ABPA Doctor in Delhi | Pulmonologist Dr. Vikas Mittal

Allergic Bronchopulmonary Aspergillosis (ABPA)

ABPA is an allergic reaction in the lungs caused by the fungus Aspergillus, which colonizes the airways especially in patients with asthma or cystic fibrosis. In this the immune system reacts excessively to Aspergillus spores. It causes inflammation and damage to the airways. Leads to recurrent asthma exacerbations, mucus plugging, and sometimes bronchiectasis.

Symptoms of ABPA

Wheezing and coughing
Thick mucus production, sometimes with brownish plugs.
Fever during exacerbations
Shortness of breath
Chest discomfort

Causes of ABPA

It can cause due to:

Inhalation of Aspergillus Spores, which are found in soil, dust, compost, decaying plants, and indoor mold.
Because of underlying asthma, as asthmatic patients have inflamed airways, making it easier for fungi to colonize and trigger an allergic reaction.
Cystic fibrosis can also cause ABPA as people with CF have thick mucus in their lungs, which traps Aspergillus and leads to chronic inflammation.
Weakened Immune Response or Overactive Immune System.
Genetic susceptibility

Diagnosis

ABPA can be diagnosed by:

Clinical Symptoms: Asthma symptoms that worsen suddenly. Cough with thick brown mucus plugs.
Blood Tests: Elevated Total IgE levels (often >1000 IU/mL),Aspergillus-specific IgE and IgG antibodies, Eosinophilia (high eosinophil count in CBC).
Skin Prick Test: Immediate allergic reaction (wheal and flare) to Aspergillus antigen confirms hypersensitivity.
Chest Imaging (HRCT Scan): Shows central bronchiectasis (widening of airways).
Sputum Culture: May grow Aspergillus species, though not always necessary for diagnosis.

Treatment for ABPA

Oral Corticosteroids (First-line Treatment): Prednisolone is the mainstay, usually started in moderate-to-high doses and then tapered over weeks/months. Helps to reduce the lung inflammation and control the symptoms.
Antifungal Therapy: Itraconazole or Voriconazole is added in some cases to reduce fungal load. It helps to decrease the steroid dependence and prevents flare-ups.
Inhaled Bronchodilators & Steroids: It is useful if patient has underlying asthma. It helps to control the airway hyperreactivity
Monitoring & Follow-up: Regular check of IgE levels to monitor the disease’s activity. Repeat the HRCT scan if symptoms get worse. Watch for side effects of long-term steroid use

Frequently Asked Questions (FAQs)

1. Is ABPA common?

It is rare but occurs in some people who have asthma or cystic fibrosis.

2. How is ABPA different from asthma?

ABPA is a complication in which the fungal allergy worsens asthma symptoms and causes lung damage.

3. Can ABPA be cured?

Not completely, but its symptoms and lung damage can be controlled with treatment.

4. Can ABPA cause permanent lung damage?

Yes, if it remains untreated it can cause bronchiectasis and fibrosis.