Allergic bronchopulmonary aspergillosis: Indian scenario
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Pulmonary aspergillosis is a clinical spectrum of lung disease caused by the fungus Aspergillus. The classification of pulmonary aspergillosis includes saprophytic aspergillosis in the form of pulmonary aspergilloma, immune disease in the form of allergic bronchopulmonary aspergillosis (ABPA), IgE mediated asthma, hypersensitivity pneumonitis, allergic Aspergillus sinusitis (AAS) and infectious disease in the form of invasive and semi-invasive pulmonary aspergillosis.

Golden-brown rubbery flecks or plugs of sputum production is characteristic and has been reported in 5%–54% of cases. Cough, breathlessness and wheezing are the common symptoms seen in ABPA. A very recent study from India found a higher prevalence of Aspergillus sensitization (39.5%) and ABPA (27%) in 564 patients with asthma.

Oral corticosteroid remains the cornerstone for the treatment of ABPA. The goal of therapy is to achieve symptom resolution, clearance of radiographic infiltrates, and establishment of a stable baseline serum level of total IgE. There are two dose schedules of oral glucocorticoid therapy, low dose and high dose. In low dose oral glucocorticoid therapy, Prednisolone 0.5 mg/kg/d is given for 2 wk, then on alternate day for 6–8 weeks and then tapered 5–10 mg every 2 weeks and then discontinued. In high dose glucocoticoid therapy Prednisolone 0.75 mg/kg is given for 6 weeks, followed by 0.5 mg/kg for 6 weeks, then taper 5 mg every 6 weeks to continue for a total of atleast 6–12 months.

Higher dose and prolonged use of steroids associated with better outcome. During the acute episode, usual starting dose of prednisone is 0.5 mg/kg daily for 2 weeks then reduced to an alternate day regime for 2–3 months, after that it should be tapered off in next 2–3 months.

Presently ABPA is one of the important emerging immunologically mediated respiratory diseases, commonly presenting in patients of asthma. It should be highly suspected in patients presenting with history of asthma, peripheral blood eosinophilia, recurrent pneumonitits or transient (fleeting) pulmonary infiltrates mimicking pulmonary tuberculosis. In such suspected patients, detailed evaluations are needed to prove the diagnosis. Early diagnosis and proper treatment may alter the prognosis of disease and further prevent end stage lung fibrosis.

Source: http://www.ijaai.in/article.asp?issn=0972-6691;year=2019;volume=33;issue=2;spage=63;epage=69;aulast=Prasad#ref50
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