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：

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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, 蔡柏蔷, 徐凯峰, 等. 变态反应性支气管肺曲菌病23例分析. 中华内科杂志, 2007, 46(3): 208-212.
5.	李然, 胥杰, 孙永昌, 等. 变态反应性支气管肺曲霉菌病11例临床分析. 中华哮喘杂志(电子版), 2011, 5(6): 423-428.
6.	彭娟, 韩锋锋, 杨天芸, 等. 变应性支气管肺曲霉病四例临床分析并文献复习. 中国呼吸与危重监护杂志, 2015, 14(5): 456-461.
7.	曾超, 刘媛媛, 曾飞球, 等. 变应性支气管肺曲霉菌病3例分析. 罕少疾病杂志, 2012, 19(4): 4-7.
8.	邹敏芳, 李硕, 杨燕, 等. 变应性支气管肺曲霉病的临床特征及漏诊原因分析. 中华医学杂志, 2019, 99(16): 1221-1225.
9.	沈华浩, 孙永昌, 林江涛, 等. 变应性支气管肺曲霉病诊治专家共识. 中华医学杂志, 2017, 97(34): 2650-2656.
10.	中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2016年版). 中华结核和呼吸杂志, 2016, 39(9): 675-697.
11.	中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
12.	成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识. 中华结核和呼吸杂志, 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.	王梦雨, 乔艳俊, 王红民. 变应性支气管肺曲霉病26例临床分析. 中国呼吸与危重监护杂志, 2019, 18(3): 231-235.
16.	李乃健, 邱日皇, 黄智勇, 等. 69例误诊为支气管哮喘的病例分析. 中国呼吸与危重监护杂志, 2015, 14(1): 22-26.
17.	马艳良, 张为兵, 余兵, 等. 支气管哮喘患者中变应性支气管肺曲霉病的检出及临床特点初步调查. 中华结核和呼吸杂志, 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-Montañez 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.	陆海雯, 卫平, 徐金富. 变应性支气管肺曲霉病的诊断标准变迁及影像学分类进展. 中国呼吸与危重监护杂志, 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, 蔡柏蔷, 徐凯峰, 等. 变态反应性支气管肺曲菌病23例分析. 中华内科杂志, 2007, 46(3): 208-212.
5. 李然, 胥杰, 孙永昌, 等. 变态反应性支气管肺曲霉菌病11例临床分析. 中华哮喘杂志(电子版), 2011, 5(6): 423-428.
6. 彭娟, 韩锋锋, 杨天芸, 等. 变应性支气管肺曲霉病四例临床分析并文献复习. 中国呼吸与危重监护杂志, 2015, 14(5): 456-461.
7. 曾超, 刘媛媛, 曾飞球, 等. 变应性支气管肺曲霉菌病3例分析. 罕少疾病杂志, 2012, 19(4): 4-7.
8. 邹敏芳, 李硕, 杨燕, 等. 变应性支气管肺曲霉病的临床特征及漏诊原因分析. 中华医学杂志, 2019, 99(16): 1221-1225.
9. 沈华浩, 孙永昌, 林江涛, 等. 变应性支气管肺曲霉病诊治专家共识. 中华医学杂志, 2017, 97(34): 2650-2656.
10. 中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2016年版). 中华结核和呼吸杂志, 2016, 39(9): 675-697.
11. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组. 慢性阻塞性肺疾病诊治指南(2013年修订版). 中华结核和呼吸杂志, 2013, 36(4): 255-264.
12. 成人支气管扩张症诊治专家共识编写组. 成人支气管扩张症诊治专家共识. 中华结核和呼吸杂志, 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. 王梦雨, 乔艳俊, 王红民. 变应性支气管肺曲霉病26例临床分析. 中国呼吸与危重监护杂志, 2019, 18(3): 231-235.
16. 李乃健, 邱日皇, 黄智勇, 等. 69例误诊为支气管哮喘的病例分析. 中国呼吸与危重监护杂志, 2015, 14(1): 22-26.
17. 马艳良, 张为兵, 余兵, 等. 支气管哮喘患者中变应性支气管肺曲霉病的检出及临床特点初步调查. 中华结核和呼吸杂志, 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-Montañez 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. 陆海雯, 卫平, 徐金富. 变应性支气管肺曲霉病的诊断标准变迁及影像学分类进展. 中国呼吸与危重监护杂志, 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

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