Allergic bronchopulmomary aspergillosis (ABPA) is an adverse reaction to the presence of a certain type of fungus in your airways. It tends to occur in people with chronic lung conditions, such as asthma and cystic fibrosis. Medications can help control it, but regular monitoring of your lungs is necessary since this condition can get worse.
This condition occurs when you breathe in the fungus Aspergillus fumigatus, which is found in several places, including soil, water, and dust. The fungus causes a chronic reaction that leads to recurring inflammation of the lungs.
According to the Cystic Fibrosis Foundation, ABPA occurs in roughly two to 11 percent of people with cystic fibrosis (CFF). A study published in the Chest Journal also found that ABPA has also been found in around 13 percent of people presenting in asthma clinics (Agarwal, 2009).
ABPA is more common in adolescents and males (CFF).
The symptoms of ABPA resemble the symptoms that occur with cystic fibrosis or asthma. Because of this, sufferers who already have these conditions often don’t realize there is an additional problem.
The first signs of ABPA often include:
- shortness of breath
- mild fever
- coughing up mucus with brownish flecks
Other symptoms include coughing up larger amounts of mucus and experiencing asthma attacks brought on by exercise.
In severe cases, ABPA can cause permanent changes to your central airways. They can become wider, which leads to bronchiectasis. This condition can cause serious breathing problems or heart failure. These complications occur more often in people with advanced cystic fibrosis.
Your doctor will perform several tests to determine if you have ABPA. Diagnosing this condition can be hard because the symptoms it causes are very similar to those of cystic fibrosis and asthma. Your doctor will also have to rule out other possible causes, such as pneumonia. The tests your doctor might use include:
- chest X-rays or CT (computed tomography) scans to look for widened airways. CT scans use several X-rays to create a detailed image of your lungs.
- blood tests to check for high levels of antibodies that are fighting Aspergillus and white blood cells called eosinophils
- sputum (phlegm) culture to look for Aspergillus and eosinophils
- skin test to check for an allergy to Aspergillus, although it doesn’t differentiate between ABPA and a regular allergy to the fungus
Treating ABPA involves reducing the symptoms when flare-ups occur and trying to prevent them from happening again.
Your doctor will prescribe corticosteroids, such as prednisone, to help with lung inflammation. You can take these in pill or liquid form. You will likely be on it for several weeks before your doctor weans you off them gradually. It is usually stopped altogether when the symptoms have disappeared. You might experience side effects such as weight gain, an increased appetite, and an upset stomach from these medications.
Your doctor might also prescribe asthma medications that help your airways open so that you have room to cough up mucus. This helps remove the fungus from your airways.
Treating the Fungus
Your doctor might have you take an antifungal medication, such as itraconazole, to get rid of as much of the fungus in your airways as possible. This can help prevent ABPA from getting worse. You will use it up to two times per day for up to six months unless your symptoms go away before then. You might have side effects such as a fever, upset stomach, or a rash from this medication.
Although your symptoms might disappear before your prescription runs out, never stop taking your medication until you consult with a doctor. This ensures the condition is fully treated and lessens the risk of a reoccurrence.
ABPA can lead to increased damage to your lungs without causing your symptoms to become worse. For this reason, your doctor will regularly check your lungs and airways with chest X-rays and pulmonary function (breathing) tests. Your doctor will also monitor your antibody and eosinophil levels.
Exposure to Aspergillus is very hard to avoid since the fungus is found in several common environments. Taking your prescribed medications might help prevent recurring flare-ups.