ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS

Abstract

As we approach the end of this century, we approach the fiftieth anniversary of the initial report of allergic bronchopulmonary aspergillosis (ABPA).3 All of the initial clinical and research studies were carried out in England.11, 12 Sixteen years after the initial case report from England, the first case was reported in the United States.9 At first considered a rarity in the United States, increasing numbers of cases were identified.4, 16 However, the relative rarity of ABPA, lack of awareness of the disease, and absence of specific diagnostic criteria did not promote early detection of ABPA in many cases. Cases of ABPA were often labeled the PIE syndrome (pulmonary infiltrates with eosinophilia), and physicians waited for spontaneous improvement, which often occurred, but with a later recurrence. This spontaneous improvement characterizes an important aspect of ABPA: It is often a low-grade, nonacute respiratory syndrome of fluctuating severity that might persist for years without diagnosis. Two to three decades ago, many advanced cases were diagnosed only when patients coughed up golden brown plugs or mucous casts of bronchi, which were colonies of Aspergillus fumigatus growing in mucous in the airway.11 Such cases were usually far advanced ABPA with marked central bronchiectasis and significant fibrotic changes in pulmonary tissue. As awareness of ABPA increased, radiographic diagnosis advanced, serologic assessment improved, and the number of diagnosed cases of ABPA increased.