Allergic Bronchopulmonary Aspergillosis (ABPA)
What is Allergic Bronchopulmonary Aspergillosis (ABPA)?
Allergic Bronchopulmonary Aspergillosis, or ABPA, is an allergic lung reaction to a common mold called Aspergillus fumigatus. This fungus exists almost everywhere in the environment. Most people breathe in Aspergillus spores every day without any problems. But in some people with asthma or cystic fibrosis, the immune system overreacts to the fungus.
When your immune system treats Aspergillus as a serious threat, it launches an inflammatory attack in your airways. This creates thick mucus plugs, airway inflammation, and lung damage over time. ABPA is not an infection. The fungus does not invade your lung tissue. Instead, your body's own immune response causes the symptoms and damage.
Without treatment, ABPA can lead to permanent scarring in the lungs called bronchiectasis. This condition makes breathing progressively harder. Early detection through blood tests and imaging helps prevent long-term complications. ABPA affects about 1 to 2 percent of people with asthma and up to 15 percent of people with cystic fibrosis.
Symptoms
- Worsening asthma symptoms that don't respond to usual treatments
- Coughing up brown or blood-tinged mucus plugs
- Wheezing and shortness of breath
- Low-grade fever
- Chest pain or discomfort
- Fatigue and general feeling of being unwell
- Weight loss in some cases
Some people with ABPA have mild symptoms that come and go. Others experience severe breathing problems. In early stages, symptoms may be mistaken for poorly controlled asthma. If you have asthma or cystic fibrosis and notice your breathing is getting worse despite medication, talk to your doctor about ABPA testing.
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Causes and risk factors
ABPA develops when your immune system has an exaggerated allergic response to Aspergillus fumigatus. This mold lives in soil, decaying vegetation, dust, and water systems. Everyone inhales Aspergillus spores regularly. In most people, the immune system clears these spores without issue. But in people with asthma or cystic fibrosis, the airways are already inflamed and more sensitive. The immune system produces too many antibodies and inflammatory cells called eosinophils in response to the fungus.
Risk factors include having asthma or cystic fibrosis, a family history of allergic conditions, and genetic factors that affect immune response. ABPA is more common in people whose asthma started in childhood. The condition is not contagious. You cannot catch it from another person. While you cannot avoid breathing in Aspergillus spores entirely, reducing exposure to moldy environments may help prevent flare-ups.
How it's diagnosed
Doctors diagnose ABPA using a combination of clinical history, imaging studies, and blood tests. Chest X-rays or CT scans may show mucus plugs or signs of lung inflammation. Blood tests are essential for confirming the diagnosis. An elevated eosinophil count above 500 cells per microliter is one of the major diagnostic criteria. Eosinophils are white blood cells that increase during allergic reactions. Your doctor will also check for Aspergillus-specific antibodies in your blood and may test your total IgE levels.
Rite Aid offers testing for eosinophils as part of our flagship blood panel. Getting your eosinophil count checked regularly can help detect ABPA early and monitor how well treatment is working. Early detection prevents permanent lung damage. If you have asthma or cystic fibrosis and experience worsening symptoms, regular blood testing provides valuable information about your immune response.
Treatment options
- Corticosteroids like prednisone to reduce lung inflammation and lower eosinophil counts
- Antifungal medications such as itraconazole to reduce fungal load in the airways
- Inhaled corticosteroids to control underlying asthma
- Bronchodilators to open airways and improve breathing
- Omalizumab, a biologic medication for severe cases that don't respond to other treatments
- Chest physiotherapy to help clear mucus from the lungs
- Avoiding environments with high mold exposure when possible
- Regular monitoring with blood tests and imaging to catch flare-ups early
Treatment focuses on calming the immune overreaction and preventing lung damage. Most people need ongoing medication management. Work closely with a pulmonologist who has experience treating ABPA. Regular blood testing helps your doctor adjust medications based on your eosinophil levels and other markers of inflammation.
Concerned about Allergic Bronchopulmonary Aspergillosis (ABPA)? Get tested at Rite Aid.
- Simple blood draw at your nearest lab
- Results in days, not weeks
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Frequently asked questions
ABPA is an allergic reaction to Aspergillus, not an infection. In ABPA, the fungus does not invade your lung tissue. Instead, your immune system overreacts to fungal spores in your airways. A true Aspergillus infection, called invasive aspergillosis, occurs when the fungus actually grows into lung tissue. This typically only happens in people with severely weakened immune systems.
ABPA is a chronic condition that requires ongoing management rather than a one-time cure. Treatment can control symptoms and prevent lung damage. Some people experience long remission periods with no symptoms. However, flare-ups can occur throughout life, especially if you stop treatment. Regular monitoring and medication adjustments help keep the condition under control.
During active treatment or flare-ups, your doctor may check eosinophil levels every few weeks to monitor response. Once your condition is stable, testing every 3 to 6 months is typical. Your healthcare provider will create a monitoring schedule based on your specific situation. Regular blood testing helps catch flare-ups before they cause permanent damage.
An eosinophil count above 500 cells per microliter is one of the major criteria for diagnosing ABPA. However, an elevated eosinophil count alone does not confirm ABPA. Many conditions can raise eosinophils. Your doctor will consider this result along with your symptoms, imaging studies, and Aspergillus-specific antibody tests to make a diagnosis.
ABPA is extremely rare in people who do not have asthma or cystic fibrosis. Nearly all cases occur in people with one of these underlying lung conditions. If you have neither asthma nor CF and have respiratory symptoms, your doctor will likely look for other causes first.
While medication is the primary treatment for ABPA, lifestyle adjustments can help. Reduce exposure to moldy environments by using dehumidifiers, fixing water leaks promptly, and avoiding activities like composting. Eating an anti-inflammatory diet rich in vegetables, fruits, and omega-3 fatty acids may support immune health. Stress management and adequate sleep also help regulate immune function.
Standard asthma medications like bronchodilators and inhaled steroids help manage symptoms but do not fully treat ABPA. You will likely need additional medications, including oral corticosteroids and antifungal drugs. ABPA requires more aggressive treatment than asthma alone. Never assume your asthma treatment is enough if you have been diagnosed with ABPA.
Untreated ABPA can lead to permanent lung damage called bronchiectasis. This condition involves scarring and widening of the airways. Bronchiectasis makes breathing progressively harder and increases your risk of lung infections. Early treatment prevents this irreversible damage. If you have worsening asthma symptoms, get evaluated promptly.
Yes, ABPA has five recognized stages. These range from acute episodes with active inflammation to remission periods with no symptoms. Some people progress to later stages with lung scarring if not treated early. Your doctor will determine your stage based on symptoms, blood tests, and imaging. Treatment aims to move you into remission and prevent progression.
You cannot completely prevent ABPA if you are genetically predisposed to it. However, good asthma control may reduce your risk. Keeping your airways as healthy as possible makes them less reactive. Avoid environments with heavy mold exposure when you can. If you notice your asthma getting harder to control, see your doctor early for evaluation.