Clinical Characteristics and Prognosis of Allergic Bronchopulmonary Aspergillosis: A Retrospective Cohort Study

Abstract

Background:The clinical features, treatment, and prognosis of allergic bronchopulmonary aspergillosis (ABPA) are not well-defined. Objective: We aimed to investigate the clinical characteristics, therapy, and prognosis of ABPA to aid its clinical recognition. Methods: A total of 232 patients with ABPA were analyzed retrospectively. The characteristics of ABPA in terms of its misdiagnosis, computed tomography classification, therapy, and its relationship with asthma were analyzed, and risk factors for acute exacerbation of ABPA were analyzed based on follow-up data. Results: Of the 232 ABPA patients, 132 had a history of misdiagnosis. Compared with the misdiagnosed patients, ABPA patients with central bronchiectasis, a high total eosinophil count, and mucus plugs were less likely to be misdiagnosed. Compared with serological ABPA, ABPA with central bronchiectasis was more likely to occur in older people and in patients with mucus plugs, and decreased forced vital capacity and diffusing capacity for carbon monoxide. ABPA patients with asthma were more likely to have bronchiectasis, decreased lung function in 1 s FEV1 and FEV1/FVC, and shorter time to first acute exacerbation compared with ABPA patients without asthma. Patients receiving glucocorticoids plus antifungal therapy had a longer time to first exacerbation than those receiving glucocorticoid therapy alone. Univariate and multivariate analyses revealed that duration of asthma history, duration of misdiagnosis, mucus plugs, and poor pulmonary function were risk factors for acute exacerbation of ABPA. Conclusion: To our knowledge, this is the largest sample size study of ABPA in China. ABPA patients with a history of asthma and/or central bronchiectasis on high-resolution computed tomography are prone to frequent acute exacerbations. The use of glucocorticoids combined with antifungal drugs can prolong the time to the first acute exacerbation in ABPA patients. Longer durations of asthma history and misdiagnosis, mucus plugs, and poor pulmonary function are risk factors for acute exacerbation of ABPA.

The Difference in All-Cause Mortality Between Allergic Bronchopulmonary Aspergillosis with and without Chronic Obstructive Pulmonary Disease

“…Smoking history was closely associated with genesis and development of COPD and worse pulmonary function, which was also demonstrated in this study. Although a retrospective study found that DLCO/VA was lower in patients who had ABPA with CB, 18 CB had no significant association with DLCO/VA in this study. Thus, the important factor leading to the decline in pulmonary ventilation and diffusing capacity in our patients was coexisting COPD, and not CB.…”

“…31 In another study, 1 out of 46 patients with ABPA had COPD, 32 and in a recent retrospective analysis by Zeng, 3 out of 193 patients with ABPA had COPD. 18 It can be speculated that a large number of patients with COPD and ABPA are underdiagnosed or misdiagnosed, leading to a higher age at the time of first diagnosis in these patients. These two aspects lead to the fact that the age of patients with ABPA and COPD is much higher than that of ABPA patients without COPD.…”

“…5,14 Considering the fact that the combination with COPD can significantly increase the mortality of patients with asthma, 15 COPD may also have a similar impact on patients with ABPA. Most studies performed in patients with ABPA were case reports or cross-sectional studies with the follow-up duration ranging from 3 months to 43.7 months, [16][17][18][19][20] and few studies focused on the long-term follow-up and prognosis, especially for…”

Clinical Manifestations of Human Exposure to Fungi

“…In susceptible hosts (mainly patients with asthma or cystic fibrosis), repeated inhalation of A. fumigatus spores, followed by respiratory tract colonization, triggers an immune hypersensitivity reaction [ 21 ]. This reaction is mediated by an immunoglobulin E (IgE), with possible involvement of immunoglobulin G (IgG)-mediated immune complex and cell-mediated hypersensitivity reactions [ 22 , 23 ].…”

Clinical and immunological characteristics of Aspergillus fumigatus-sensitized asthma and allergic bronchopulmonary aspergillosis

“…The clinical manifestations include chronic asthma or bronchiectasis and recurrent wandering pulmonary shadows or mucus blockage in lung images ( 6 ). While ABPA was mostly found in patients with bronchial asthma or cystic fibrosis in Western countries, it was more common in patients with asthma and bronchiectasis in China ( 7 ). A study revealed that the estimated prevalence of ABPA in adults with asthma was at 2.5% ( 8 ) and could rise up to 45% in patients with A.f -sensitized asthma ( 9 ).…”