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[Allergic bronchopulmonary aspergillosis (ABPA)]
1Department of Respiratory Diseases, International Medical Center of Japan, Tokyo, Japan.
Abstract:
The entity of allergic pulmonary aspergillosis includes various diseases of the lung which are caused by not only allergic reactions to aspergillus but also destructive inflammations due to saprophytic infection of aspergillus in lower respiratory tracts. We focus our discussion on ABPA with our own experience of 11 cases and overview of the disease. First of all, We propose that the entity of ABPA should be expanded from one that has been defined by the diagnostic criteria established by Rosenberg et al in 1977. We have to consider stage of ABPA, the existence of ABPA without asthma and ABPA complicated with chronic bacterial infection in lower respiratory tracts and the progression of ABPA to infectious and invasive aspergillosis. It is important for the diagnosis of ABPA to study not only allergic reactions to aspergillus but also chest HRCT which reveals the central bronchiectasis and mucus plugging that are thought characteristic of the disease. Systemic steroid therapy is indispensable in the acute stage of the disease. Bronchial toileting for the removal of mucoid impaction is also important. In the chronic stage of the disease, antifungal drugs and inhaled steroid therapy should be considered in intractable cases on recurrence to prevent the disease progression and lung injuries.
Insights
Allergic bronchopulmonary aspergillosis (ABPA) encompasses a broader range of lung diseases than previously defined. Diagnosis requires considering allergic reactions, HRCT findings, and disease staging for effective management.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Infectious Diseases
Background:
- Allergic pulmonary aspergillosis (ABPA) is a complex lung condition involving allergic reactions and destructive inflammation caused by Aspergillus.
- Current diagnostic criteria for ABPA, established in 1977, may not fully encompass the disease's spectrum.
Observation:
- This study reviews 11 cases of ABPA, proposing an expanded definition.
- Key diagnostic indicators include allergic responses to Aspergillus and characteristic findings on chest HRCT, such as central bronchiectasis and mucus plugging.
Findings:
- The proposed expanded entity of ABPA includes various stages, cases without asthma, and complications with chronic bacterial infections.
- Progression to infectious and invasive aspergillosis is a potential concern.
Implications:
- Management strategies should differentiate between acute and chronic stages.
- Systemic steroids are crucial for acute ABPA; bronchial toileting aids mucus removal.
- Antifungal and inhaled steroid therapies may be necessary for chronic or recurrent cases to prevent lung injury.