of the lung field, on an imaginary line drawn from the hilum to the chest wall) as bronchiectasis may extend to the periphery (in 40% of the cases) High attenuation mucus (HAM): pathognomonic finding NEW STAGING SLIDE has been put in the pictures Hope this will be helpful to all the colleagues for better patient management Regards

68/female known case of bronchial asthma ; interpret abg