Date: 26 November 2013
This recording of peak flow was taken prior to and during the first 4 weeks of inhaled steroids (Becotide 100 and Duovent both 2 puffs 4x daily). The patient had had asthma since age 4, and been treated with bronchodilators and oral courses of steroids when severely affected. The chart, which the patient completed at home, shows that early in week one her peak flow varied from 200-250 L/min. As the medication started to work, the peak flows gradually increased to reach 360-420 L/min in the 4th week. The lower value each morning is characteristic of asthma.
The response to steroids is important confirmation of the diagnosis of asthma (reversible airways obstruction). Many years later she developed ABPA, while on inhaled steroids, with severe upper lobe central bronchiectasis, an IgE of 6,800 Kiu/L, positive aspergillus precipitins, an Aspergillus RAST of 58.7KUa/L (normal <0.4) and eosinophilia.
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The following images were obtained by endoscopy of falcons with aspergillosis. A Lung Worm (serratospiculum sp.) B Lying in betweeen loops of the intestine.C An aspergillus lesion in between the loops of the intestineD Showing cranial pole of left kidney, ovary and oviduct.
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Cultures were grown on malt extract agar. Light microscopy at 1000x stained with lacto-phenol cotton blue.
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Cultures were grown on malt extract agar. Light microscopy at 1000x stained with lacto-phenol cotton blue.
