Pulmonary aspergillosis in patients with asthma

Asthma is a complex respiratory condition characterized by airway inflammation and hyper-responsiveness, and poses a significant global health burden, affecting millions worldwide. Its origins lie in interactions between genetic, environmental, and host factors. While typically manageable, asthma can lead to severe exacerbations and complications if left untreated. The association between asthma and fungal infections, particularly with Aspergillus species, has garnered attention due to its impact on disease severity and management. We aim to provide a comprehensive overview of this association focusing on its various clinical presentations, risk factors, diagnostic approaches, and treatment strategies. Allergic bronchopulmonary aspergillosis (ABPA) emerges as a prevalent form of aspergillosis in asthmatic individuals, presenting challenges in both diagnosis and management. We discuss the evolving diagnostic criteria for ABPA, emphasizing the importance of clinical suspicion, radiological findings, serological tests, and pulmonary function tests. Moreover, we address the therapeutic interventions, review the roles of systemic glucocorticoids, antifungal agents, and emerging novel therapeutic agents. Early detection and intervention in fungal infections in asthma patients, particularly ABPA, are essential to mitigate exacerbations, improve symptom control, and prevent severe complications. This review underscores the necessity for heightened awareness and proactive management of fungal infections in the context of asthma, aiming to enhance patient care and quality of life.