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[Allergic bronchopulmonary aspergillosis in patients with chronic obstructive pulmonary disease: report of 3 cases]
Xiao-fang Liu1, Yong-chang Sun1, Jian-min Jin1
1Department of Respiratory Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Objective:
To improve the clinical knowledge on allergic bronchopulmonary aspergillosis (ABPA) combined with COPD by report of cases.
Methods:
We retrospectively analyzed the clinical information of 3 cases of ABPA combined with COPD diagnosed in our hospital from Jan. 2009 to Dec. 2012.
Results:
The 3 patients were all males, and aged from 68 to 82 years. The main complaints of all the patients were exertional dyspnea, cough and sputum production, with episodes of wheezing. All patients denied the history of allergic diseases, e.g., asthma, rhinitis, sinusitis, eczema, and family history of asthma. They all had a history of heavy smoking. The pulmonary function tests indicated obstructive impairment, and the ratio of FEV1 to FVC (FEV1/FVC) after bronchodilators were 30%, 33% and 43%, respectively, with no significant bronchodilator reversibility, which were consistent with the diagnostic criteria for COPD, with 1 case in GOLD grade III and 2 cases in GOLD grade IV based on the GOLD spirometric criteria for COPD severity. Lung HRCT showed emphysema with or without bulla formation. All cases showed immediate positive response to Aspergillus antigen by skin prick test (SPT), increased serum total IgE > 1000 kU/L, increased serum level of Aspergillus specific IgE (>0.35 kU/L) and IgG (>40 mg/L). Central bronchiectasis was also evident on HRCT scan in the 3 patients. In addition, the eosinophil percentage in peripheral blood was all >5%. Pulmonary infiltrates, brown phlegm plugs, and growth of Aspergillus fumigatus were also noted in some cases. After the diagnosis of ABPA, the patients were all given oral prednisone therapy, with notable improvement in dyspnea and FEV1.
Conclusions:
ABPA in COPD is uncommon, but early identification and initiation of systemic corticosteroid therapy can lead to improvement in symptoms and prognosis. For COPD patients with recurrent attacks of wheezing or are unresponsive to combination therapy of inhaled long-acting bronchodilators and corticosteroids, concurrent ABPA should be suspected and investigated accordingly.
Insights
Allergic bronchopulmonary aspergillosis (ABPA) is uncommon in chronic obstructive pulmonary disease (COPD) but early corticosteroid treatment improves symptoms and prognosis. Suspect ABPA in COPD patients with persistent wheezing unresponsive to standard therapies.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus.
- Chronic obstructive pulmonary disease (COPD) is a progressive lung disease characterized by airflow limitation.
- The co-occurrence of ABPA and COPD is considered rare, posing diagnostic challenges.
Observation:
- This case series reports on three male patients aged 68-82 with diagnosed ABPA and COPD.
- Patients presented with exertional dyspnea, cough, sputum, and wheezing, with a history of heavy smoking but no prior allergic disease history.
- Pulmonary function tests confirmed severe obstructive impairment consistent with COPD (GOLD grades III-IV), and HRCT revealed emphysema and central bronchiectasis.
Findings:
- All patients exhibited positive skin prick tests to Aspergillus antigen, elevated total IgE (>1000 kU/L), increased Aspergillus-specific IgE (>0.35 kU/L), and IgG (>40 mg/L).
- Peripheral blood eosinophilia (>5%) was noted in all cases.
- Treatment with oral prednisone led to significant improvements in dyspnea and FEV1.
Implications:
- Early diagnosis and treatment of ABPA in COPD patients are crucial for improving clinical outcomes.
- Clinicians should consider ABPA in COPD patients experiencing recurrent wheezing or poor response to standard inhaled therapies.
- Investigating concurrent ABPA in refractory COPD cases may lead to better patient management and prognosis.
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