SESSION TITLE: Asthma
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 29, 2014 at 08:45 AM - 10:00 AM
PURPOSE: ABPA is an immunologic pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus. The prevalence of ABPA in patients with bronchial asthma remains unclear. Contemporary reports suggest that ABPA occurs in upto 11% of patients with asthma. We made an attempt to find out prevalence of ABPA in patients of bronchial asthma using minimal essential criteria laid down by Greenberger et al.
METHODS: 100 consecutive asthmatic patients, who visited our hospital were subjected to Aspergillus fumigatus skin test(intradermal). Those patients who showed positive Type I hypersensitivity reaction, were further investigated for ABPA (viz. total serum IgE, IgE specific-A.fumigatus and HRCT scan).
RESULTS: Among 100 patients, 34 patients showed positive response to A.fumigatus skin test. Elevated serum total IgE levels (>417 IU/ml) was observed in 30 patients, raised serum IgE specific-A.fumigatus (>0.35 kUA/l) was observed in 31 patients. 26 patients out of 34 skin test positivity patients provide consent for HRCT chest scan, of which 25 had bronchiectactic changes present (includes central as well as peripheral). A diagnosis of ABPA (both ABPA-S and CB) was established in 30 patients of bronchial asthma.
CONCLUSIONS: Our study showed prevalence of 30% in patients of bronchial asthma. We observed female preponderance (17/30), mostly affected was younger age group (18/30 in 15-30 years). Elevated serum total IgE levels were observed in all ABPA patients with a mean of 6747.10±6235.13, is significant. Mean specific IgE-A.fumigatus was 44.68±46.27. We also observed that elevated serum absolute eosinophilic count (>1000 cells/cumm) was present in 15 (50%) patients of ABPA, which is not significant. Moreover, 6 (20%) patients had AEC levels less than 500 cells/cumm. Among other HRCT findings mucoid impaction was observed in 14 patients, pleural thickening, consolidation, nodules/tree in bud appearance and cavitory lesions were seen in 5,5, 9 and 1 patient respectively.
CLINICAL IMPLICATIONS: Early suspicion of ABPA especially in patients of bronchial asthma can prevent the the progression of the disease to bronchiectasis.
DISCLOSURE: The following authors have nothing to disclose: Vishal Chopra, Kalpeshkumar Patel, Ashrafjit Chahal, Don Mascarenhas, Prabhleen Kaur
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