The patient removed the iguana from home the day after the BPT and started treatment with budesonide 320 µg and formoterol 9 µg twice a day.
Twenty four hours later her symptoms resolved and she stopped needing rescue inhaled salbutamol. A PEF monitoring performed in the 2 following weeks revealed normal values with no significant variations within the same day.
Non-specific bronchial hyperreactivity and serum and sputum ECP were assessed 6 and 15 weeks after stopping exposure to iguana (Figure 2). At 6 weeks the PC20 methacoline was 6.50 mg/ml, and serum and sputum ECP were 10.50 and 9.29 mg/l, respectively. Eosinophil count in blood was within normal limits (441/mm3).
Formoterol was then stopped, but the patient remained under treatment with budesonide 400 µg twice a day for one month, then reduced to 200 µg twice a day. At 15 weeks the PC20 methacoline was 16.44 mg/ml, and serum and sputum ECP were 21.0 and 28.1 mg/l, respectively. Budesonide had been stopped 10 days before the last methacoline and ECP assessments, and the patient continued smoking around 10 cigarettes a day.
* DISCUSSION *