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Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis
Ritesh Agarwal1, Inderpaul S Sehgal1, Sahajal Dhooria1
1a Department of Pulmonary Medicine , Postgraduate Institute of Medical Education and Research (PGIMER) , Chandigarh , India.
Introduction:
Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. It is the most prevalent of the Aspergillus disorders with an estimated five million cases worldwide. Despite six decades of research, the pathogenesis, diagnosis and treatment of this condition remains controversial. The International Society for Human and Animal Mycology has formed a working group to resolve the controversies around this entity. In the year 2013, this group had proposed new criteria for diagnosis and staging, and suggested a treatment protocol for the management of this disorder. Since then, several pieces of new evidence have been published in the investigation and therapeutics of this condition. Areas covered: A non-systematic review of the available literature was performed. We summarize the current evidence in the evaluation and treatment of this enigmatic disorder. We suggest modifications to the existing criteria and propose a new scoring system for the diagnosis of ABPA. Expert commentary: All patients with asthma and cystic fibrosis should routinely be screened for ABPA using A. fumigatus-specific IgE levels. Glucocorticoids should be used as the first-line of therapy in ABPA, and itraconazole reserved in those with recurrent exacerbations and glucocorticoid-dependent disease.
Insights
Allergic bronchopulmonary aspergillosis (ABPA), a common Aspergillus disorder, requires updated diagnostic and treatment strategies. Routine screening in asthma and cystic fibrosis patients is recommended, with glucocorticoids as first-line therapy.
Area of Science:
- Medical Mycology
- Pulmonology
- Allergy Immunology
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is a prevalent, complex pulmonary disorder affecting an estimated five million people globally.
- Despite extensive research, its pathogenesis, diagnosis, and treatment remain subjects of ongoing debate and controversy.
- The International Society for Human and Animal Mycology has addressed these challenges by forming a working group to refine diagnostic and therapeutic approaches.
Purpose of the Study:
- To review current evidence on the evaluation and treatment of Allergic bronchopulmonary aspergillosis (ABPA).
- To propose modifications to existing diagnostic criteria and introduce a novel scoring system for ABPA diagnosis.
- To provide expert commentary on recommended screening and therapeutic strategies for ABPA management.
Main Methods:
- A non-systematic literature review was conducted to synthesize recent findings.
- Analysis focused on advancements in the investigation and therapeutics of ABPA.
- Existing diagnostic and staging criteria were evaluated for potential revisions.
Main Results:
- Current evidence on ABPA evaluation and treatment is summarized.
- Modifications to existing diagnostic criteria are suggested.
- A new scoring system for ABPA diagnosis is proposed.
Conclusions:
- Routine screening for ABPA using Aspergillus fumigatus-specific IgE levels is advised for all patients with asthma and cystic fibrosis.
- Glucocorticoids are recommended as the primary treatment for ABPA.
- Itraconazole should be reserved for patients experiencing recurrent exacerbations or those with glucocorticoid-dependent disease.
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