ABPA, i.e. Allergic Broncho Pulmonary Aspergillosis is a frequently missed and under diagnosed cause of shortness of breath.
It usually mimics asthma , but is a separate entity. It occurs due to hypersensitivity reactions in lungs to Aspergillus fungus allergen.
Diagnosis:
1. Either Skin prick test to Aspergillus positive, or Specific IgE against Aspergillus fumigatus more than 0.35 IU
2. Total IgE more than 1000.
Types:
Depending on how much lung has been damaged
1. ABPA-S: no damage to lung parenchyma
2. ABPA-CB: Bronchiectasis present
3. ABPA-CB-ORF: apart from Bronchiectasis Other Radiological Features present in chest HRCT
Treatment:
Mainly Oral steroids apart from supportive therapy for concomitant diseases and regular monitoring
Allergen avoidance
Chest physiotherapy
Breathing exercises
LTOT where needed
Immunisation
Patient education on side effects of oral steroids, teaching how to identify early signs, prophylactic measures.
Clue:
Severe asthma not getting controlled on high dose ICS-LABA.
