Allergic Bronchopulmonary Aspergillosis

doi:10.1378/chest.08-2586

Chest

Volume 135, Issue 3, March 2009, Pages 805-826

https://doi.org/10.1378/chest.08-2586 Get rights and content

Allergic bronchopulmonary aspergillosis (ABPA) is an immunologic pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus. Clinically, a patient presents with chronic asthma, recurrent pulmonary infiltrates, and bronchiectasis. The population prevalence of ABPA is not clearly known, but the prevalence in asthma clinics is reported to be around 13%. The disorder needs to be detected before bronchiectasis has developed because the occurrence of bronchiectasis is associated with poorer outcomes. Because many patients with ABPA may be minimally symptomatic or asymptomatic, a high index of suspicion for ABPA should be maintained while managing any patient with bronchial asthma whatever the severity or the level of control. This underscores the need for routine screening of all patients with asthma with an Aspergillus skin test. Finally, there is a need to update and revise the criteria for the diagnosis of ABPA. This review summarizes the advances in the diagnosis and management of ABPA using a systematic search methodology.

Section snippets

Epidemiology of ABPA

Aspergillus hypersensitivity (AH) is defined by the presence of an immediate-type cutaneous hypersensitivity to A fumigatus antigens, and it is the first step in the development of ABPA.²⁴ Only a minority of patients with AH develop the complete clinical picture of ABPA.²⁵ The population prevalence of ABPA in asthma, generally referred to as 1 to 2%,5, 13, 26, 27 is based on the inference of only three studies (one peer-reviewed and two non-peer-reviewed studies).28, 29 In the only

Conclusions

A high index of suspicion for ABPA should be maintained while managing any patient with bronchial asthma whatever the severity or the level of control. Host immunologic responses are central to the pathogenesis, and they are the primary determinants of the clinical, biologic, pathologic, and radiologic features of this disorder. ABPA may precede the clinical recognition of the disorder for many years or even decades, and it is often misdiagnosed as a variety of pulmonary diseases. Because a

Acknowledgment

The author wishes to thank Dr. Amanjit Bal, Assistant Professor, Department of Histopathology, PGIMER, Chandigarh for providing the histopathology photographs.

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: The author has no conflicts of interest to disclose.

: Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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Chest

Global MedicineAllergic Bronchopulmonary Aspergillosis

Section snippets

Epidemiology of ABPA

Conclusions

Acknowledgment

Stud Mycol

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Trends Immunol

Lancet

Respir Med

Chest

Chest

Respir Med

Immunol Allergy Clin North Am

Chest

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

Immunol Allergy Clin North Am

J Allergy Clin Immunol

J Lab Clin Med

J Cyst Fibros

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

Br J Dis Chest

Chest

Respir Med

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Clin Radiol

Clin Radiol

Radiol Clin North Am

Respir Med

The clinical spectrum of aspergillosis—part 1: epidemiology, pathogenicity, infection in animals and immunology of Aspergillus

Crit Rev Clin Lab Sci

Treatment of aspergillosis: clinical practice guidelines of the infectious diseases society of America

Clin Infect Dis

Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis

Ann Intern Med

Allergic bronchopulmonary aspergillosis: staging as an aid to management

Ann Intern Med

Allergic bronchopulmonary aspergillosis: natural history and classification of early disease by serologic and roentgenographic studies

Arch Intern Med

Allergic bronchopulmonary aspergillosis in patients with and without evidence of bronchiectasis

Ann Allergy

Clinical aspects of allergic bronchopulmonary aspergillosis

Front Biosci

Allergy and hypersensitivity

Broncho-pulmonary aspergillosis; a review and a report of eight new cases

Thorax

[Diagnosis of bronchopulmonary aspergillosis is often made too late]

Med Klin (Munich)

Allergic bronchopulmonary aspergillosis: a retrospective study of 35 cases

Indian J Chest Dis Allied Sci

Global Medicine
Allergic Bronchopulmonary Aspergillosis