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Diagnosis and treatment of allergic bronchopulmonary aspergillosis
1Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Abstract:
Allergic bronchopulmonary aspergillosis (ABPA) is an underdiagnosed pulmonary disorder in asthmatic patients and patients with cystic fibrosis. Its clinical and diagnostic manifestations arise from an allergic response to multiple antigens expressed by fungi, most commonly Aspergillus fumigatus, colonizing the bronchial mucus. The clinical course is one of recurrent exacerbations characterized by chest infiltrates evident on chest x-ray films and associated with cough, wheeze, and sputum production that usually respond to oral corticosteroid treatment. Specific immunologic and radiologic markers of disease include elevation of the total serum IgE levels, presence of aspergillus IgE antibodies, and the occurrence of central bronchiectasis. Long-term treatment with corticosteroids is often required for effective management. The adverse effects of chronic corticosteroid use have led to attempts at treatment with antifungal agents such as itraconazole. Itraconazole has been reported anecdotally to be effective, and evidence for its effectiveness in randomized trials is still accruing. Consideration should be given to its use as a corticosteroid-sparing agent or for treatment of patients in whom corticosteroid response is poor. The natural history and prognosis of ABPA are not well characterized but may be complicated by progression to bronchiectasis and pulmonary fibrosis. If ABPA is diagnosed and treated before the development of bronchiectasis and fibrosis, these complications may be prevented.
Insights
Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder in asthma and cystic fibrosis patients. Early diagnosis and treatment, potentially with antifungal agents like itraconazole, can prevent serious lung damage.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Infectious Diseases
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is an underdiagnosed pulmonary condition.
- It affects patients with asthma and cystic fibrosis.
- ABPA results from an allergic reaction to fungi, primarily Aspergillus fumigatus, in the airways.
Purpose of the Study:
- To review the clinical manifestations, diagnosis, and management of ABPA.
- To explore the role of antifungal agents, such as itraconazole, in ABPA treatment.
- To highlight the importance of early diagnosis for preventing long-term lung complications.
Main Methods:
- Review of clinical and diagnostic features of ABPA.
- Discussion of immunologic markers (elevated IgE, Aspergillus IgE antibodies) and radiologic findings (central bronchiectasis).
- Evaluation of treatment strategies, including corticosteroids and antifungal agents like itraconazole.
Main Results:
- ABPA exacerbations involve chest infiltrates, cough, wheeze, and sputum production.
- Central bronchiectasis, elevated IgE, and Aspergillus IgE antibodies are key diagnostic markers.
- Corticosteroids are standard treatment, but itraconazole is being investigated as a steroid-sparing option.
Conclusions:
- Early diagnosis and treatment of ABPA are crucial for preventing irreversible lung damage like bronchiectasis and fibrosis.
- Itraconazole shows promise as an alternative or adjunctive therapy, potentially reducing corticosteroid dependence.
- Further research is needed to solidify the role of antifungal agents in ABPA management.