Table 2—

Definition of allergic bronchopulmonary aspergillosis(ABPA) and proposed definition of severe asthma with fungal sensitisation (SAFS), with some additional features

FeatureABPA#SAFS (proposed)
Clinical features
 AsthmaAny severitySevere
 Pulmonary infiltrates (history)Yes, which resolve with corticosteroidsNo
 EosinophiliaYes, if not on systemic corticosteroidsNot studied, but not required
 Central bronchiectasisYes, but many patients with early disease do not have this featureNo
 Thick mucous plugsYes, usuallyUnknown
 Chronic rhinosinusitis, with or without nasal polypsOccasionalSometimes
Fungal features
 Aspergillus precipitins positive (2× asthma control)Yes (almost all cases)No
 Aspergillus IgG test positive (2× asthma control)YesNo
 Aspergillus prick test positive (>3 mm)YesYes or no+
 Other fungal skin tests positive (>3 mm)No§Yes or no+
 Serum IgE elevated (>1000 IU·mL−1)Yes (may be only >500 IU·mL−1, especially if on corticosteroids)No (<1000 IU·mL−1)
 Aspergillus-specific RAST test positive (2× asthma control)YesYes or no+
 Other fungal RAST test positiveNo§Yes or no+
 Airways colonised by Aspergillus fumigatusYesUnknown
  • Ig: immunoglobulin; RAST: radioallergosorbent test. #: as defined by Ricketti et al. 126 and Patterson et al. 127; : typically British Thoracic Society level 4 or equivalent; +: at least one fungal skin or RAST test positive (better and more specific tests may emerge in the future); §: there are rare instances of bronchopulmonary mycosis due to other fungi, with typical clinical features.