Allergic Bronchopulmonary Aspergillosis (ABPA)

AsthmaCystic fibrosisTuberculosisSarcoidosisHIV/AIDS Lowered immune resistance, as occurs with certain cancers , chemotherapy , or after organ transplants Use of steroid or antimicrobial medicationsHospitalization Symptoms Symptoms of ABPA are usually those of progressive asthma. These include: Shortness of breathWheezingWeakness, malaiseUnintended weight lossChest pain As ABPA progresses, other symptoms may occur, including: Production of thick, brownish, and/or bloody sputumLow-grade fever In severe, long-term cases, ABPA can cause: Bronchiectasiswidening of areas of the bronchus, usually caused by inflammationScarring of lungs Diagnosis The doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include: Chest x-ray a test that uses radiation to take a picture of structures inside the body, in this case the lungs Sputum teststo check sputum for: Presence of AFHigh levels of eosinophils Blood tests to detect: High levels of eosinophilsAntibodies suggesting an allergic reaction to AFSkin prick teststo check for allergic sensitivity by placing small amounts of AF in the skinBiopsy of lung or sinus tissue Pulmonary function tests (PFTs) used to monitor breathing capacity of the lungs Since ABPA can appear quite similar to non-ABPA induced asthma, it is often difficult to determine to what extent ABPA is contributing to your symptoms. Therefore, ABPA is typically diagnosed after several repeat tests for ABPA are positive over a number of months or years.

Treatment The goals of treatment include: Suppressing the allergic reaction to AFMinimizing lung inflammationPreventing AF from colonizing the lungs ABPA is usually treated with two medications: Prednisonean oral corticosteroid medicationAntifungal drugs, such as itraconazole (Sporanox), amphotericin B, or voriconazole Prevention Avoiding exposure to AF is the best way to prevent ABPA. However, this is difficult, because AF is so prevalent in the environment. Guidelines to help prevent exposure to AF include: Avoiding areas with: Decaying vegetationStanding waterKeeping your home as dust-free as possibleRemaining in air-filtered, air-conditioned environments whenever possible Measures to avoid symptoms and prevent permanent lung damage caused by ABPA include: Ongoing testing and monitoring of ABPAEarly and continuing medical treatment for the disease RESOURCES: American Lung Associationhttp://www.lungusa.org Centers for Disease Control and Prevention (CDC)http://www.cdc.gov National Institute of Diabetes & Digestive & Kidney Diseaseshttp://www.niddk.nih.gov CANADIAN RESOURCES: BC Health Guidehttp://www.bchealthguide.org/ The Canadian Lung Association

http://www.lung.ca References: Ferri, Fred F. Ferris Clinical Advisor 2007. 9th ed. St. Louis, MO: Mosby, 2007. Mayo Clinic and Foundation for Medical Education and Researchwebsite. Available at: http://www.mayo.edu/ . The Merck Manual of Medical Information . 2nd ed. Simon and Schuster, Inc; 2004. National Institute of Diabetes & Digestive & Kidney Diseaseswebsite. Available at: http://www.niddk.nih.gov . Last reviewed November 2007 by Rosalyn Carson-DeWitt, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.