Curriculum · Respiratory
Allergic bronchopulmonary aspergillosis
What it is
Allergic bronchopulmonary aspergillosis, shortened to ABPA, affects 1% to 12% of immunocompetent patients with asthma. It is a disease of asthma, not of COPD, and that distinction matters when a nonsmoker with obstruction is being worked through.
Causes and risk
Asthma or cystic fibrosis is the ground it grows on. It is important to consider in patients with recurrent exacerbations.
How it presents
Recurrent wheezing and coughing over weeks, with the new production of brown sputum plugs, is the picture. In a described example, a woman with a long history of asthma and multiple allergies, treated four times in 3 months for asthma exacerbations, feels better on the first day of a corticosteroid, but any attempt at tapering leads to a recurrence of symptoms, despite previously good control on a regular high-dose inhaled corticosteroid and a long-acting agonist, and she returns with the same symptoms even after completing a course of levofloxacin for a suspected pneumonia. The examination is unremarkable apart from diffuse expiratory wheezing, with no fever and no other abnormal vital signs.