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ABPA — RACP Adult Medicine MCQ

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ModerateRespiratoryABPARACP Adult Medicine

A 45-year-old man with asthma presents with a 3-day history of worsening wheeze despite regular high-dose ICS/LABA. His FeNO is 65 ppb and blood eosinophils are 600 cells/µL. Total IgE is 450 IU/mL. Skin prick testing shows strong positivity to Aspergillus fumigatus. His IgE to Aspergillus is elevated. What complication should be considered?

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Correct answer: C — Allergic bronchopulmonary aspergillosis (ABPA)

ABPA is a hypersensitivity reaction to Aspergillus fumigatus colonising the airways. Diagnostic criteria include asthma or CF, positive Aspergillus skin prick test, elevated total IgE (>1000 IU/mL in classic cases but lower thresholds used), elevated specific IgE/IgG to Aspergillus, blood eosinophilia, and central bronchiectasis on HRCT. Treatment is oral prednisolone (often with itraconazole as a steroid-sparing agent). Omalizumab is emerging as adjunctive therapy. High FeNO supports eosinophilic airway inflammation.

Reference: eTG – 2025 – Respiratory; ISHAM – 2013 – ABPA Diagnostic Criteria