DOI: http://dx.doi.org/10.18203/2349-3933.ijam20214479

Allergic bronchopulmonary aspergillosis in resistant asthmatics

Gokulakrishnan Harikrishnan, Govardhini Vaiyakkani, Sridhar Sundaravadanam

Abstract


Background: Allergic bronchopulmonary aspergillosis (ABPA) is an immune mediated lung disease caused due to hypersensitivity reaction of antigen Aspergillus fumigates. ABPA is more prevalent in patients with asthma and cystic fibrosis. Thus, the current investigation was done to estimate the prevalence and association of ABPA with resistant asthma, to identify the clinical and laboratory pointers of ABPA and to identify the effect of ABPA and its treatment on the course of resistant asthma.

Methods: Current investigation was a prospective and non-blinded study conducted on patients of Rajiv Gandhi government general hospital, Chennai with bronchial asthma, having frequent exacerbation related problems. Demographic, clinical (hematological) and radiological investigations were performed for staging and treatment of all the enrolled patients. Follow up of patients was done periodically to investigate re-admission of respiratory events or other illnesses. All the collected data was statistically analyzed.

Results: Prevalence of ABPA in treatment resistant bronchial asthma patients was 19%. Positive family history, history of atopy and recurrent exacerbations were identified as significant risk factors among ABPA patients. Whereas duration and severity of asthma had no significant association with ABPA patients, bronchiectasis and parenchymal damage were significantly observed in patients of ABPA. Skin prick test serum eosinophils and IgE antibody levels were observed as good screening test parameters to identify ABPA. Prednisolone and itraconazole are considered as highly reliable and effective treatment strategies in ABPA.

Conclusions: Current investigation revealed that ABPA must be considered as a possible prevailing disease in treatment refractory cases of asthma on conventional steroids.


Keywords


ABPA, Aspergillus fumigates, Resistant asthma, Prevalence, Clinical and radiological pointers, Immunocompromised patients

Full Text:

PDF

References


Patterson K, Strek ME. Allergic bronchopulmonary aspergillosis. Proc Am Thorac Soc. 2010;7(3):237-44.

Shah A, Panjabi C. Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity. Allergy Asthma Immunol Res. 2016;8(4):282-97.

Patel G, Greenberger PA. Allergic bronchopulmonary aspergillosis. Allergy Asthma Proc. 2019;40(6):421-4.

Greenberger PA. Allergic bronchopulmonary aspergillosis. Allergy Asthma Proc. 2012 ;33 (1):61-3.

Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43(8):850-73.

Tillie-Leblond I, Tonnel AB. Allergic bronchopulmonary aspergillosis. Allergy. 2005;60(8):1004-13.

Hinson KF, Moon AJ, Plummer NS. Broncho-pulmonary aspergillosis; a review and a report of eight new cases. Thorax. 1952;7(4):317-33.

Agarwal R, Sehgal IS, Dhooria S. Allergic bronchopulmonary aspergillosis. Indian J Med Res. 2020;151(6):529-49.

Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015;70:270-7.

Stevens DA, Moss RB, Kurup VP, Knutsen AP, Greenberger P, Judson MA, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis-state of the art: Cystic Fibrosis Foundation Consensus Conference. Clin Infect Dis. 2003;37(3):S225-64.

Agarwal R, Dua D, Choudhary H, Aggarwal AN, Sehgal IS, Dhooria S et al. Role of Aspergillus fumigatus-specific IgG in diagnosis and monitoring treatment response in allergic bronchopulmonary aspergillosis. Mycoses. 2017;60:33-9.

Greenberger PA, Bush RK, Demain JG, Luong A, Slavin RG, Knutsen AP. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract. 2014;2(6):703-8.

Denning DW, Pleuvy A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol. 2013;51:361-70.

Elliott MW, Newman-Taylor AJ. Allergic bronchopulmonary aspergillosis. Clin Exp Allergy. 1997;27(1):55-9.

Shah A. Allergic bronchopulmonary aspergillosis. Indian J Chest Dis Allied Sci. 1998;40:41-54.

Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R et al. Allergic bronchopulmonary aspergillosis: Review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43:850-73.

Kirsten D, Nowak D, Rabe KF, Magnussen H. Diagnosis of bronchopulmonary aspergillosis is often made too late. Med Klin (Munich). 2016;88:353-6.

Agarwal R, Sehgal IS, Dhooria S, Aggarwal AN. Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis. Expert Rev Respir Med. 2016;10:1317-34.

Gergen PJ, Arbes SJ, Jr, Calatroni A, Mitchell HE, Zeldin DC. Total IgE levels and asthma prevalence in the US population: Results from the national health and nutrition examination survey 2005-2006. J Allergy Clin Immunol. 2009;124:447-53.

Agin K, Namavary D. Frequency of specific immunoglobulin G antibodies and immediate skin test reactivity to Aspergillus fumigatus antigen among adults with allergic asthma: Tehran. Int J Med Toxicol Forensic Med. 2012;2:97-102.

Vlahakis NE, Aksamit TR. Diagnosis and treatment of allergic bronchopulmonary aspergillosis. Mayo Clin Proc. 2001;76(9):930-8.

Kanu A, Patel K. Treatment of allergic bronchopulmonary aspergillosis (ABPA) in CF with anti-IgE antibody (omalizumab). Pediatr Pulmonol. 2008;43(12):1249-51.

Dhooria S, Sehgal IS, Muthu V, Agarwal R. Treatment of allergic bronchopulmonary aspergillosis: from evidence to practice. Future Microbiol. 2020;15:365-76.

Sunman B, Ademhan TD, Ozsezen B, Emiralioglu N, Yalcin E, Özçelik U. Current approach in the diagnosis and management of allergic bronchopulmonary aspergillosis in children with cystic fibrosis. Front Pediatr. 2020;8:582964.

Kumar R, Gaur SN. Prevalence of allergic bronchopulmonary aspergillosis in patients with bronchial asthma. Asian Pac J Allergy Immunol. 2000;18(4):181-5.

Becker JW, Burke W, McDonald G, Greenberger PA, Henderson WR, Aitken ML. Prevalence of allergic bronchopulmonary aspergillosis and atopy in adult patients with cystic fibrosis. Chest. 1996;109(6):1536-40.

Paterson IC, Middleton WG, Grant IW, Douglas AC. Asthmatic pulmonary eosinophilia: a review of 65 cases. Br J Dis Chest 1977;71:115.

Muthu V, Sehgal IS, Prasad KT, Dhooria S, Aggarwal AN, Garg M et al. Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: A distinct subset of ABPA with a lesser risk of exacerbation. Med Mycol. 2020;58(2):260-3.