PURPOSE: ABPA is radiologically classified on the presence or absence of central bronchiectasis (CB) as ABPA-CB and ABPA-S respectively. Few studies have described the long-term follow up of patients with ABPA-S. The aim of this study was to describe the long-term outcomes of ABPA-S.
METHODS: Patients were diagnosed as ABPA-S if they met all the following criteria: asthma, immediate cutaneous hyperreactivity to A fumigatus antigen, total IgE levels >1000 IU/mL, A fumigatus specific IgE levels >0.35 kUA/L and normal HRCT of the chest. The patients were treated with prednisolone for a total duration of at least 6-12 months. Itraconazole 200 mg twice daily for four months was added in case of relapses. They were followed up with history and physical examination, chest radiograph and total IgE levels every six weeks. In addition, an annual spirometry and a HRCT scan of the chest were done every two years. The baseline characteristics of these patients have already been previously reported (Chest 2006; 130:442-448; Chest 2007; 132:1183-1190; Respir Med 2010; 104:204-210; PLoS One 2010; 5:e15346). This study describes the long-term outcomes of patients with ABPA-S.
RESULTS: Of the 55 patients with ABPA-S, 41 (17 men, 24 women; mean (SD) age, 38.3 [13.4] years) consented for performance of repeat HRCT scans. The median duration of asthma prior to diagnosis of ABPA was six years. The duration of follow up ranged from 24-77 months with the mean (SD) follow up duration being 43.7 (10.1) months. There was neither any deterioration of lung function during the follow-up period (p values=0.06 and 0.20 for FEV1 and FVC respectively) nor development of CB in any patient. Sixteen patients had a relapse during the follow-up period, and 10 patients were classified as glucocorticoid-dependent ABPA.
CONCLUSIONS: Although relapses are frequently seen, the long-term outcome of ABPA-S is good with no patient developing CB.
CLINICAL IMPLICATIONS: Patients with ABPA-S should be actively diagnosed and treated to prevent deterioration of lung function and development of CB.
DISCLOSURE: The following authors have nothing to disclose: Ritesh Agarwal, Mandeep Garg, Biman Saikia, Dheeraj Gupta, Arunaloke Chakrabarti
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