Diagnosis of Allergic Bronchopulmonary Aspergillosis: A Case-Based Approach

Sahajal Dhooria; Ritesh Agarwal


Future Microbiol. 2014;9(10):1195-1208. 

In This Article

How Does ABPA Manifest Clinically?

Although many patients with ABPA are diagnosed in the third or fourth decade of life,[8] there is no specific age or gender predilection for its occurrence.[9] Even children and the elderly may be afflicted.[10,11] Familial occurrence has been documented in up to 5% of cases.[12] Patients usually have previous diagnosis of asthma with the average duration of asthma prior to the diagnosis of ABPA being 6–15 years.[8,9,11] Asthma may be controlled (20%) or uncontrolled (80%) with the usual asthma medications.[13] Rarely, patients may present de novo without prior history of asthma.[14] The typical patient presents with fever, weight loss, cough, expectoration of mucus plugs, hemoptysis, breathlessness and wheezing,[8,15,16] although the most common presentation is that of poorly controlled asthma. Expectoration of brownish mucus plugs, considered to be a characteristic symptom has been reported in 30–70% of patients.[13,17,18] Physical examination is usually noncontributory except for finding of polyphonic wheeze on auscultation. In approximately 15% of cases, crackles are present indicating the presence of bronchiectasis, and a similar proportion may reveal clubbing (especially in those with long-standing bronchiectasis).[13] Many classical manifestations are less common in recent studies as compared with the early ones due to early diagnosis.[9,13,17,18] In fact, chest clinics may not encounter bronchiectasis in ABPA, and see only the serological stage of ABPA (ABPA-S).[19]