Allergic Bronchopulmonary Aspergillosis: Clinical Manifestations, Diagnosis and Management: Importance of Early Anticipation as One Underlying Cause for Intractable Bronchial Asthma, Cystic Fibrosis Flare Ups

Allergic bronchopulmonary aspergillosis (ABPA) is a medical condition seen more often in patients having difficult to treat bronchial asthma. It is an immune reaction to the presence of Aspergillus fumigatus present in the airways of patients having bronchial asthma and cystic fibrosis of the lung. The allergic response is archestrated via type-2, T-Helper lymphocytes leading to activation of eosinophilic recruitment and releasing of other inflammatory substances. Manifestations of ABPA include profound cough, breathlessness, wheezing, raised eosinophil counts and total IgE in blood. There are fleeting patchy shadows seen on chest x-rays, which, if not managed early, lead to bronchiectasis. The mainstay of treatment is high dose and prolonged Corticosteroids along with anti-fungal medications. Anticipation of this condition and early management in patients having intractable bronchial asthma help clinical recovery and prevent complications.