Monitoring
Monitor patients with a diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in order to detect asymptomatic exacerbations. After treatment with prednisolone for either stage 1 (acute) or stage 3 (exacerbation), check total serum IgE every 2 months for 1 year. If the total serum IgE level does not drop by >35% over the first 8 weeks of therapy, confirm that the patient is taking the oral corticosteroid as instructed, and consider other causes such as infection.[48] If total serum IgE increases by >100% at any stage, evaluation with a chest x-ray is indicated.[47]
Chest x-ray or computed tomography scan of the chest should be repeated after 4-8 weeks of therapy, to document clearing of infiltrates.[47]
Yearly pulmonary function testing and spirometry is recommended. A decrease in vital capacity of ≥15% may indicate an exacerbation of ABPA.[80]
In patients with cystic fibrosis (CF) and exacerbation of respiratory symptoms or new chest infiltrates, investigate for ABPA. Check total serum IgE levels tested yearly in all patients with CF: if the result is >500 kilounits/L, test for immediate cutaneous reactivity to Aspergillus. If the serum total IgE is between 200 and 500 kilounits/L, repeat the test and, if suspicion is high, consider other additional diagnostic tests, such as Aspergillus-specific IgE and serum precipitating antibodies (serum precipitins) to A fumigatus.[25]
If long-term corticosteroid use is anticipated, suggested baseline measurements include: body weight, height and blood pressure; bone mineral density; and basic laboratory tests such as full blood count, blood glucose values, and lipid profile.[78]
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