Clinical Characteristics of Allergic Bronchopulmonary Aspergillosis in Patients with and without Bronchiectasis
J Asthma. 2021 Mar 17:1-11. doi: 10.1080/02770903.2021.1904979. Online ahead of print.
Objective: Allergic bronchopulmonary aspergillosis (ABPA) is classified radiologically as serologic ABPA (ABPA-S) or ABPA with central bronchiectasis (ABPA-CB). This retrospective case series study aimed to describe and compare the clinical characteristics of both forms of ABPA. Methods: Patients with ABPA treated in the hospital between February 2011 and June 2019 were enrolled and were divided into ABPA-S and ABPA-CB groups based on whether their cases were complicated with central bronchiectasis. Demographic data, symptoms, laboratory values, comorbidities, and image findings were collected. ABPA-S patients were followed up retrospectively through medical records. Results: Ninety-three (93) patients were enrolled, including 74 ABPA-CB patients and 19 ABPA-S patients. The most common predisposing condition was asthma (36.6%), with a median course of 30 years (IQR 13-42.5) prior to ABPA diagnosis. 54.8% of patients had been misdiagnosed, with ABPA-S more likely than ABPA-CB to have been misdiagnosed as asthma (p< 0.01). Obstructive ventilation dysfunction and mixed ventilation dysfunction were found in 21 patients (22.6%) and 18 patients (19.4%), respectively. Compared with ABPA-S, ABPA-CB had a higher median blood eosinophil count [880 vs. 700 cells/μl], serum IgE [2,957 vs. 2,616 IU/ml], and Aspergillus fumigatus specific-IgE [20.6 vs. 7.31 kUA/L], although these findings were not statistically significant. Three ABPA-S patients developed bronchiectasis during follow-up and experienced relapses more than twice. Conclusions: Our findings suggested that the clinical characteristics between ABPA-CB and ABPA-S were mostly similar. ABPA-S had a relatively lower immunological activity level than ABPA-CB, but was still immunologically active and could develop bronchiectasis.