Allergic Bronchopulmonary Aspergillosis and Asthma

Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder resulting from exaggerated immune responses against Aspergillus species (most commonly A. fumigatus) colonizing the airways of patients with asthma or cystic fibrosis. The clinical presentation of ABPA is usually with difficult-to-treat asthma, pulmonary infiltrates, peripheral blood eosinophilia, and bronchiectasis. The disorder results from airway fungal colonization and skewed type-2 inflammation, possibly due to underlying genetic susceptibility. Despite seven decades of research, the best treatment practice remains to be determined. Oral glucocorticoids or itraconazole are the primary treatment options but are not curative. Biological agents and newer inhaled therapies hold promise. The revised guidelines from the ABPA working group of the International Society for Human and Animal Mycology will likely streamline the management of this enigmatic disorder.