[Allergic bronchopulmonary aspergillosis (ABPA)].

ABSTRACT

The entity of allergic pulmonary aspergillosis includes various diseases of the lung which are caused by not only allergic reactions to aspergillus but also destructive inflammations due to saprophytic infection of aspergillus in lower respiratory tracts. We focus our discussion on ABPA with our own experience of 11 cases and overview of the disease. First of all, We propose that the entity of ABPA should be expanded from one that has been defined by the diagnostic criteria established by Rosenberg et al in 1977. We have to consider stage of ABPA, the existence of ABPA without asthma and ABPA complicated with chronic bacterial infection in lower respiratory tracts and the progression of ABPA to infectious and invasive aspergillosis. It is important for the diagnosis of ABPA to study not only allergic reactions to aspergillus but also chest HRCT which reveals the central bronchiectasis and mucus plugging that are thought characteristic of the disease. Systemic steroid therapy is indispensable in the acute stage of the disease. Bronchial toileting for the removal of mucoid impaction is also important. In the chronic stage of the disease, antifungal drugs and inhaled steroid therapy should be considered in intractable cases on recurrence to prevent the disease progression and lung injuries.