Allergic bronchopulmonary aspergillosis in resistant asthmatics

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.