Prognosis
With correct and timely diagnosis, prompt and appropriate treatment, and careful monitoring, the overall prognosis for patients with allergic bronchopulmonary aspergillosis (ABPA) is good.[5] Untreated, ABPA can progress to cause bronchiectasis and fibrosis, with resultant loss of lung function.
Due to the wide spectrum of disease activity that can be classified as stage 1 to 5, the diagnosis may be easier to make in severe disease, but early diagnosis in those with mild disease is optimal to prevent progression to later disease stages.[22]
Stage 1: acute
Acute exacerbation typically responds well to systemic corticosteroids, which can prevent bronchial destruction. Medium dose steroids can be considered to prevent side effects and may be as effective as high dose steroids.[76]
Stage 2: remission
In this stage the patient has no acute symptoms, no infiltrates, or no systemic corticosteroid use for >6 months. The typical course of this stage is that of a stable condition, with routine monitoring of lung function and asthma maintenance medications.
Stage 3: exacerbation
This diagnosis is made in a patient with a previous diagnosis of ABPA who presents with recurrence of symptoms, or who is asymptomatic but has had elevation of total serum IgE >100% over baseline on monitoring. Prompt institution of oral corticosteroids usually resolves the exacerbation, but lack of improvement after 2 months of prednisone treatment suggests a poorer prognosis.
Stage 4: corticosteroid-dependent asthma
This is the most common stage at which ABPA is diagnosed.[72]
Unfortunately, by this stage the patient has been unable to be weaned off oral corticosteroids without experiencing an exacerbation. Bronchiectasis has already occurred by this point.
Stage 5: end-stage fibrosis
This is the second most common stage for a diagnosis of ABPA to be made and carries the poorest prognosis due to the irreversible restrictive and obstructive lung changes that have occurred by this point.
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