Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Faculty of Medicine, University of Cologne and University Hospital Cologne, Cologne, Germany.
Mycoses. 2024 Oct;67(10):e13810. doi: 10.1111/myc.13810.
Allergic bronchopulmonary aspergillosis (ABPA) is a complex lung disease associated with significant morbidity. The ABPA Working Group (AWG) of the International Society for Human and Animal Mycology (ISHAM) revised their management guidelines in 2024, but there is currently no standardised tool to assess adherence to these recommendations.
We extracted key recommendations from the updated 2024 ISHAM-AWG guidelines, focusing on critical areas: screening and diagnosis of ABPA, managing acute and treatment-dependent ABPA, and monitoring treatment response. Each item was assigned a score ranging from zero to three. We assigned negative scores to interventions not recommended by the guidelines.
We identified 38 items indicative of optimal clinical care for patients with ABPA. The score for screening asthmatics for ABPA was set at three points. For diagnosing ABPA, 16 items were included, with a score ranging from 12 to 16 points, depending on the specific components used (predisposing conditions, serum A. fumigatus-specific IgE and IgG, serum total IgE, blood eosinophil count and chest computed tomography). The management of acute ABPA comprised 11 items, with a maximum score of three points. For treatment-dependent ABPA, there were nine items (scores ranging from -3 to 6). Follow-up care comprised 10 items with a maximum score of 10-13 points, covering imaging, spirometry, testing serum total IgE levels and therapeutic drug monitoring.
The EQUAL ABPA score has been developed as a comprehensive tool to quantify guideline adherence. Future studies will evaluate to which extent guideline adherence is associated with improved clinical outcomes for patients with ABPA.
变应性支气管肺曲霉病（ABPA）是一种与显著发病率相关的复杂肺部疾病。国际人体与动物真菌学会（ISHAM）ABPA 工作组（AWG）于 2024 年修订了其管理指南，但目前尚无评估这些建议遵循情况的标准化工具。
我们从更新的 2024 年 ISHAM-AWG 指南中提取了关键建议，重点关注关键领域：ABPA 的筛查和诊断、急性和治疗依赖性 ABPA 的管理以及治疗反应监测。每个项目的评分范围为零至三分。我们为指南不推荐的干预措施分配了负分。
我们确定了 38 个项目，这些项目表明了对 ABPA 患者进行最佳临床护理的指标。对哮喘患者进行 ABPA 筛查的评分设定为三分。诊断 ABPA 时，纳入了 16 个项目，根据使用的特定组件（易患条件、血清烟曲霉特异性 IgE 和 IgG、血清总 IgE、血嗜酸性粒细胞计数和胸部计算机断层扫描），评分范围为 12 至 16 分。急性 ABPA 的管理包括 11 个项目，最高得分为三分。对于治疗依赖性 ABPA，有 9 个项目（评分范围为-3 至 6）。随访护理包括 10 个项目，最高得分为 10-13 分，涵盖影像学、肺量测定、检测血清总 IgE 水平和治疗药物监测。
EQUAL ABPA 评分已被开发为一种量化指南遵循情况的综合工具。未来的研究将评估指南遵循情况与改善 ABPA 患者临床结局之间的关系。
