Allergic Bronchopulmonary Aspergillosis

Aspergillus fumigates is a fungus. It’s found in several places, including soil, water, and dust. ABPA occurs when you breathe in this fungus. It causes a chronic reaction that leads to recurring inflammation of the lungs.

The Cystic Fibrosis Foundation reports that ABPA occurs in roughly 2 to 11 percent of people with cystic fibrosis. One study found ABPA in around 13 percent of asthma clinics. It’s also more common in adolescents and males.

The symptoms of ABPA resemble the symptoms that occur with cystic fibrosis or asthma. For that reason, people who have these conditions often don’t realize there may be an additional problem.

The first signs of ABPA often include:

• shortness of breath
• wheezing
• 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 check 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 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, though it won’t be able to tell the difference 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.

Treating Inflammation

Your doctor will prescribe corticosteroids, such as prednisone, to help with lung inflammation. You can take these in pill or liquid form. You’ll likely be on it for several weeks before your doctor weans you off them gradually. You’ll usually stop taking them completely 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’ll 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.

Even if your symptoms disappear before your prescription runs out, never stop taking your medication without asking your doctor. You want to make sure you fully treat the condition and lessen the risk of a reoccurrence.

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.

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. With careful monitoring, you can prevent ABPA from getting worse.