Allergic Bronchopulmonary Aspergillosis

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is an immunological lung disorder caused by a hypersensitivity to a fungal species, usually Aspergillus fumigatus. Although A. fumigatus is the most common etiologic agent, being responsible for approximately 90% of human infections, it is not the only pathogen in this genus. A. flavus, A. terreus, A. niger, and A. nidulans can also be responsible for human disease.

This disease was initially described in 1952, with the first patient to be diagnosed with ABPA in the United States reported in 1968 (Bierman et al. Allergic bronchopulmonary aspergillosis. In: Warren Bierman C, Pearlman DS, (eds) Allergy, asthma and immunology from infancy to adulthood. 1996. pp 566–571). This condition is estimated to effect more than four million patients worldwide (Agarwal et al. 2013a). It typically occurs in asthmatics and patients with cystic fibrosis (CF), manifesting with poorly controlled asthma, recurrent pulmonary infiltrates, and bronchiectasis. Indolent in nature, ABPA may begin in infancy or childhood but remain dormant or undiagnosed for years. Despite extensive research and over six decades of clinical experience, the pathogenesis, diagnosis, and treatment of this disease are incompletely understood. Primary therapy consists of oral corticosteroids and antifungals. Considering ABPA being a very manageable condition if treated in a timely fashion, it is becoming more imperative for clinicians to have the fundamental knowledge regarding the care of these patients in order to prevent delays in diagnosis and treatment, potentially preserving lung function.