Presentation and diagnosis of allergic bronchopulmonary aspergillosis in asthma

Allergic bronchopulmonary aspergillosis (ABPA) can be difficult to detect and the diagnosis is often delayed because the presentation is nonspecific.

Consider the possibility of ABPA in a patient with:

• unexplained shadowing on chest X-ray
• segmental collapse on chest X-ray
• difficult-to-control asthma (despite management of comorbidities such as allergic rhinitis)
• a productive cough of sticky mucous plugs or blood
• recurrent asthma exacerbations
• haemoptysis.

ABPA should also be considered in a patient who appears to have pneumonia on X-ray but is reasonably well. Although a computed tomography (CT) scan is not a routine diagnostic test for ABPA, if it was performed because pneumonia was a presumed diagnosis and the scan shows mucous plugging, bronchiectasis, bronchial dilatation or airspace change, this may indicate ABPA.

If ABPA is suspected in a patient with asthma, or if a patient with asthma displays any of the above features without an alternative cause, consider referral to a respiratory physician for diagnosis and management. Features that are of particular concern are haemoptysis and transient pulmonary infiltrates on chest X-ray.