Clinical Features of Allergic Bronchopulmonary Aspergillosis in Korea

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a complex disease, triggered by a hypersensitivity reaction to the allergen Aspergillus fumigatus. This disease occurs frequently in patients with cystic fibrosis and severe asthma in Western countries, with a prevalence of 2%-15%. However, there have been only a few case reports in Korea. We investigated the clinical and immunological features of patients with ABPA. Ten adult patients diagnosed with ABPA, according to Greenberger's criteria, were analyzed during the period January 2001 to December 2010 in a tertiary hospital. Skin-prick tests, pulmonary function tests, and high-resolution computed tomography (HRCT) were performed, and total serum IgE and A. fumigatus-specific IgE were measured. The patient cohort consisted of men who were middle-aged (median, 62.5; range, 19.0-79.0 years) at the diagnosis of ABPA with a long duration of asthma (median, 15.0; range, 1-48 years). Approximately 40% of the patients had a history of pulmonary tuberculosis more than 10 years prior to the study (median 23.5; range, 10.0-31.0 years) accompanied by severe obstructive lung function and radiological post-tuberculous destructive lung lesions. These patients also tended to have increased levels of immunologic parameters, such as total eosinophil count, total IgE, and A. fumigates-specific IgE, compared to those without tuberculosis sequels. Two patients with steroid-dependent asthma were treated with anti-IgE therapy and showed good responses. We report the clinical features of 10 ABPA patients, including 4 with histories of post-tuberculosis destructive lesions. Furthermore, anti-IgE antibody therapy may be an alternative strategy in cases of steroid-dependent ABPA.

Effectiveness and Safety of Omalizumab in Patients with Allergic Bronchopulmonary Aspergillosis Complicated by Chronic Bacterial Infection in the Airways

“…One of the possible reasons for the higher prevalence of chronic respiratory infections might be that Japanese patients with ABPA are older, as previously reported by us and other researchers. The median age of patients with ABPA was in the 30s in the studies conducted in India [21] but was in the 50s or 60s in those conducted in Japan [6] and Korea [22]. In the present study, the median patient age at diagnosis of ABPA was 52 years, and the median age at the time of treatment with omalizumab was 62 years.…”

Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity

“…A study from Korea highlighted that ABPA could possibly occur in patients with destructive lung disease due to tuberculosis. 66 Physical examination in ABPA may not be fruitful if the patient is asymptomatic. Rhonchi, crepitations, and bronchial breathing may be heard depending on the degree of the lung disease present.…”

Allergic bronchopulmonary mycosis - pathophysiology, histology, diagnosis, and treatment

“…Table 1 summarizes the clinical characteristics of ABPA/ABPM in cohort studies reported from Japan, Korea, China, and India [ 6 7 33 34 35 36 37 38 39 40 41 ]. The inclusion criteria for each study were different; the presence of asthma was indispensable in the studies by Agarwal et al [ 6 33 ], and central bronchodilation or mucous plugs were required for the study by Oguma et al [ 7 ].…”

“…It has been suggested that ABPA mostly develops in patients aged 30–40 years old, which is in agreement with the cases in India [ 6 33 34 35 38 ]. Meanwhile, the median age of patients with ABPA in Japan and Korea was 50–70 years [ 7 36 37 39 ], and that of Chinese patients was 40–50 years [ 40 41 ]. Two studies in Japan and Korea that examined the age of onset for ABPA demonstrated that the median age at disease onset was 50–60 years [ 7 37 ].…”