Allergic bronchopulmonary aspergillosis
What is Allergic bronchopulmonary aspergillosis?
Allergic bronchopulmonary aspergillosis is a lung condition that happens when your immune system overreacts to a common mold called Aspergillus fumigatus. This mold lives in soil, compost, and decaying plants. Most people breathe it in every day without any problems. But if you have asthma or cystic fibrosis, your lungs can have an extreme allergic response to this mold.
When you have this condition, the mold spores get trapped in your airways. Your immune system attacks them with white blood cells and antibodies. This response causes inflammation and mucus buildup in your lungs. Over time, the inflammation can damage your airways and lead to breathing problems.
The condition is also called ABPA for short. It is not an infection because the mold does not invade your lung tissue. Instead, it is an allergic reaction that keeps happening every time you breathe in the mold spores. Early diagnosis and treatment can help prevent permanent lung damage.
Symptoms
- Wheezing that gets worse over time
- Coughing that produces brown or bloody mucus plugs
- Shortness of breath during normal activities
- Fever and feeling generally unwell
- Worsening asthma symptoms that do not respond to usual treatment
- Chest pain or tightness
- Fatigue and low energy
- Loss of appetite and unintended weight loss
Some people with early-stage ABPA may only notice their asthma getting harder to control. Symptoms can come and go, which makes the condition tricky to diagnose. If you have asthma or cystic fibrosis and notice new respiratory symptoms, talk to your doctor right away.
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Causes and risk factors
ABPA develops when you have asthma or cystic fibrosis and breathe in Aspergillus fumigatus mold spores. This mold is everywhere in the environment. It grows on dead leaves, stored grain, compost piles, and indoor plants. Having asthma or cystic fibrosis makes you much more likely to develop this allergic response. About 1 to 2 percent of people with asthma and 7 to 10 percent of people with cystic fibrosis develop ABPA.
Your genes may also play a role in how your immune system responds to the mold. People with certain genetic markers are more prone to allergic reactions. Other risk factors include living in humid climates where mold grows easily, working in occupations with high mold exposure like farming or gardening, and having a history of other allergies. Taking inhaled steroids for asthma can sometimes make it easier for the mold to grow in your airways.
How it's diagnosed
Doctors diagnose ABPA using a combination of blood tests, imaging, and lung function tests. Blood tests check for high levels of antibodies to Aspergillus fumigatus and elevated eosinophils, which are white blood cells involved in allergic reactions. A skin prick test can show if you are allergic to the mold. Chest X-rays or CT scans may reveal inflammation or mucus plugs in your lungs.
Your doctor may also test your sputum for signs of the mold and measure your lung function with breathing tests. Specialized allergy testing for Aspergillus fumigatus can help confirm the diagnosis. Talk to your doctor about which tests are right for you. They can refer you to a pulmonologist or allergist who specializes in this condition.
Treatment options
- Oral corticosteroids like prednisone to reduce lung inflammation and calm your immune response
- Antifungal medications such as itraconazole to reduce the amount of mold in your airways
- Inhaled corticosteroids to manage underlying asthma symptoms
- Bronchodilators to help open your airways and make breathing easier
- Regular monitoring with blood tests and imaging to check for flare-ups or lung damage
- Reducing mold exposure by using air purifiers and avoiding damp environments
- Staying up to date with asthma or cystic fibrosis management plans
- Working with a pulmonologist who has experience treating ABPA
Frequently asked questions
ABPA is a severe and ongoing allergic reaction that happens deep in your lungs, not just in your nose or sinuses. Regular mold allergies cause sneezing, runny nose, and itchy eyes. ABPA causes lung inflammation, wheezing, and can lead to permanent lung damage if not treated. It only affects people who have asthma or cystic fibrosis.
ABPA cannot be cured, but it can be managed effectively with treatment. The goal is to control symptoms, prevent flare-ups, and stop lung damage from getting worse. Many people do well with a combination of corticosteroids and antifungal medications. You will need regular follow-up with your doctor to monitor the condition.
Flare-up frequency varies from person to person. Some people have symptoms that come and go several times a year. Others may go months or years without a flare-up if their treatment plan is working well. Regular monitoring with blood tests and imaging helps catch flare-ups early before they cause serious damage.
No, ABPA is not contagious. You cannot catch it from another person. It is an allergic reaction that happens inside your own lungs when you breathe in Aspergillus fumigatus mold spores. The mold itself is in the environment, not spread from person to person.
Untreated ABPA can cause permanent lung damage over time. The ongoing inflammation can lead to bronchiectasis, which is when your airways become scarred and widened. This makes it harder to clear mucus and increases your risk of lung infections. You may also develop pulmonary fibrosis, where lung tissue becomes stiff and scarred.
You cannot completely prevent ABPA, but you can lower your risk. Avoid areas with high mold levels like compost piles, damp basements, and piles of leaves. Use air purifiers with HEPA filters in your home. Keep your asthma well controlled with your regular medications. If you notice your asthma getting worse, see your doctor right away.
ABPA is an allergic reaction, not an infection. The mold does not invade your lung tissue like bacteria or viruses do. Instead, your immune system overreacts to the mold spores in your airways. This causes inflammation and mucus buildup. Infections usually respond to antibiotics, but ABPA needs corticosteroids and antifungal medications.
Doctors check for antibodies to Aspergillus fumigatus in your blood, specifically IgE and IgG antibodies. They also measure your total IgE level, which is usually very high in ABPA. Eosinophil counts are often elevated as well. These tests help confirm that your immune system is reacting to the mold.
Many people need long-term treatment to keep ABPA under control. You may take corticosteroids during flare-ups and antifungal medications for several months at a time. Some people can reduce their medication dose over time if their condition is stable. Your doctor will create a treatment plan based on how your body responds.
Yes, children with asthma or cystic fibrosis can develop ABPA. It is important to watch for worsening respiratory symptoms that do not improve with usual asthma treatments. Early diagnosis in children helps prevent long-term lung damage. If your child has asthma or cystic fibrosis and shows new symptoms, talk to their doctor about testing.