Allergic bronchopulmonary aspergillosis among asthmatics

Allergic bronchopulmonary aspergillosis (ABPA), an immunologically mediated lung disease is now well recognised as a significant cause of chronic lung disease in the West. This study aimed at determining the extent of this entity in 540 patients with severe bronchial asthma and 96 patients with mild or moderate asthma. Of these 134 were subjected to detailed examinations in the form of a skin test, serological test, sputum examination and peripheral blood eosinophil count. Eight patients (1.2% of the total and 6% of selected patients) had evidence of ABPA. A further 50 patients (8% of total and 37% of selected patients) had evidence of allergy to the fungus as depicted by positive skin test reactivity. The latter patients could be either early ABPA or potential candidates for the development of ABPA later. Skin test sensitivity to both Aspergillus fumigatus and A niger were demonstrated in Sri-Lankan asthmatics. Skin test sensitivity could be considered a screening test for the diagnosis of ABPA. A scheme for the diagnosis of ABPA using simple criteria could be devised keeping in mind the cost and availability of tests.