Allergic bronchopulmonary aspergillosis (ABPA) complicating asthma

Convenor(s):

Ritesh Agarwal
Arunaloke Chakrabarti
David W Denning

Website: http://www.abpaworkinggroup.org/

Overview

Allergic bronchopulmonary aspergillosis (ABPA) remains an important entity to clinicians because of the fact that the condition is glucocorticoid sensitive, and early diagnosis and treatment can prevent progression to end-stage lung disease. The disease has a global presence albeit with differences in clinical presentation in developed versus the developing countries. In the developing countries, the condition is often misdiagnosed as pulmonary tuberculosis and most patients present with bronchiectasis. Despite six decades of research, there is still no consensus regarding its epidemiology, pathogenesis, categorization, diagnosis, and treatment. We proposed a consortium approach to work together and exchange ideas for resolving the problems in ABPA complicating asthma. These questions led the International Society for Human and Animal Mycology (ISHAM) to approve a working group on allergic bronchopulmonary aspergillosis complicating asthma in September 2011.This working group comprises clinicians, scientists and mycologists involved in all aspects of ABPA, including clinical surveillance, epidemiology, genetic susceptibility factors, diagnosis, and treatment, develop a consortium to work together and to exchange ideas for resolving the problems. As International Society for Human and Animal Mycology (ISHAM) has undertaken a special effort in establishment of Working Groups on particular themes and topics, we have planned to develop this network under the umbrella of ISHAM, though participation in the consortium is open to everybody with interest in ABPA. However, as ISHAM is such dynamic organization with strong commitment in the field of Medical Mycology, we would encourage everyone to join ISHAM (www.isham.org) if you are not a member already although this is not a prerequisite to join the ABPA working group.

 

Objectives of the working group are to:

  1. Increase the awareness of ABPA among physicians treating asthma patients
  2. Describe the global burden of the disease
  3. Collaborate on issues related to epidemiology and pathophysiology
  4. Collaborate on issues related to genetic susceptibility
  5. Frame objective evidence-based consensus diagnostic criteria
  6. Formulate a consensus management protocol
  7. Issues related to heterogeneous presentation of disease with special reference to developed and developing countries

 

Achievements

The working group has analyzed the burden of allergic bronchopulmonary aspergillosis in India and the paper has been published (PLoS One 2014; 9(12): e114745) (Link here to the article)

The working group had made a call to evaluate new diagnostic tests and validate existing tests. Following this we have:

  1. Validated the utility of serum galactomannan in ABPA (Mycoses 2015; 58(7): 408-412). In this study, serum galactomannan was evaluated in 70 patients with ABPA and the sensitivity of galactomannan was found to be only 27%
  2. Evaluated the utility of IgE (total and A. fumigatus specific) in monitoring for response and exacerbations in allergic bronchopulmonary aspergillosis. In this study involving 81 patients with ABPA, it was found that the total IgE is a useful test in monitoring treatment responses in ABPA while A. fumigatus specific IgE has limited utility

Publications

R. Agarwal, D.W. Denning, A. Chakrabarti
Estimation of the Burden of Chronic and Allergic Pulmonary Aspergillosis in India
PLoS One 2014; 9 (12): e114745 (Link here to the article)

 

R. Agarwal, A.N. Aggarwal, I.S. Sehgal, S. Dhooria, D. Behera, A. Chakrabarti
Performance of serum galactomannan in patients with allergic bronchopulmonary aspergillosis
Mycoses 2015; 58(7): 408-412