Allergic bronchopulmonary aspergillosis
From IDWiki
Background
- Colonization of the airways prompting an allergic reaction that worsens asthma
- Caused by a Th2 response to Aspergillus, usually in patients with asthma or cystic fibrosis
Clinical Manifestations
- Characterized by poorly-controlled asthma or pneumonia, mucoid impaction, persistent eosinophilia
- The course is characterized by exacerbations and remissions, leading to eventual pulmonary fibrosis and chronic pulmonary aspergillosis
- The most important diagnostic criterion is elevated Aspergillus-specific IgE
- Supportive criteria include elevated total IgE >417 IU/mL, Aspergillus-specific IgG, Aspergillus serum precipitins, positive skin prick test for Aspergillus, or eosinophilia
- Other findings include Aspergillus on sputum culture, brown mucous plugs with dead eosinophils, and CXR or CT showing bronchiectasis
Management
- Indications for treatment
- Diagnose with Aspergillus-IgE
- If ongoing symptoms despite appropriate management of asthma (including oral steroids), treat with itraconazole
- If CF patient has frequent exacerbations or falling FEV1, treat with itraconazole
- Itraconazole 200 mg/day for 16 weeks, which decreases steroid use and increases patient function
