Allergic Bronchopulmonary Aspergillosis: Key Points
ABPA is a fungal allergy driven by Aspergillus in asthma and COPD; oral steroids are the base treatment, with antifungals as useful adjuncts.
What Is ABPA
ABPA is an allergic lung disease caused by sensitization to Aspergillus fumigatus. It usually appears in people with asthma or, less often, cystic fibrosis, bronchiectasis, or COPD. It can cause repeated shadows and airway damage if untreated.
Typical Signs
Cough, sputum, and wheezing are common, and brown sticky plugs are characteristic. Blood eosinophil counts and total IgE are usually high. Chest imaging shows fleeting, moving infiltrates and sometimes mucus plugs or bronchiectasis.
How It Is Diagnosed
Diagnosis needs asthma or related disease plus Aspergillus-specific IgE or skin positivity and a raised total IgE above 1000 U/mL. Supported findings include eosinophilia, typical imaging, and Aspergillus IgG. Early testing in asthma avoids delay.
Main Treatments
Oral corticosteroids are the foundation and can prevent permanent lung damage. Azole antifungals such as itraconazole or voriconazole reduce steroid need and relapses. Inhaled steroids alone are not enough for active disease.
Follow Up
Total IgE is tracked to gauge activity; a rise suggests relapse. Lung function and imaging are checked over time. With early and steady treatment, most patients do well.
