ABPA, i.e. Allergic Broncho Pulmonary Aspergillosis is an often missed cause of shortness of breath
Clue: uncontrolled asthma on high dose ICS-LABA
Diagnosis:
Skin prick test positive to Aspergillus fumigatus or Specific IgE Af more than 0.35
Total IgE more than 1000
Types:
ABPA-S: no lung parenchyma damage
ABPA-CB: Bronchiectasis present
ABPA-CB-ORF: other radiological features also present
Treatment:
Oral steroids
Supportive therapy
Chest physiotherapy
LTOT
Immunisation
Allergen avoidance