History and exam
Key diagnostic factors
common
history of asthma
In adult patients with asthma, the overall prevalence of allergic bronchopulmonary aspergillosis was estimated to be around 2.5% based on global pooled data from the Global Initiative for Asthma reports in 2013, though a subsequent large meta-analysis in 2023 reported a pooled prevalence of as high as 11.3%.[3][11]
history of cystic fibrosis (CF)
The reported prevalence of allergic bronchopulmonary aspergillosis (ABPA) is variable for patients with CF.[12] Older studies have reported a prevalence ranging from 2% (based on the Epidemiologic Study of Cystic Fibrosis registry from the US/Canada) to 7.8% (based on the Epidemiologic Registry of CF from Europe), and as high as 13.5% to 25.0% in some smaller studies.[12][13][14][15] A subsequent large systematic review in 2015 reported an 9% pooled prevalence of ABPA in patients with CF, and as high as 39% prevalence of Aspergillussensitisation. Notably there was significant statistical heterogeneity, differences in criteria used, and publication bias among the studies.[16]
teenagers and young adults with CF
In patients with CF, allergic bronchopulmonary aspergillosis (ABPA) is most common in teenagers, but the diagnosis should be considered in any person with CF >6 years of age.[25] The mean age at diagnosis in people with CF is 15.3 years.[13]
In people with asthma, ABPA is most common from teenage years to the fourth decade of life, but it can occur at any age.[20]
history of allergic and hypersensitivity disorders
Most patients report a history of other allergic conditions such as allergic rhinitis, allergic rhinoconjunctivitis, and atopic dermatitis.[7] Hypersensitivity to the A fumigatus mould in the asthmatic airway is thought to be the main pathological mechanism in allergic bronchopulmonary aspergillosis.[19]
cough
Allergic bronchopulmonary aspergillosis (ABPA) is associated with preceding diagnosis of asthma or progression to corticosteroid-dependent asthma. Coughing is a manifestation of the underlying asthma exacerbation and bronchial hyperreactivity.[1] Increased productive cough is a common symptom in patients with CF and ABPA.
mucus plugs
The acute inflammatory response of allergic bronchopulmonary aspergillosis can increase mucus production. The mucus is typically purulent and may form plugs, which can be expectorated.
wheezing
Allergic bronchopulmonary aspergillosis is associated with preceding diagnosis of asthma or progression to corticosteroid-dependent asthma. Wheezing is a manifestation of the underlying asthma exacerbation and bronchial hyperreactivity associated with excess mucus production and plugging.[1]
Other diagnostic factors
common
fever
Allergic bronchopulmonary aspergillosis commonly presents with fever.
pleuritic chest pain
Common clinical finding in allergic bronchopulmonary aspergillosis, usually occurring in association with cough and increased sputum production.
haemoptysis
Possible sign of allergic bronchopulmonary aspergillosis.[7]
uncommon
digital clubbing
Usually seen only in advanced, chronic disease.
cyanosis
Usually seen only in advanced, chronic disease.
weight loss
In CF patients, allergic bronchopulmonary aspergillosis exacerbation of CF may sometimes be associated with weight loss.
Risk factors
strong
asthma
In adult patients with asthma, the overall prevalence of allergic bronchopulmonary aspergillosis was estimated to be around 2.5% based on global pooled data from the Global Initiative for Asthma reports in 2013, though a subsequent large meta-analysis in 2023 reported a pooled prevalence of as high as 11.3%.[3][11]
cystic fibrosis
The reported prevalence of allergic bronchopulmonary aspergillosis is variable for patients with cystic fibrosis (CF).[12] Older studies have reported a prevalence ranging from 2% (based on the Epidemiologic Study of Cystic Fibrosis registry from the US/Canada) to 7.8% (based on the Epidemiologic Registry of CF from Europe), and as high as 13.5% to 25.0% in some smaller studies.[12][13][14][15] A subsequent large systematic review in 2015 reported an 9% pooled prevalence of ABPA in patients with CF, and as high as 39% prevalence of Aspergillus sensitisation. Notably there was significant statistical heterogeneity, differences in criteria used, and publication bias among the studies.[16]
allergic and hypersensitivity disorders
A pathological immune response resulting in airway (e.g., allergic bronchopulmonary aspergillosis [ABPA], severe asthma with fungal sensitisation) or alveolar (e.g., hypersensitivity pneumonitis secondary to mould) inflammation.[6] In patients predisposed to ABPA, exposure to Aspergillus antigens results in a predominantly Th2 response, which is characterised by IL-4 and IL-5-mediated eosinophilic inflammation and production of anti-Aspergillus IgE and IgG antibodies, ultimately resulting in a type 1-3 hypersensitivity reaction against Aspergillus antigens.
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