Summary
Definition
History and exam
Key diagnostic factors
- history of asthma
- history of cystic fibrosis (CF)
- teenagers and young adults with CF
- history of atopy
- cough
- mucus plugs
- wheezing
Other diagnostic factors
- fever
- pleuritic chest pain
- haemoptysis
- finger clubbing
- cyanosis
- weight loss
Risk factors
- asthma
- cystic fibrosis
- atopy
- HLA-DR2- and HLA-DR5-positive
- IL-10 promoter polymorphisms
- surfactant protein polymorphisms
- CFTR gene
Diagnostic investigations
1st investigations to order
- skin test for Aspergillus fumigatus sensitivity
- serum total IgE
- FBC with peripheral blood eosinophil count
- chest x-ray
- CT chest
- Aspergillus-specific IgE
Investigations to consider
- Aspergillus-specific IgG
- serum precipitating antibodies to Aspergillus fumigatus
- sputum culture and microscopy
- HLA antigens
Treatment algorithm
stage 1: acute
stage 2: remission
stage 3: exacerbation
stage 4: corticosteroid-dependent asthma
stage 5: end-stage fibrosis
Contributors
Authors
Cristine Radojicic, MD
Staff Physician
Department of Pulmonary, Allergy and Critical Care
Cleveland Clinic
Cleveland
OH
Disclosures
CR is on the Advisory Board for CSL Behring and the Speakers Bureau for BioCryst.
Peer reviewers
Martin Schöni, MD
Professor
Department of Pediatrics
University of Bern
Bern
Switzerland
Disclosures
MS declares that he has no competing interests.
Jordan Fink, MD
Professor of Pediatrics
Allergy-Immunology Division
Medical College of Wisconsin
Milwaukee
WI
Disclosures
JF is an author of a number of references cited in this topic.
Differentials
- Asthma exacerbation
- Non-ABPA infectious exacerbation of cystic fibrosis
- Chronic eosinophilic pneumonia (CEP)
More DifferentialsGuidelines
- ABPA and aspergillus lung infection, cystic fibrosis patients
- Practice guidelines for the diagnosis and management of aspergillosis
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