Allergic Bronchopulmonary Aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a form of lung disease that occurs in some people who are allergic to a ubiquitous fungus, Aspergillus. Although Aspergillus is found widely in the environment, it is particularly common in places where there is dead and decaying vegetation, such as dead leaves or compost piles. The allergic reaction causes inflammation of the airways and lungs in susceptible people, typically those with asthma or cystic fibrosis. With ABPA, the allergic reaction causes the immune system to overreact, leading to lung inflammation. Symptoms include coughing, breathing difficulty, and airway obstruction due to bronchospasm and mucus buildup. Other symptoms include shortness of breath, difficulty exercising, chest pain or tightness, wheezing, and cough associated with brownish or reddish sputum, fever, and fatigue. ABPA is seen in 1-15% of patients with cystic fibrosis and >1% of patients with asthma.

Patients with asthma and ABPA have difficulty controlling their asthma despite multiple medications. If ABPA is suspected, diagnostic tests include CBC, IgE level, Aspergillus antibodies (IgE, IgG, and precipitins), aspergillus antigen skin testing, CT chest, and possibly bronchoscopy and/or biopsy. ABPA is usually treated with a combination of oral corticosteroids and anti-fungal medicine such as itraconazole.