Allergic bronchopulmonary aspergillosis - Clinical perspectives

This article provides clinical perspectives of ABPA, a disease that presents as asthma and is caused by hypersensitivity to Aspergillus antigens in the bronchi. Criteria to diagnose ABPA are based on clinical, radiographic, and laboratory features that now emphasize serologic tests that can detect the disease before irreversible damage to bronchi and lungs occurs. These criteria are critically examined, and their variability at presentation and at various stages during the course of the disease are pointed out. An algorithmic approach to diagnose ABPA is presented; it is grounded on clinical presentation and is built on broad use of screening tests, selective use of serologic tests, and computed tomography. Pathogenesis, pathology, stages of the disease, and differential diagnoses of ABPA are also briefly reviewed.