A Study on Prevalence of Allergic Bronchopulmonary Aspergillosis in Patients of Bronchial Asthma

Abstract

Objective: To determine the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients of bronchial asthma. Methods: Two hundred and forty four patients of bronchial asthma, recruited consecutively over a period of three years were analyzed prospectively by clinical evaluation, chest radiography, skin test, sputum culture for fungus and serum precipitin test. Those patients with suspicion of ABPA were further investigated by serum titers of specific IgG and IgE against A. fumigatus. Diagnosis of ABPA was made on pre determined major and minor criteria, where at least five major criteria had to be present. Results: During the study period, 244 patients (150 males; 94 females) with bronchial asthma diagnosed on basis of clinical features and spirometric findings were recruited in the study, with mean age of 27.1 years (9 to 60 years). Mean duration of illness of these patients was 11.2 years (1.5 to 32 years). Immediate cutaneous reactivity to A. fumigatus (Type I) revealed hypersensitivity to the fungus in 30.3% of the patients. On basis of clinical, radiological and immunological criteria, 18 (7.4%) patients (13 males and 5 females) were diagnosed to have ABPA. Their mean age was 33.5 years (17 to 48 years) and mean duration of illness was 11.8 years (1.5 to 28 years). Family history suggestive of atopy was present in 61.5% and history of passage of mucus plugs was present in 66.6% patients. All these patients with ABPA were misdiagnosed as cases of pulmonary tuberculosis, and were given anti tuberculosis treatment. Conclusion: Allergic bronchopulmonary aspergillosis is seen in 7.4% patients with bronchial asthma. Efforts should be made to improve the awareness level about this disease, among general physicians who frequently confuse it with pulmonary tuberculosis, for timely diagnosis and institution of appropriate treatment so as to avoid misuse of antitubercular drugs and prevention of end stage irreversible lung damage.