Definition

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

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

Causes

ABPA is caused by an allergic reaction to an inhaled fungus. It grows and flourishes in decaying vegetation, soil, certain foods, dust, and water. The inhaled fungus colonizes mucus in the lungs, causing:

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

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Risk Factors

Factors that may increase your chances of ABPA:

• Asthma or other allergies
• Cystic fibrosis
• Tuberculosis
• Sarcoidosis
• Family history

Symptoms

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

• Shortness of breath
• Cough
• Wheezing
• Weakness
• Chest pain

As ABPA progresses, other symptoms may occur:

• Production of thick, brownish, and/or bloody sputum
• Mild fever
• Unintended weight loss

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Images may be taken of your bodily structures. This can be done with:

• Chest x-ray
• CT scan

Your bodily fluids and tissues may be tested. This can be done with:

• Sputum tests
• Blood tests
• Skin prick tests
• Biopsy of lung or sinus tissue

Your lungs may be tested. This can be done with pulmonary function tests (PFTs).

ABPA can appear quite similar to non-ABPA induced asthma. 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 the fungus
• Minimizing lung inflammation
• Preventing the fungus from colonizing the lungs

ABPA is usually treated with:

• Steroids—may be taken by mouth or inhaled depending on the severity of the symptoms
• Antifungal drugs
• Medications used for asthma, such as bronchodilators or other anti-allergy medication

Prevention

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