Allergic bronchopulmonary aspergillosis is a hypersensitivity reaction to bronchial colonization by Aspergillus fumigatus mold, typically affecting patients with asthma or cystic fibrosis.
Exposure of atopic people to fungal spore elements results in the formation of immunoglobulin E and immunoglobulin G antibodies.
Presents as asthma complicated by bronchial obstruction, fever, malaise, expectoration of brownish mucus plugs, peripheral blood eosinophilia, and hemoptysis.
Treatment involves environmental control measures, corticosteroids, and azole antifungals.
Early detection and treatment can prevent the development of bronchiectasis or pulmonary fibrosis that otherwise occurs in the later stages of the disease.
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to mold that occurs when bronchi become colonized by Aspergillus fumigatus in an otherwise immunocompetent person. Patients usually have a prior diagnosis of atopy, asthma, or cystic fibrosis. Exposure of an atopic person to fungal elements results in the formation of IgE and IgG antibodies. Typically, the patient presents with bronchial obstruction, airway inflammation, and mucoid impaction that can lead to bronchiectasis, fibrosis, and respiratory compromise.
History and exam
Key diagnostic factors
- history of asthma
- history of cystic fibrosis (CF)
- teenagers and young adults with CF
- history of atopy
- mucus plugs
Other diagnostic factors
- pleuritic chest pain
- finger clubbing
- weight loss
- cystic fibrosis
- HLA-DR2- and HLA-DR5-positive
- IL-10 promoter polymorphisms
- surfactant protein polymorphisms
- CFTR gene
1st investigations to order
- skin test for Aspergillus fumigatus sensitivity
- serum total IgE
- CBC 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
stage 1: acute
stage 2: remission
stage 3: exacerbation
stage 4: corticosteroid-dependent asthma
stage 5: end-stage fibrosis
- Asthma exacerbation
- Non-ABPA infectious exacerbation of cystic fibrosis
- Chronic eosinophilic pneumonia
- Practice guidelines for the diagnosis and management of aspergillosis
- Allergic bronchopulmonary aspergillosis clinical care guidelines
Asthma in adults
Asthma in childrenMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer