Prevalence of allergic bronchopulmonary aspergillosis in patients with bronchial asthma

Two Hundred patients with bronchial asthma were studied to identify the pre valence of allergic bronchopulmonary aspergillosis (ABPA). The patients sel ected required intermittent short courses of steroids and their mean durati on of illness was 12 years. Absolute eosinophil count was > 500/mm(3) in 53 % of the cases. Chest X-rays showed small homogenous shadows with patchy in filtrations in 25% and fluctuating pneumonic shadows in 14% of the cases. R aised specific IgG and positive serum precipitin against Aspergillus fumiga tus (AF) were present in 24% and 13%, respectively. Cases with radiological and immunological suspicion were further investigated for ABPA. Skin-tests for Type-I and Type-III reactivity were positive with AF extract in 87% (n = 47) and 36% (n = 47) of the cases. A thorax CT of 31 patients showed cen tral bronchiectasis in 24 cases, labeling these patients as ABPA-CB (ABPA w ith central bronchiectasis) and an other 7 as ABPA-S (serological positive) . CT was not done in one case who, because of other positive findings, was also labeled as ABPA-S. Thus, these 32 asthmatics were found to have ABPA. Among them, there was raised specific IgG (100%) and raised specific IgE ag ainst AF (100%), positive skin test for Type-I and Type-III reactivity (100 % and 53%) against AF. There was elevated total IgE (100%, n = 29), a posit ive family history of asthma (63%), peripheral eosinophilia (100%) and a hi story of passage of brownish plugs (31%). Radiological findings suggested s oft shadow with infiltration in 31% and fluctuating pneumonic shadows in 69 % of cases. CT Thorax (n 31) showed central bronchiectasis in 78% of theses patients. Based on the present data, the prevalence of ABPA in bronchial a sthma patients is 16% (12% with central bronchiectasis and 4% only serologi cally positive). Therefore, patients should be investigated and diagnosed i n an early phase of ABPA (ABPA-S) and should be treated to prevent permanen t lung damage.