How are mold-related allergic bronchopulmonary aspergillosis (ABPA) and allergic bronchopulmonary mycosis (ABPM) staged?

Updated: Sep 18, 2017
  • Author: Shih-Wen Huang, MD; Chief Editor: Harumi Jyonouchi, MD  more...
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Answer

In stage I (acute), diagnostic criteria are met (ie, asthma without infiltrate, peripheral eosinophilia >8%, histologic diagnosis of mucus impaction, sputum positive for Aspergillus species or other fungus, positive skin test and precipitin to fungus, elevated total serum IgE).

Stage II (remission) occurs after therapy with prednisone and with the lack of any subsequent radiologic findings for 6 months. IgE levels decline and stabilize. This stage may be permanent, but exacerbation may occur.

In stage III (exacerbation), radiologic findings include increased infiltrates, and the total serum IgE level at least doubles. Symptoms, including wheezing, fever with a temperature around 38.5°C, myalgia, and sputum production, may be increased.

Stage lV (prednisone-dependent asthma) occurs when repeated efforts to taper steroids fail. Diagnosis is established in some patients at this stage. Levels of IgE specific to fungi are elevated, as are precipitin antibody values. New infiltrates may be apparent if the prednisone dose is low.

Stage V (fibrotic) is end-stage fibrotic lung disease. Irreversible obstructive and restrictive pulmonary physiologic abnormalities occur. Anti-fungal antibody titers remain high. Patients develop honeycomb fibrosis, cyanosis, arterial hypoxemia, and respiratory failure. Death occurs with cor pulmonale. No patients regress from stage V to stage lV.


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