What are the recommended treatment options for managing ABPA in patients with asthma or cystic fibrosis?

Management of allergic bronchopulmonary aspergillosis (ABPA) in patients with asthma or cystic fibrosis primarily involves the use of corticosteroids to control the hypersensitivity reaction and reduce pulmonary inflammation. In cystic fibrosis, treatment consideration arises particularly when there is elevated aspergillus serology (aspergillus-specific IgG and/or IgE) combined with declining pulmonary function despite optimized pulmonary treatment, and consistent radiological changes on chest X-ray or CT scan suggestive of ABPA or other aspergillus airway disease. In such cases, corticosteroids are the mainstay to suppress the immune response and improve lung function ¹.

Antifungal therapy may be considered in cystic fibrosis patients with chronic Aspergillus fumigatus complex respiratory infection and declining pulmonary status to suppress the infection, but this should be guided by specialist microbiological advice and discontinued if no benefit is observed ¹. This approach aims to reduce fungal burden and antigenic stimulus contributing to ABPA. Routine antifungal use is not recommended in stable patients without clinical deterioration ¹.

In asthma patients with ABPA, corticosteroids remain the cornerstone of treatment to control inflammation and prevent progression of lung damage (Greenberger et al., 2007). Antifungal agents such as itraconazole may be used adjunctively to reduce fungal load and steroid requirements, although specialist input is advised to tailor therapy and monitor for adverse effects (Greenberger et al., 2007).

Overall, the integrated management strategy for ABPA in asthma or cystic fibrosis involves careful assessment of clinical status, serological markers, and imaging findings to guide corticosteroid therapy, with adjunctive antifungal treatment considered in cases of persistent or worsening disease despite optimized care. Specialist microbiological and respiratory advice is essential to optimize antifungal choice and duration ¹ (Greenberger et al., 2007).