Analysis of clinical features and underlying diseases of allergic bronchopulmonary aspergillosis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

GONG Piping , ZHANG Moqin , CHEN Xi , ZHANG Ping’an ,  MA Yanliang

Department of Pulmonary and Critical Care Medicine, Peking University People’s Hospital, Beijing 100044, P. R. China;

Corresponding?author：

MA Yanliang, Email: helloyl1979@126.com

Keywords：

Allergic bronchopulmonary aspergillosis; Bronchial asthma; Bronchiectasis; Chronic obstructive pulmonary disease

DOI：

10.7507/1671-6205.202109029

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective Allergic bronchopulmonary aspergillosis (ABPA) is characterized by anexaggerated reaction to airway colonization aspergillus which affects patients with underlying diseases such asbronchial asthma, cystic fibrosis or other respiratory diseases. ABPA exhibit significant heterogeneity due to theunderlying diseases. The clinical features of patients with ABPA were analyzed retrospectively, so as to explore theimpact of underlying diseases on clinical characteristics. Methods The clinical data of hospitalized patients diagnosed with ABPA from January 2010 to September 2019 in Peking University People's Hospital were reviewed for retrospective analysis. Results A total of 40 ABPA patients were enrolled. Of which 8 cases (20.0%) were previously diagnosed as chronic obstructive pulmonary disease and/or bronchiectasis, named non-asthma group; while the other 32 cases met the diagnosis criteria of asthma, named asthma group. The non-asthma ABPA patients had a shorter course [78 (6 - 300) months vs. 192 (39 - 480) months, P=0.02], a higher percentage of peripheral blood neutrophils (79.9%±12.5% vs. 68.1%±18.1%, P=0.01) and higher score of emphysema [2 (0 - 2) vs. 0 (0 - 1), P=0.02] than the asthma group. Conclusions There is no significant difference in clinical and radiological characteristics between ABPA patients without asthma and those with asthma. The diagnosis of ABPA should also be considered when patients with chronic pulmonary diseases such as chronic obstructive pulmonary disease and bronchiectasis have aggravation of dyspnea, increase of eosinophils in peripheral blood and typical imaging features such as mucus attenuation.

Citation： GONG Piping, ZHANG Moqin, CHEN Xi, ZHANG Ping’an, MA Yanliang. Analysis of clinical features and underlying diseases of allergic bronchopulmonary aspergillosis. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(12): 846-852. doi: 10.7507/1671-6205.202109029 Copy

1.	Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax, 2015, 70(3): 270-277.
2.	Bains SN, Judson MA. Allergic bronchopulmonary aspergillosis. Clin Chest Med, 2012, 33(2): 265-281.
3.	Muthu V, Sehgal IS, Prasad KT, et al. Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: A distinct subset of ABPA with a lesser risk of exacerbation. Med Mycol, 2020, 58(2): 260-263.
4.	徐凌, 蔡柏薔, 徐凱峰, 等. 變態反應性支氣管肺曲菌病23例分析. 中華內科雜志, 2007, 46(3): 208-212.
5.	李然, 胥杰, 孫永昌, 等. 變態反應性支氣管肺曲霉菌病11例臨床分析. 中華哮喘雜志(電子版), 2011, 5(6): 423-428.
6.	彭娟, 韓鋒鋒, 楊天蕓, 等. 變應性支氣管肺曲霉病四例臨床分析并文獻復習. 中國呼吸與危重監護雜志, 2015, 14(5): 456-461.
7.	曾超, 劉媛媛, 曾飛球, 等. 變應性支氣管肺曲霉菌病3例分析. 罕少疾病雜志, 2012, 19(4): 4-7.
8.	鄒敏芳, 李碩, 楊燕, 等. 變應性支氣管肺曲霉病的臨床特征及漏診原因分析. 中華醫學雜志, 2019, 99(16): 1221-1225.
9.	沈華浩, 孫永昌, 林江濤, 等. 變應性支氣管肺曲霉病診治專家共識. 中華醫學雜志, 2017, 97(34): 2650-2656.
10.	中華醫學會呼吸病學分會哮喘學組. 支氣管哮喘防治指南(2016年版). 中華結核和呼吸雜志, 2016, 39(9): 675-697.
11.	中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南(2013年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
12.	成人支氣管擴張癥診治專家共識編寫組. 成人支氣管擴張癥診治專家共識. 中華結核和呼吸雜志, 2012, 35(7): 485-492.
13.	Bhalla M, Turcios N, Aponte V, et al. Cystic fibrosis: scoring system with thin-section CT. Radiology, 1991, 179(3): 783-788.
14.	Agarwal R, Sehgal IS, Dhooria S, et al. Allergic bronchopulmonary aspergillosis. Indian J Med Res, 2020, 151(6): 529-549.
15.	王夢雨, 喬艷俊, 王紅民. 變應性支氣管肺曲霉病26例臨床分析. 中國呼吸與危重監護雜志, 2019, 18(3): 231-235.
16.	李乃健, 邱日皇, 黃智勇, 等. 69例誤診為支氣管哮喘的病例分析. 中國呼吸與危重監護雜志, 2015, 14(1): 22-26.
17.	馬艷良, 張為兵, 余兵, 等. 支氣管哮喘患者中變應性支氣管肺曲霉病的檢出及臨床特點初步調查. 中華結核和呼吸雜志, 2011, 34(12): 909-913.
18.	Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol, 2013, 51(4): 361-370.
19.	Agarwal R, Srinivas R, Jindal SK. Allergic bronchopulmonary aspergillosis complicating chronic obstructive pulmonary disease. Mycoses, 2008, 51(1): 83-85.
20.	Agarwal R, Hazarika B, Gupta D, et al. Aspergillus hypersensitivity in patients with chronic obstructive pulmonary disease: COPD as a risk factor for ABPA?. Med Mycol, 2010, 48(7): 988-994.
21.	Bafadhel M, McKenna S, Agbetile J, et al. Aspergillus fumigatus during stable state and exacerbations of COPD. Eur Respir J, 2014, 43(1): 64-71.
22.	Jin JM, Liu XF, Sun YC. The prevalence of increased serum IgE and Aspergillus sensitization in patients with COPD and their association with symptoms and lung function. Respir Res, 2014, 15(1): 130.
23.	Bonaiti G, Merati V, Pesci A, et al. Allergic bronchopulmonary aspergillosis screening in bronchiectasis: is there always a precise answer to a clear question?. Eur Ann Allergy Clin Immunol, 2019, 51(1): 41-43.
24.	Boz AB, Celmeli F, Arslan AG, et al. A case of allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis. Pediatr Pulmonol, 2009, 44(1): 86-89.
25.	Judson MA. Allergic bronchopulmonary aspergillosis after infliximab therapy for sarcoidosis: a potential mechanism related to T-helper cytokine balance. Chest, 2009, 135(5): 1358-1359.
26.	Acosta-Rivera V, Melendez-Monta?ez JM, De Jesús-Rojas W. Allergic bronchopulmonary aspergillosis with or without asthmatic symptoms?. Cureus, 2021, 13(6): e15498.
27.	Kadamkulam Syriac A, Malhotra G, Anez de Gomez CI, et al. Mycobacterium avium intracellulare infection complicated by allergic bronchopulmonary aspergillosis in a non-asthmatic patient. BMJ Case Rep, 2018, 2018: bcr2018224835.
28.	陸海雯, 衛平, 徐金富. 變應性支氣管肺曲霉病的診斷標準變遷及影像學分類進展. 中國呼吸與危重監護雜志, 2014, 13(5): 534-536.
29.	Asano K, Hebisawa A, Ishiguro T, et al. New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation. J Allergy Clin Immunol, 2021, 147(4): 1261-1268.
30.	Agarwal R, Dhooria S, Sehgal IS, et al. A randomised trial of voriconazole and prednisolone monotherapy in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J, 2018, 52(3): 1801159.
31.	Agarwal R, Dhooria S, Sehgal IS, et al. A randomized trial of itraconazole vs prednisolone in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Chest, 2018, 153(3): 656-664.

1. Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax, 2015, 70(3): 270-277.
2. Bains SN, Judson MA. Allergic bronchopulmonary aspergillosis. Clin Chest Med, 2012, 33(2): 265-281.
3. Muthu V, Sehgal IS, Prasad KT, et al. Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: A distinct subset of ABPA with a lesser risk of exacerbation. Med Mycol, 2020, 58(2): 260-263.
4. 徐凌, 蔡柏薔, 徐凱峰, 等. 變態反應性支氣管肺曲菌病23例分析. 中華內科雜志, 2007, 46(3): 208-212.
5. 李然, 胥杰, 孫永昌, 等. 變態反應性支氣管肺曲霉菌病11例臨床分析. 中華哮喘雜志(電子版), 2011, 5(6): 423-428.
6. 彭娟, 韓鋒鋒, 楊天蕓, 等. 變應性支氣管肺曲霉病四例臨床分析并文獻復習. 中國呼吸與危重監護雜志, 2015, 14(5): 456-461.
7. 曾超, 劉媛媛, 曾飛球, 等. 變應性支氣管肺曲霉菌病3例分析. 罕少疾病雜志, 2012, 19(4): 4-7.
8. 鄒敏芳, 李碩, 楊燕, 等. 變應性支氣管肺曲霉病的臨床特征及漏診原因分析. 中華醫學雜志, 2019, 99(16): 1221-1225.
9. 沈華浩, 孫永昌, 林江濤, 等. 變應性支氣管肺曲霉病診治專家共識. 中華醫學雜志, 2017, 97(34): 2650-2656.
10. 中華醫學會呼吸病學分會哮喘學組. 支氣管哮喘防治指南(2016年版). 中華結核和呼吸雜志, 2016, 39(9): 675-697.
11. 中華醫學會呼吸病學分會慢性阻塞性肺疾病學組. 慢性阻塞性肺疾病診治指南(2013年修訂版). 中華結核和呼吸雜志, 2013, 36(4): 255-264.
12. 成人支氣管擴張癥診治專家共識編寫組. 成人支氣管擴張癥診治專家共識. 中華結核和呼吸雜志, 2012, 35(7): 485-492.
13. Bhalla M, Turcios N, Aponte V, et al. Cystic fibrosis: scoring system with thin-section CT. Radiology, 1991, 179(3): 783-788.
14. Agarwal R, Sehgal IS, Dhooria S, et al. Allergic bronchopulmonary aspergillosis. Indian J Med Res, 2020, 151(6): 529-549.
15. 王夢雨, 喬艷俊, 王紅民. 變應性支氣管肺曲霉病26例臨床分析. 中國呼吸與危重監護雜志, 2019, 18(3): 231-235.
16. 李乃健, 邱日皇, 黃智勇, 等. 69例誤診為支氣管哮喘的病例分析. 中國呼吸與危重監護雜志, 2015, 14(1): 22-26.
17. 馬艷良, 張為兵, 余兵, 等. 支氣管哮喘患者中變應性支氣管肺曲霉病的檢出及臨床特點初步調查. 中華結核和呼吸雜志, 2011, 34(12): 909-913.
18. Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol, 2013, 51(4): 361-370.
19. Agarwal R, Srinivas R, Jindal SK. Allergic bronchopulmonary aspergillosis complicating chronic obstructive pulmonary disease. Mycoses, 2008, 51(1): 83-85.
20. Agarwal R, Hazarika B, Gupta D, et al. Aspergillus hypersensitivity in patients with chronic obstructive pulmonary disease: COPD as a risk factor for ABPA?. Med Mycol, 2010, 48(7): 988-994.
21. Bafadhel M, McKenna S, Agbetile J, et al. Aspergillus fumigatus during stable state and exacerbations of COPD. Eur Respir J, 2014, 43(1): 64-71.
22. Jin JM, Liu XF, Sun YC. The prevalence of increased serum IgE and Aspergillus sensitization in patients with COPD and their association with symptoms and lung function. Respir Res, 2014, 15(1): 130.
23. Bonaiti G, Merati V, Pesci A, et al. Allergic bronchopulmonary aspergillosis screening in bronchiectasis: is there always a precise answer to a clear question?. Eur Ann Allergy Clin Immunol, 2019, 51(1): 41-43.
24. Boz AB, Celmeli F, Arslan AG, et al. A case of allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis. Pediatr Pulmonol, 2009, 44(1): 86-89.
25. Judson MA. Allergic bronchopulmonary aspergillosis after infliximab therapy for sarcoidosis: a potential mechanism related to T-helper cytokine balance. Chest, 2009, 135(5): 1358-1359.
26. Acosta-Rivera V, Melendez-Monta?ez JM, De Jesús-Rojas W. Allergic bronchopulmonary aspergillosis with or without asthmatic symptoms?. Cureus, 2021, 13(6): e15498.
27. Kadamkulam Syriac A, Malhotra G, Anez de Gomez CI, et al. Mycobacterium avium intracellulare infection complicated by allergic bronchopulmonary aspergillosis in a non-asthmatic patient. BMJ Case Rep, 2018, 2018: bcr2018224835.
28. 陸海雯, 衛平, 徐金富. 變應性支氣管肺曲霉病的診斷標準變遷及影像學分類進展. 中國呼吸與危重監護雜志, 2014, 13(5): 534-536.
29. Asano K, Hebisawa A, Ishiguro T, et al. New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation. J Allergy Clin Immunol, 2021, 147(4): 1261-1268.
30. Agarwal R, Dhooria S, Sehgal IS, et al. A randomised trial of voriconazole and prednisolone monotherapy in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J, 2018, 52(3): 1801159.
31. Agarwal R, Dhooria S, Sehgal IS, et al. A randomized trial of itraconazole vs prednisolone in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Chest, 2018, 153(3): 656-664.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of clinical features and underlying diseases of allergic bronchopulmonary aspergillosis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content