Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Clin Exp Allergy. 2013 Aug;43(8):850-73. doi: 10.1111/cea.12141.
Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus, manifesting with poorly controlled asthma, recurrent pulmonary infiltrates and bronchiectasis. There are estimated to be in excess of four million patients affected world-wide. The importance of recognizing ABPA relates to the improvement of patient symptoms, and delay in development or prevention of bronchiectasis, one manifestation of permanent lung damage in ABPA. Environmental factors may not be the only pathogenetic factors because not all asthmatics develop ABPA despite being exposed to the same environment. Allergic bronchopulmonary aspergillosis is probably a polygenic disorder, which does not remit completely once expressed, although long-term remissions do occur. In a genetically predisposed individual, inhaled conidia of A. fumigatus germinate into hyphae with release of antigens that activate the innate and adaptive immune responses (Th2 CD4(+) T cell responses) of the lung. The International Society for Human and Animal Mycology (ISHAM) has constituted a working group on ABPA complicating asthma (www.abpaworkinggroup.org), which convened an international conference to summarize the current state of knowledge, and formulate consensus-based guidelines for diagnosis and therapy. New diagnosis and staging criteria for ABPA are proposed. Although a small number of randomized controlled trials have been conducted, long-term management remains poorly studied. Primary therapy consists of oral corticosteroids to control exacerbations, itraconazole as a steroid-sparing agent and optimized asthma therapy. Uncertainties surround the prevention and management of bronchiectasis, chronic pulmonary aspergillosis and aspergilloma as complications, concurrent rhinosinusitis and environmental control. There is need for new oral antifungal agents and immunomodulatory therapy.
变应性支气管肺曲霉病（ABPA）是一种由烟曲霉过敏引起的免疫性肺部疾病，表现为控制不佳的哮喘、反复肺部浸润和支气管扩张。据估计，全球有超过 400 万患者受到影响。认识到 ABPA 的重要性与改善患者症状以及延迟或预防支气管扩张有关，因为支气管扩张是 ABPA 肺部永久性损伤的一种表现。环境因素可能不是唯一的发病因素，因为并非所有接触相同环境的哮喘患者都会发展为 ABPA。ABPA 可能是一种多基因疾病，一旦表达就不会完全缓解，尽管确实会出现长期缓解。在遗传易感性个体中，吸入的烟曲霉分生孢子发芽成菌丝，释放出激活肺部固有和适应性免疫反应（Th2 CD4+T 细胞反应）的抗原。国际人类和动物真菌学会（ISHAM）已经成立了一个 ABPA 合并哮喘工作组（www.abpaworkinggroup.org），该工作组召开了一次国际会议，总结了当前的知识状况，并制定了基于共识的诊断和治疗指南。提出了新的 ABPA 诊断和分期标准。尽管已经进行了少量随机对照试验，但长期管理仍研究不足。主要治疗方法包括口服皮质类固醇控制发作、伊曲康唑作为皮质类固醇节省剂和优化哮喘治疗。支气管扩张、慢性肺部曲霉病和曲霉菌瘤等并发症的预防和管理、并发鼻窦炎和环境控制存在不确定性。需要新的口服抗真菌药物和免疫调节治疗。
