Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis

Nepomuceno, Ilynn B.; Esrig, Silvia; Moss, Richard B.

doi:10.1378/chest.115.2.364

Cited by 135 publications

(102 citation statements)

References 36 publications

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“…stage 3 [9], the current treatment of choice is a combination of glucocorticoids and itraconazole [29,30]. An interesting proposition is the use of itraconazole monotherapy as first-line therapy for acute-stage ABPA [35], as this would avoid the adverse effects of glucocorticoid therapy altogether. However, any azole therapy has to be balanced in light of the emerging importance of azole-resistant Aspergillus species not only in Europe but also in Asia [36,37].…”

Section: Discussionmentioning

confidence: 99%

A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma

et al. 2015

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Whether use of high-dose steroids in acute-stage allergic bronchopulmonary aspergillosis (ABPA) is associated with superior outcomes is not known. Herein, we compare the efficacy and safety of two glucocorticoid protocols in ABPA.Treatment-naive ABPA subjects randomly received either high-dose or medium-dose oral prednisolone. The primary outcomes were exacerbation rates and glucocorticoid-dependent ABPA after 1 and 2 years, respectively, of treatment. The secondary end-points were composite response rates after 6 weeks, improvement in lung function, time to first exacerbation, cumulative dose and adverse effects.92 subjects (high-dose n=44, medium-dose n=48) were included in the study. The numbers of subjects with exacerbation after 1 year (high-dose 40.9% versus medium-dose 50%, p=0.59) and glucocorticoiddependent ABPA after 2 years (high-dose 11.4% versus medium-dose 14.6%, p=0.88) were similar in the two groups. Although composite response rates were significantly higher in the high-dose group, improvement in lung function and time to first exacerbation were similar in the two groups. Cumulative glucocorticoid dose and side-effects were significantly higher in the high-dose group.Medium-dose oral glucocorticoids are as effective and safer than high-dose in treatment of ABPA.@ERSpublications Medium-dose glucocorticoids are as effective as high-dose in treatment of allergic bronchopulmonary aspergillosis

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Section: Discussionmentioning

confidence: 99%

A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma

et al. 2015

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“…ABPA was diagnosed in 22% of atopic individuals with CF but in only 2% of non-atopic patients. 69 In another study, the majority of patients with ABPA were atopic, as defined by positive skin prick test to at least one common aeroallergen, other than A. fumigates. 67 Total IgE concentration was found to be increased in A. fumigatus sensitised patients with CF but with no ABPA.…”

Section: Abpamentioning

confidence: 99%

“…60,[64][65][66][67][68][69][70][71] ABPA is a lung disease caused by immediate hypersensitivity reaction against Aspergillus fumigatus. The most clinically relevant characteristics are impaired mucociliary clearance, mucoid impactions, wheezing, pulmonary infiltrates, bronchiectasis and fibrosis.…”

Section: Abpamentioning

confidence: 99%

“…66,86,87 In other studies involving CF, 31-59% of patients were sensitised to A. fumigates. 67,88 When considering CF and ABPA, although sensitisation to A. fumigatus is crucial to ABPA diagnosis, it is important to differentiate lung colonisation by Aspergillus (40%), 69 allergic sensitisation (20-60%), 66,85 and clinically proven ABPA, a sizeable minority ranging from 1 to 11%. 71,89 The evolution from simple sensitisation to ABPA constitutes a crucial phase which urges to be correctly diagnosed in order to prevent disease progression.…”

Section: Allergic Sensitisation and Clinical Relevancementioning

confidence: 99%

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Cystic fibrosis, atopy, asthma and ABPA

Antunes

Fernandes

Borrego

et al. 2010

Allergologia et Immunopathologia

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The role of atopy on cystic fibrosis (CF) progression remains unclear but evidence suggests that it may influence the appearance of co-morbid conditions such as CF asthma or allergic bronchopulmonary aspergillosis (ABPA). Recognising asthma in patients with CF is not always easy but the identification of atopic markers favours the diagnosis. Physicians should be aware of this fact in order to achieve a better control of respiratory symptoms in patients with CF. Bronchial mucosa inflammation and abnormal mucus predispose to mould colonisation. These patients are at higher risk of allergic sensitisation, especially when atopic susceptibility is present. In the particular case of A. fumigatus, allergic sensitisation precedes ABPA development, which occurs in up to 10% of CF patients. Progression of lung function deterioration is most strikingly pronounced in patients with ABPA. Therefore, sensitisation with A. fumigatus should be regularly tested in patients with CF, especially those at higher risk. Recombinant allergens constitute an important advance in differentiating Aspergillus sensitisation from ABPA itself.

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“…[5][6][7] ABPA affects between 2%-15% of patients with CF (PWCF) and recurrent episodes impact pulmonary function. 1, [8][9][10][11] It manifests as an allergic, hypersensitive, Th2 CD4 + cell-driven response to Af and the diagnosis of ABPA in CF is particularly challenging due to overlapping clinical, immunological and radiological features that are similar to those of a pulmonary exacerbation. To address this, consensus conference criteria were published to aid clinicians in diagnosing CF-ABPA.…”

Section: Abbreviationsmentioning

confidence: 99%