Allergy and Airway |

Asthma for APBA: Though Major, but Not Obligatory FREE TO VIEW

Gopal Chawla; Amrit Pal Kansal; Komaldeep Kaur; Kamal Deep; Prabhleen Kaur
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Government Medical College, Patiala, India

Chest. 2014;146(4_MeetingAbstracts):8A. doi:10.1378/chest.1989122
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SESSION TITLE: Asthma Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Allergic bronchopulmonary aspergillosis (ABPA) is a complex immunological pulmonary disorder caused by hypersensitivity to Aspergillus species mainly Aspergillus fumigatus. The presence of asthma is one of the minimal essential diagnostic criteria for ABPA. Cases of ABPA in nonasthmatic patients have been occasionally reported in the literature.

METHODS: This study was conducted in patients presenting to the Department of Pulmonary Medicine in tertiary centre where diagnoses of ABPA was established using Rosenberg-Patterson criteria and each case was analysed for presence or absence of asthma

RESULTS: During study period , 22 cases were diagnosed to have allergic bronchopulmonary aspergillosis conforming to the usual Rosenberg-Patterson criteria. Out of them in 6 patients, there was no history of asthma and there was no clinical evidence of airflow obstruction at the time of the diagnosis either. Symptom duration in these patients varied from 2 months to 1 year. On investigations, chest x-ray revealed lesions and peripheral blood eosinophilia was present. Then they were subjected to total and specific IgE antibodies and other investigations to prove the diagnosis of ABPA

CONCLUSIONS: The diagnosis of ABPA is based on hematological, radiological and immunological criteria along with presence of asthma, and occasionally, cystic fibrosis. ABPA is rarely thought of in the absence of asthma, as this is the first criterion for diagnosis. Because of the absence of bronchial asthma, these cases are often mistaken initially for other pulmonary disorders. This leads to unnecessary delay in the diagnosis and treatment initiation. Furthermore, the remarkable radiologic similarity to pulmonary tuberculosis has important clinical implications in high tuberculous prevalent areas. This cases reflects the difficulty in recognizing ABPA in the absence of clinical asthma Therefore, ABPA should be included in the differential diagnosis in patients with radiographic abnormalities and peripheral eosinophilia even in those patients who have no history of asthma.

CLINICAL IMPLICATIONS: ABPA most commonly occurs in patients with pre-existing bronchial asthma, a high index of suspicion should be maintained in the absence of asthma. ABPA without clinical asthma can and does pose diagnostic difficulties as in our case. Thus ABPA should be kept as a diagnostic possibility in patients with radiographic abnormalities and peripheral eosinophilia but no history or symptoms related to bronchial asthma.

DISCLOSURE: The following authors have nothing to disclose: Gopal Chawla, Amrit Pal Kansal, Komaldeep Kaur, Kamal Deep, Prabhleen Kaur

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