People with ABPA sometimes may develop bronchiectasis, which is a form of airway damage. It may snowball into deteriorating lung function with a high risk of infection. People who suffer from lung diseases are also susceptible...
Introduction
ABPA, short for Allergic bronchopulmonary aspergillosis, is a lung disease that is not very common. The disease is caused when people are exposed to a type of fungus called Aspergillus.
It usually happens to those people who are allergic to Aspergillus. So, the immune system of people who have ABPA overreacts to Aspergillus causing inflammation in the lungs.
ABPA leads to causes bronchospasm, which is the tightening of airway muscles, and it causes the building up of mucus resulting in breathing difficulty, coughing, and blockage of the airway.
People with ABPA sometimes may develop bronchiectasis, which is a form of airway damage. It may snowball into deteriorating lung function with a high risk of infection. People who suffer from lung diseases are also susceptible to Bronchiectasis, often leading to swelling of the lungs such as asthma, cystic fibrosis, and chronic infections.
More about Aspergillus
A type of fungus, Aspergillus is usually present in the environment. It can be present everywhere, in the soil, water, dust, rotting vegetation, marijuana, and certain foods and ground spices.
The fungus forms into very tiny particles called spores with the capacity to stay afloat in the air. When normal people inhale the spores present in the air, they don’t get into trouble. In most cases, the fungus can thrive in the mucus in the airways or breathing tubes. This phenomenon is known as colonization.
However, the presence of Aspergillus in the airways is not an immediate threat of a sudden (or acute), and severe infection by this fungus. Our immune system is usually resilient and is capable to shield the body from infections like these.
In some cases of people with a weak immune system, Aspergillus can reach the lungs, often causing an acute infection. However, in certain instances, getting exposed to Aspergillus can elicit an allergic immune response without particularly targeting the tissues that cause allergic bronchopulmonary aspergillosis (ABPA).
Some palpable signs and symptoms of ABPA
One can identify if a person has ABPA from the following symptoms, all of which may manifest or at times a few of them:
- Frequent coughing
- Difficulty exercising
- Wheezing
- Chest pain or tightness
- Coughing up brownish mucus plugs
- Coughing up blood (called hemoptysis)
- Shortness of breath
- On and off fever
- Fatigue
ABPA along with asthma
ABPA, although uncommon, can lead to asthma, which often becomes hard to manage, afflicting less than 1% of people with asthma. When someone with asthma develops ABPA, they face difficulty in controlling their symptoms even after taking multiple medications. Considering that ABPA can be effectively treated, it is occasionally taken into account when dealing with cases of poor asthma control.
ABPA with cystic fibrosis (CF)
A genetic disorder, cystic fibrosis affects the lungs. Studies have found that ABPA is present in 1-15% of people who have cystic fibrosis. When people with cystic fibrosis experience deteriorating symptoms and their lung function does not improve with other CF therapies, the possibility of ABPA is taken into consideration.
How to confirm if someone has ABPA?
There is no individual APBA test to ascertain if a patient has it. The doctor can diagnose if a person has ABPA by looking at the symptoms and findings of a set of tests, which may include lung function and allergy tests. It is important to note that diagnosing ABPA can be difficult.
Usually, blood tests are conducted to detect signs of an allergic response, which involves assessing the level of immunoglobulin E (IgE) in the body. Higher IgE levels are linked to various types of allergies, and it is not uncommon for people with asthma to have higher-than-normal IgE levels.
But, in cases of ABPA, the IgE level is extremely high, reaching more than 1000 ng/ml or 417 IU/ml. So, closely monitoring IgE levels can help assess the control of ABPA, apart from other relevant measures. It is also important to ensure that regular monitoring of total IgE levels is continued to facilitate this assessment.
Treatment of ABPA
Therapy is often useful in helping a patient improve and the illness will go into remission. During the remission period a person you may have very few signs of ABPA. However, when repeated ABPA flare-ups occur, it calls for further treatment.
Apart from monitoring the patient for improvement in symptoms, there are a slew of tests such as X-ray or CT findings, blood tests, and lung function that can help to assess if the treatment is working. When the allergic reaction is under control, the IgE level generally gets lower.
Eventually, the doctor can help in deciding how long a treatment is required. The healthcare provider can provide all the information regarding symptoms of medicinal side effects and a concrete plan for follow-up visits.
The main objective of the treatment for ABPA is to reign in inflammation and prevent further injury to the lungs. Treatment of ABPA comprises a combination of oral corticosteroids and anti-fungal drugs.
Corticosteroids, a type of medication, are generally prescribed to treat inflammation and prevent allergic reactions. However, when it comes to treating ABPA, inhaled corticosteroids alone, which are commonly used for asthma management, are not sufficient for effective results.
Typically, treatment for ABPA is done with oral corticosteroids for an extended period, often spanning several months. So, one should discuss with the doctor the potential side effects associated with oral corticosteroids and the available strategies for treating them.
The second type of ABPA treatment is the use of anti-fungal medications. These medicines are effective in killing Aspergillus preventing it from colonizing the airway. Usually, one of these anti-fungal drugs is prescribed for at least three to six months. Even this treatment cannot give a permanent cure for ABPA and may have side effects. Hence, the patient will be closely watched for signs of side effects including liver damage.
Conclusion
One should discuss with the doctor if there are symptoms of ABPA like coughing frequently that brings up “plugs” of brown mucus or blood. If the doctor says that one may have ABPA, then seek the advice of a specialist who manages ABPA. It is advisable to take all doses of the prescribed medicine to successfully treat ABPA. If you want to get an exact quote of ABPA panel test price in your area, talk directly to the diagnostic centre.
FAQs
What is ABPA in TB?
ABPA is often erroneously diagnosed as pulmonary TB because of identical clinical and radiological features. A prolonged diagnosis of ABPA can lead to progressive lung damage which snowballs into fibrosis and respiratory failure.
What is considered the best ABPA test?
The best-chosen test for screening asthmatic patients for ABPA is the A. fumigatus- specific IgE. Aspergillus skin prick test is considered less sensitive than A. fumigatus- specific IgE level. It has the chance of potentially missing one in ten asthmatic patients being screened for ABPA.
What is the IgE-specific test for Aspergillus?
The Aspergillus Fumigatus Allergy Blood Test is conducted to measure the levels of IgE antibodies in the blood, to detect an allergy to Aspergillus fumigatus. There is no need for any specific preparations before undergoing this test.
What causes ABPA disease?
Allergic bronchopulmonary aspergillosis (ABPA) is a blown-up immune response to Aspergillus species, primarily A. fumigatus, which mainly affects people with asthma or, less frequently, cystic fibrosis.
Who treats ABPA?
ABPA is best treated by an allergist. Consulting with an allergist can help in finding whether you or your child have ABPA. It is done by diagnosing the symptoms and conducting tests such as lung function and allergy tests. The treatment mainly focuses on managing inflammation to prevent further lung damage.
Can ABPA be cured?
There is no permanent cure for ABPA. The condition is manageable with corticosteroids, which can be taken orally or with puffers. It is important to note that antifungal medications are usually ineffective.
How severe is ABPA?
In severe cases, ABPA is ominous by causing permanent changes to the central airways. They also tend to become wider, leading to bronchiectasis. This condition may cause breathing problems or heart failure.
What is the treatment of choice for ABPA?
The treatment for allergic bronchopulmonary aspergillosis (ABPA) looks to efficiently manage episodes of acute inflammation and minimize the risk of further lung damage. The specific approach to treatment, including the use of systemic glucocorticoids and antifungal agents, depends on the severity and activity of the disease. Antifungal therapy may be beneficial in reducing the frequency and intensity of exacerbations.
What foods should you avoid if you have ABPA?
Some of the common foods to avoid if one has ABPA include dairy, wheat, nuts/seeds, food additives, sugar, and alcohol. It is also very important that one avoids trigger foods and keep their asthma in control and well-managed to prevent serious asthma attacks.
Does ABPA cause pain?
Fever may occur but it is not so common. ABPA may also lead to chest pain, cough that brings up blood or brown-colored mucus, and too much of certain white blood cells in the blood (eosinophilia).
