Allergic bronchopulmonary aspergillosis

The history, clinical features, diagnosis, treatment, and monitoring of allergic bronchopulmonary aspergillosis (ABPA) are described. ABPA is characterized by an immunologic reaction to the antigens of noninvasive Aspergillus fumigatus, which colonizes the bronchial lumen of affected individuals. It is a potential and often unrecognized pulmonary fibrotic complication in patients with asthma and cystic fibrosis. ABPA can occur at any age and may lead to cor pulmonale, respiratory failure, and death as a result of end-stage fibrotic lung destruction. Early diagnosis is essential for management of ABPA. Criteria for diagnosis of ABPA are (1) episodic bronchial obstruction, (2) peripheral blood eosinophilia, (3) immediate cutaneous reactivity to A. fumigatus, (4) precipitating serum antibodies to A. fumigatus, (5) elevated total serum IgE, (6) history of pulmonary infiltrates, (7) elevated serum IgE and serum IgG to A. fumigatus, and (8) proximal bronchiectasis. The total serum IgE concentration and chest roentgenograms can be used to monitor drug therapy. ABPA has five stages: acute, remission, exacerbation, corticosteroid-dependent asthma, and fibrotic. The most effective treatment for ABPA is oral prednisone 0.5 mg/kg/day for 14 days, on alternate days for three months, and tapering by 5 mg every two weeks for an additional three months. ABPA is a potentially fatal, noninfectious, inflammatory pulmonary disease coexistent with asthma and cystic fibrosis. With early diagnosis, adequate oral corticosteroid treatment, and IgE and chest roentgenographic monitoring, fibrotic lung complications can be averted and corticosteroid adverse effects minimized.