CHEST RADIOGRAPHIC STAGING IN ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS- RELATIONSHIP WITH IMMUNOLOGICAL FINDINGS

The question of whether a chest radiographic severity staging system c ould be correlated with standard blood/serum diagnostic indices in all ergic bronchopulmonary aspergillosis (ABPA) was addressed in 41 patien ts. Asthma and positive Aspergillus fumigatus (AF) serology were consi dered essential diagnostic inclusion criteria. Eosinophil count, serum immunoglobulin (Ig)E and immediate skin hypersensitivity were also te sted to grade patients as ''definite'' or ''likely'' ABPA. Definite ca ses had all five of these factors present, whereas likely cases had th ree or more. Chest radiographs were examined by experienced radiologis ts blinded to the clinical data. The six-stage radiographic score (0-5 ) was based on the severity and duration of changes seen: stage 0: nor mal; stage 1: transient hyperinflation; stage 2: transient minor chang es; stage 3: transient major changes; stage 4: permanent minor changes ; and stage 5: permanent major changes. Significant positive correlati ons (p<0.05) were observed between peak AF titres (expressed as an ind ex), peak eosinophil count and radiographic severity stage. When consi dered as subgroups, these correlations approached, but did not reach, significance for the group with ''likely'' ABPA (n=28), but in the gro up with definite ABPA (n=13), there was a high correlation between rad iographic score and peak AF index (r=0.59), as well as peak eosinophil count (r=0.62). This study suggests that the peak Aspergillus fumigat us index and eosinophil counts correlate best with the severity of rad iographic stages in allergic bronchopulmonary aspergillosis. This ches t radiographic staging system may be useful in the clinical assessment and management of patients with allergic bronchopulmonary aspergillos is, particularly in those patients with more severe radiographic stage s.