Treating Allergic Bronchopulmonary Aspergillosis: A Review

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that results from a hypersensitivity reaction to the fungi Aspergillus fumigatus (Af). It presents with pulmonary infiltrates and bronchiectasis. Past research studies on ABPA have led to the conclusion that it is both underdiagnosed and much more prevalent than previously assumed. The underdiagnosing of ABPA is due to a lack of consensus regarding diagnosis and treatment. Complications that result from delay in treatment for ABPA are pulmonary fibrosis, bronchiectasis with chronic sputum production, and severe persistent asthma with loss of lung function. Because of this, it becomes imperative that ABPA treatment guidelines are reviewed and more thoroughly evaluated regarding their efficacy. The following article addresses the epidemiology, the pathophysiology, and the treatment of ABPA. The treatment is studied in detail regarding the types of medications used and their proven clinical impact on patients according to past research studies. The aim of this article is to address the current need for larger clinical trials in order to learn more and establish more formal treatment protocols for ABPA.

Use of monoclonal antibodies for allergic bronchopulmonary aspergillosis in patients with asthma and cystic fibrosis: literature review

“… 5 To a lesser extent, a type III and type IV hypersensitivity reaction also develops, leading to an increase in IgG against the fungus and a cellular response mediated by lymphocytic infiltration and neutrophil activation. 4 , 5 …”

“…Patients should be initially followed every 6–8 weeks, and then every 3–6 months, to evaluate the stability in response to treatment and make the necessary adjustments. 4 , 44 Due to lack of response of many patients to standard of care, the use of biological drugs has been increasing in the past decade to treat ABPA, even though they are not approved by authorities worldwide for this purpose. The proposed mechanism of action for their use in ABPA relies on their inhibition of fundamental pathways for the development of the disease, such as the production of IgE and action against interleukin (IL) 4, IL-13 and IL-5.…”

“…Later on, in 1968, the first formal registry was carried out in the United States and it was not until 1977 that Rosenberg and Patterson established the first diagnostic criteria for this disease. 2 , 4 …”

“…Systemic steroids are therefore employed as the mainstay therapy, leading to numerous side effects when used for prolonged periods of time, limiting their use. 4 , 8 Antifungals are also useful for patients who require high doses of steroids or present an acute exacerbation of ABPA; they aim to control and decrease the antigenic stimulus generated by the fungus, thus reducing the inflammatory response. 4 , 5 …”

Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis: An Update on the Newest Diagnostic Tools and Therapeutic Approaches

“…The aim of ABPA treatment is to control symptoms, prevent and treat exacerbation, limit lung inflammation and reduce progression to end-stage pulmonary disease. The consequences of delayed treatment are fibrosis, bronchiectasis and loss of lung function [ 54 ].…”