What is the treatment for Allergic Bronchopulmonary Aspergillosis (ABPA)?

From the Guidelines

The treatment for Allergic Bronchopulmonary Aspergillosis (ABPA) should primarily involve oral corticosteroids, such as prednisolone at a dose of 0.5 mg/kg/day for 2-4 weeks, tapered and completed over 4 months, or oral itraconazole for 4 months as the initial therapy for treating acute ABPA, as recommended by the revised ISHAM-ABPA working group clinical practice guidelines 1.

Treatment Approach

The treatment approach for ABPA involves a combination of oral corticosteroids and antifungal medications.

• Oral corticosteroids, such as prednisolone, are effective in reducing inflammation and controlling symptoms.
• Antifungal medications, such as itraconazole, are used to reduce fungal burden and prevent progression to bronchiectasis and pulmonary fibrosis.

Management of Treatment-Dependent ABPA

For patients with treatment-dependent ABPA, long-term itraconazole, nebulised amphotericin B, or biological agents, such as omalizumab, may be recommended options for managing the condition 1.

• These treatments aim to reduce inflammation, control fungal growth, and prevent progression to bronchiectasis and pulmonary fibrosis.
• Regular monitoring of pulmonary function, IgE levels, and chest imaging is necessary to assess response to therapy and adjust treatment accordingly.

Key Considerations

• Patients with asthma or cystic fibrosis require optimizing management of these underlying conditions, including bronchodilators and airway clearance techniques.
• Patients should avoid environments with high mold exposure to prevent exacerbations.
• Treatment aims to reduce morbidity, mortality, and improve quality of life for patients with ABPA.

From the Research

ABPA Treatment Overview

• ABPA treatment typically involves oral corticosteroids, such as prednisone, to reduce inflammation and prevent lung damage 2.
• The most effective treatment for ABPA is oral prednisone 0.5 mg/kg/day for 14 days, on alternate days for three months, and tapering by 5 mg every two weeks for an additional three months 2.

Combination Therapies

• A combination of oral prednisone and itraconazole has been shown to be effective in treating ABPA, particularly in patients with cystic fibrosis 3.
• This combination therapy can help restore lung function and reduce the risk of ABPA relapses 3.
• Another study found that intravenous monthly pulse methylprednisolone treatment can be an effective therapy for ABPA in patients with cystic fibrosis, with minor side effects 4.

Alternative Therapies

• Omalizumab, an anti-IgE antibody, has been shown to be effective in reducing exacerbations and improving pulmonary function in patients with ABPA, including those with chronic bacterial infections 5.
• A randomized trial compared the efficacy and safety of prednisolone versus prednisolone and itraconazole in acute-stage ABPA complicating asthma, and found a trend towards a decline in ABPA exacerbations at 1 year with the prednisolone-itraconazole combination 6.

Treatment Considerations

• Early diagnosis and treatment of ABPA are essential to prevent lung damage and improve outcomes 2.
• Treatment should be tailored to the individual patient, taking into account the severity of the disease, the presence of comorbidities, and the risk of side effects 3, 4, 5, 6.
• Regular monitoring of lung function, serum IgE levels, and clinical symptoms is necessary to adjust treatment and prevent relapses 2, 3.