Allergic Bronchopulmonary Aspergillosis
Allergic bronchopulmonary aspergillosis (ABPA) is a form of lung disease
that occurs in some people who are allergic to a ubiquitous fungus,
Aspergillus. Although Aspergillus
is found widely in the environment, it is particularly common in places where there
is dead and decaying vegetation, such as dead leaves or compost piles. The allergic
reaction causes inflammation of the airways and lungs in susceptible people,
typically those with asthma or cystic fibrosis. With ABPA, the allergic reaction
causes the immune system to overreact, leading to lung inflammation. Symptoms
include coughing, breathing difficulty, and airway obstruction due to bronchospasm
and mucus buildup. Other symptoms include shortness of breath, difficulty
exercising, chest pain or tightness, wheezing, and cough associated with brownish or
reddish sputum, fever, and fatigue. ABPA is seen in 1-15% of patients with cystic
fibrosis and >1% of patients with asthma.
Patients with asthma and ABPA have difficulty controlling their asthma
despite multiple medications. If ABPA is suspected, diagnostic tests include CBC,
IgE level, Aspergillus antibodies (IgE, IgG, and
precipitins), aspergillus antigen skin testing, CT chest, and possibly bronchoscopy
and/or biopsy. ABPA is usually treated with a combination of oral corticosteroids
and anti-fungal medicine such as itraconazole.
Resources
Patient Education
Allergic Bronchopulmonary Aspergillosis (American Thoracic Society) ( 211 KB)
Two-page, printable handout that explains the basics of ABPA, including symptoms and treatment.
Helpful Articles
Agarwal R, Sehgal IS, Dhooria S, Aggarwal AN.
Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis.
Expert Rev Respir Med.
2016;10(12):1317-1334.
PubMed abstract