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ABPA management — SCE Respiratory MCQ

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HardAsthmaABPA managementSCE Respiratory

A 60-year-old woman with asthma has a chronic productive cough and recurrent right middle-lobe infiltrates. Total IgE is 1800 IU/mL, Aspergillus-specific IgE is positive and CT shows proximal bronchiectasis with mucus impaction. She is currently on high-dose inhaled therapy but no systemic treatment. What is the most appropriate initial management?

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Correct answer: B — Oral corticosteroid therapy with antifungal consideration after specialist review

ABPA with active symptoms is initially treated with systemic corticosteroids, with antifungal therapy considered in specialist care to reduce fungal burden or steroid exposure. Bronchial thermoplasty is not first-line for ABPA. Colistin, macrolide monotherapy and lobectomy do not address the immune response driving the disease.

Reference: BTS Clinical Statement on Aspergillus-related Chronic Pulmonary Disease; BTS/NICE/SIGN Asthma Guideline 2024