Smaller Larger

Allergic Bronchopulmonary Aspergillosis (ABPA) by Rick Alan

Definition

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic lung disorder. It is related to the fungus Aspergillus fumigatus (AF). Aspergillosis can also occur as:

A lung infection that can spread to other parts of the body (more common in patients with suppressed immune systems)
A fungal growth ( aspergilloma ) in a lung cavity that has healed from a previous lung disease or infection

Causes

ABPA is caused by an allergic reaction to inhaled AF. AF is a common fungus. It grows and flourishes in decaying vegetation, soil, certain foods, dust, and water. The allergic reaction worsens respiratory symptoms in people with asthma or cystic fibrosis . The inhaled AF colonizes mucus in the lungs, causing:

Sensitization to AF
Recurring allergic inflammation of the lungs
Packing of the alveoli (tiny air sacs in the lungs) with eosinophils (a type of white blood cell involved in certain allergic reactions and infections with parasites)

Healthy Alveoli

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition. Risk factors for ABPA include:

Symptoms

Symptoms of ABPA are usually those of progressive asthma. These include:

Shortness of breath
Wheezing
Weakness, malaise
Unintended weight loss
Chest pain

As ABPA progresses, other symptoms may occur, including:

Production of thick, brownish, and/or bloody sputum
Low-grade fever

In severe, long-term cases, ABPA can cause:

Bronchiectasis—widening of areas of the bronchus, usually caused by inflammation
Scarring of lungs

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include:

Chest x-ray —a test that uses radiation to take a picture of structures inside the body, in this case the lungs
Sputum tests—to check sputum for:
- Presence of AF
- High levels of eosinophils
Blood tests to detect:
- High levels of eosinophils
- Antibodies suggesting an allergic reaction to AF
Skin prick tests—to check for allergic sensitivity by placing small amounts of AF in the skin
Biopsy of lung or sinus tissue
Pulmonary function tests (PFTs) —used to monitor breathing capacity of the lungs

Since ABPA can appear quite similar to non-ABPA induced asthma, it is often difficult to determine to what extent ABPA is contributing to your symptoms. Therefore, ABPA is typically diagnosed after several repeat tests for ABPA are positive over a number of months or years.

Treatment

The goals of treatment include:

Suppressing the allergic reaction to AF
Minimizing lung inflammation
Preventing AF from colonizing the lungs

ABPA is usually treated with:

Prednisone (an oral corticosteroid medication)
Antifungal drugs

Prevention

Avoiding exposure to AF is the best way to prevent ABPA. However, this is difficult, because AF is so prevalent in the environment. Guidelines to help prevent exposure to AF include:

Avoiding areas with:
- Decaying vegetation
- Standing water
Keeping your home as dust-free as possible
Remaining in air-filtered, air-conditioned environments whenever possible

Measures to avoid symptoms and prevent permanent lung damage caused by ABPA include:

Ongoing testing and monitoring of ABPA
Early and continuing medical treatment for the disease

RESOURCES:

American Lung Association http://www.lungusa.org
Centers for Disease Control and Prevention (CDC) http://www.cdc.gov
National Institute of Diabetes & Digestive & Kidney Diseases http://www.niddk.nih.gov

CANADIAN RESOURCES:

The Canadian Lung Association http://www.lung.ca
Health Canada http://www.hc-sc.gc.ca/index-eng.php

References:

Ferri FF. Ferri’s Clinical Advisor 2007. 9th ed. St. Louis, MO: Mosby, 2007.
Mayo Clinic and Foundation for Medical Education and Research website. Available at: http://www.mayo.edu/ .
The Merck Manual of Medical Information . 2nd ed. Simon and Schuster, Inc; 2004.
National Institute of Diabetes & Digestive & Kidney Diseases website. Available at: http://www.niddk.nih.gov .
Wark PA, Gibson PG, Wilson AJ. Azoles for allergic bronchopulmonary aspergillosis associated with asthma. Cochrane Database Syst Rev 2004; (3): CD001108.

Last reviewed [Under Medical Review] by Tajender S. Vasu, MD

All EBSCO Publishing proprietary, consumer health and medical information found on this site is accredited by URAC. URAC's Health Web Site Accreditation Program requires compliance with 53 rigorous standards of quality and accountability, verified by independent audits. To send comments or feedback to our Editorial Team regarding the content please email us at HLEditorialTeam@ebscohost.com.

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.