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
Serum IgE Concentration
infiltrates in mid to upper lung fields
clear to infiltrates
1+ to 3+
fibrosis or cavities; chronic infiltrates
Stages of Allergic Bronchopulmonary Aspergillosis, Seropositive
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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Specialty: Pulmonology, Infectious Diseases, Immunology/Rheumatology