Overview of allergic bronchopulmonary aspergillosis

This topic covers management of allergic bronchopulmonary aspergillosis (ABPA) in patients with asthma and cystic fibrosis (CF). For management of aspergillosis in pneumonia, see Invasive pulmonary aspergillosis and Chronic pulmonary aspergillosis.

ABPA is characterised by a marked inflammatory reaction in the airways to lung colonisation with Aspergillus fumigatus. A. fumigatus is a common environmental fungus; culture of A. fumigatus from the sputum is common and is not necessarily associated with clinical disease.

ABPA predominantly occurs in patients with asthma or CF. It affects approximately 1 to 2% of people with asthma, and around 10% of people with CF, although estimates vary. In children, most cases of ABPA are related to CF rather than asthma.

The typical presentation of ABPA differs between asthma and CF, and diagnosis is difficult. Management of ABPA is similar regardless of the cause. Diagnosis and management require specialist advice.

Chronic or recurrent ABPA can cause bronchiectasis or lung fibrosis.