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Allergic Bronchopulmonary Aspergillosis: Comorbid 

Allergic Bronchopulmonary Aspergillosis: Comorbid
Allergic Bronchopulmonary Aspergillosis: Comorbid

Paul A. Greenberger

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date: 09 May 2021

Allergic bronchopulmonary aspergillosis (ABPA), a disease that complicates asthma and cystic fibrosis, is in the differential diagnosis of pulmonary infiltrates, peripheral blood or sputum eosinophilia, elevated total serum immunoglobulin E concentration, and bronchiectasis, any or all of which may occur in patients with established asthma. ABPA is one of the most important comorbid, coexisting subtypes of asthma because it results in irreversible lung destruction and may convert intermittent or persistent mild asthma into persistent severe asthma. The fact that the treatment of choice to clear pulmonary infiltrates and sputum eosinophilia is an oral steroid but not antifungal therapy remains true after 50 years of attempts to improve our understanding and treatment of ABPA. It remains to be established whether monoclonal antibodies will contribute to meaningful improvement in management of patients, or what combination therapy will be optimum instead of relying on oral glucocorticoids. Certainly, innovative, safe, and effective approaches to treatment are needed to decrease the harmful impact that untreated or inadequately treated ABPA can have on patients with asthma.

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