Highlights & Basics
- Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to bronchial colonization by Aspergillus fumigatus mold, typically affecting patients with an underlying predisposition, specifically asthma or cystic fibrosis.
- When predisposed individuals inhale the aspergillus spores, which are ubiquitous in the environment, the spores germinate in the lungs, setting off a complex immune cascade which results in the formation of immunoglobulin E and immunoglobulin G antibodies and immune-mediated lung destruction.
- ABPA usually presents in a similar way to asthma but may be complicated by bronchial obstruction, fever, malaise, expectoration of brownish mucus plugs, peripheral blood eosinophilia, and hemoptysis in later stages.
- Treatment involves corticosteroids with or without antifungal therapy. Monoclonal antibodies used for the treatment of asthma are under active investigation as a promising alternative treatment for ABPA.
- Early diagnosis and rapid initiation of treatment can prevent the development of bronchiectasis or pulmonary fibrosis that otherwise occurs in the later stages of the disease.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Chest x-ray in a patient with ABPA: ring shadows (long arrows) represent bronchiectatic airways seen in cross-section; tram lines (short arrow) seen longitudinally
Chest x-ray in a patient with ABPA: classic glove-finger pattern represents central bronchiectatic airways impacted with mucus
CT chest in a patient with ABPA: dilated, mucoid-impacted bronchiectatic airways
CT chest in a patient with ABPA: glove-finger shadow due to mucoid impaction in central bronchiectasis in a patient with asthma
Citations
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Pasteur MC, Bilton D, Hill AT; British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65(suppl 1):i1-i58.[Abstract][Full Text]
Cystic Fibrosis Foundation. Allergic bronchopulmonary aspergillosis clinical care guidelines. 2003 [internet publication].[Full Text]
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