Prevalence of Allergic Broncho Pulmonary Aspergillosis in patients with Asthma attending allergy clinic in a North West Indian Tertiary Care Institute

Abstract

Context: Allergic Broncho Pulmonary Aspergillosis (ABPA) is an allergic disorder. Aspergillus fumigatus is the most common pathogen responsible for occurrence of ABPA. There can be serious consequences of ABPA including worsening of symptoms of asthma and more sinister complications like extensive fibrosis and bronchiectasis. Aims: To find out the prevalence of ABPA among asthma patients and association of former with factors like age, sex, occupation, family history of bronchial asthma, socioeconomic status and other relevant factors. Settings and Design: This study was a descriptive type of observational study conducted at our tertiary care institute. Methods and Material: Three hundred severe asthmatic patients underwent skin prick test (SPT) for five Aspergillus species. Four tests were applied to all SPT positive patients -Total serum IgE, spirometry, chest x-ray and High-resolution Computed Tomography (HRCT) scan of thorax. The diagnosis of ABPA was made when the patient fulfilled at least three out of four criteria. Results: Out of 300 severe asthmatic patients 27 (9%) patients were found SPT positive. Out of these 27 SPT positive patients, four patients refused for further investigations, and 23 were investigated further. Out of 23 SPT positive patients, eight patients (2.7%) were diagnosed as ABPA. It was also found that two out of eight patients with ABPA were misdiagnosed and treated earlier as pulmonary tuberculosis. Conclusions: All patients with bronchial asthma should be screened for ABPA by skin test for Aspergillus. There is need to implement screening programme and meticulous approach by physicians to diagnose and treat such patients. Key Messages: A diagnosis of allergic bronchopulmonary aspergillosis should be considered in patients coming with asthma. Skin prick test can be used to screen such patients. A further workup of the skin test positive patients leads to a high diagnostic yield.

Diagnosis of allergic bronchopulmonary aspergillosis in patients with persistent allergic asthma using three different diagnostic algorithms

“…Our positivity rate of SPT Af was lower than reported rate by Hendrick et al (16.0%), 24 Eaton et al (18.4%), 25 Maurya et al (28.5%) 16 and Agarwal et al 17 (39.5%) studies. However, in our study we observed a higher prevalence of SPT Af positivity than those of reported by Ma et al 26 (5.5%) and Mathur and Mathur 27 (9.0%) studies. Several factors may affect the positivity ratio of SPT Af prevalence, including the use of various fungal allergens or exclusive use of A fumigatus antigens, using different diagnostic criteria for interpreting of a positive skin test and difference in the type of skin test (SPT or intradermal skin test) 10 .…”

Allergic bronchopulmonary aspergillosis

“…In a study of 57 patients with severe acute asthma admitted to an intensive care unit, the prevalence of ABPA was found to be 39 per cent (compared to 21% in the outpatient asthma group) 20 . The prevalence of ABPA complicating asthma reported in the last decade is summarized in Table I 21 22 23 24 25 26 27 28 29 30 31 32 . The data suggest a high prevalence of AS and ABPA in special clinics ( Table I ) and a higher prevalence in India compared to other countries.…”