Clinical Stages of Allergic Bronchopulmonary Aspergillosis

Description

Allergic bronchopulmonary aspergillosis can be staged based on the clinical and radiologic findings.

Chest radiographic findings:

(1) The radiologic infiltrates in stages I, III and IV tend to occur in the mid-to-upper lung fields and show smooth borders.

(2) The infiltrates may clear after prednisone administration and clearing of mucous plugs.

(3) Bronchiectasis in ABPA tends to be central; in patients with cystic fibrosis both central and distal bronchiectasis may be seen.

(4) With stage V disease there may be interstitial scarring, ring shadows, air-fluid levels in cavities, and widespread pulmonary fibrosis.

Corticosteroid dependent: Patients who cannot tolerate discontinuation of prednisone after 2 months of therapy due to continued asthmatic symptoms.

Stages of Allergic Bronchopulmonary Aspergillosis, Central Bronchiectasis

Designation	Chest Radiograph	Serum IgE Concentration	Stage
acute	infiltrates in mid to upper lung fields	3+	I
remission	clear	1+	II
recurrent exacerbation	infiltrates in mid to upper lung fields	3+	III
corticosteroid dependent	clear to infiltrates	1+ to 3+	IV
end-stage fibrosis	fibrosis or cavities; chronic infiltrates	1+	V

Stages of Allergic Bronchopulmonary Aspergillosis, Seropositive

Designation	Chest Radiograph	Serum IgE Concentration	Stage
acute	infiltrates in mid to upper lung fields	3+	I
remission	clear	1+	II
recurrent exacerbation	infiltrates in mid to upper lung fields	3+	III
corticosteroid dependent	clear to infiltrates	1+ to 3+	IV

Patients with the seropositive type (no central bronchiectasis) do not show progression to end-stage fibrosis (stage V seen in the central bronchiectasis type).

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Clinical Stages of Allergic Bronchopulmonary Aspergillosis

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