Allergic bronchopulmonary aspergillosis in a patient with chronic obstructive pulmonary disease
1Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
Abstract:
Allergic bronchopulmonary aspergillosis (ABPA) is a debilitating lung disease which occurs as a result of interplay between a variety of host and environmental factors. It occurs in certain susceptible individuals who develop hypersensensitivity to the colonised Aspergillus species. ABPA is a complicating factor in 2% of patients with asthma and is also seen in patients with cystic fibrosis. Asthma and chronic obstructive pulmonary disease (COPD) are known to share key elements of pathogenesis. It is well known that ABPA can occur in patients with asthma, but it has recently been reported in patients with COPD as well. We report a 55-year-old male ex-smoker who presented with complaints of exertional breathlessness and productive cough for five years and an episode of haemoptysis four days prior to presentation. Spirometery showed airflow obstruction which was not reversible with bronchodilators. Chest CT scan revealed paraseptal emphysema along with central bronchiectasis (CB) in the right upper lobe and bilateral lower lobes. A type I skin hypersensitivity reaction to Aspergillus species was elicited. He fulfilled the serological criteria for ABPA and was diagnosed as having concomitant COPD and ABPA-CB. The patient was initiated on therapy for COPD along with oral corticosteroids, on which he had remarkable symptomatic improvement.
Insights
Allergic bronchopulmonary aspergillosis (ABPA) can complicate chronic obstructive pulmonary disease (COPD). This case report highlights a patient with co-existing COPD and ABPA-CB, who showed significant improvement with targeted therapy.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Medical Mycology
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is an immune-mediated lung disease caused by hypersensitivity to Aspergillus species.
- While commonly associated with asthma and cystic fibrosis, ABPA is increasingly recognized in patients with chronic obstructive pulmonary disease (COPD).
- COPD and asthma share similar pathogenetic pathways, suggesting a potential overlap in conditions like ABPA.
Observation:
- A 55-year-old ex-smoker presented with chronic exertional dyspnea, productive cough, and hemoptysis.
- Pulmonary function tests revealed irreversible airflow obstruction, and chest CT showed emphysema with central bronchiectasis.
- Skin testing indicated a hypersensitivity reaction to Aspergillus species, meeting serological criteria for ABPA.
Findings:
- The patient was diagnosed with concomitant COPD and ABPA with central bronchiectasis (ABPA-CB).
- Treatment involved standard COPD management combined with oral corticosteroids.
- The patient experienced substantial symptomatic improvement following the initiation of therapy.
Implications:
- This case underscores the importance of considering ABPA in COPD patients presenting with specific respiratory symptoms.
- Early diagnosis and combined therapy for COPD and ABPA can lead to significant clinical benefits.
- Further research is warranted to elucidate the prevalence and management strategies for ABPA in COPD populations.
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