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

From the Guidelines

The treatment for Allergic Bronchopulmonary Aspergillosis (ABPA) primarily involves oral corticosteroids and antifungal medications, with a recommended initial dose of oral prednisolone at 0.5 mg/kg/day for 2-4 weeks, tapered and completed over 4 months, or oral itraconazole for 4 months as an alternative 1. The choice between these two options depends on the patient's specific condition and the presence of any contraindications to systemic glucocorticoids.

• For patients with acute ABPA, oral prednisolone or itraconazole monotherapy is recommended, with the combination of both reserved for recurrent ABPA exacerbations 1.
• The treatment regimen should be tailored to the individual patient's needs, taking into account factors such as the severity of symptoms, the presence of underlying conditions like asthma or cystic fibrosis, and the patient's response to treatment.
• Monitoring of treatment response is crucial, with clinical improvement, reduced IgE levels, and improved pulmonary function tests serving as key indicators of success 1.
• In cases where patients are dependent on oral corticosteroids and experience difficulty in weaning, itraconazole may be considered as a steroid-sparing agent 1.
• The use of biological agents, such as omalizumab, may be considered in refractory cases, with dosing based on weight and IgE levels 1.
• It is essential to note that the treatment approach may vary depending on the specific classification of ABPA, with different management strategies recommended for ABPA-S, ABPA-B, ABPA-MP, ABPA-HAM, and ABPA-CPF 1.
• Overall, the goal of treatment is to reduce the inflammatory response to Aspergillus antigens, decrease the fungal burden, and improve the patient's quality of life, while minimizing the risk of adverse events and treatment-related complications 1.

From the Research

Treatment Options for ABPA

• 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.
• A combination of oral prednisone for 18 days together with itraconazole therapy for at least 12 months can also be effective in treating ABPA, especially in patients with cystic fibrosis 3.
• Systemic glucocorticoids or antifungal agents can be used to suppress the inflammatory response or fungal growth and prevent exacerbations 4.
• Biological agents may be used in patients with severe disease or glucocorticoid dependence 4.
• The treatment approach involves reducing symptoms, preventing disease progression, and minimizing the future risk of exacerbations 4.

Treatment Pathway

• The treatment pathway for ABPA can be complex and may involve a combination of medications, including systemic glucocorticoids, antifungal agents, and biologics 5.
• A case-based approach can be used to illustrate the treatment options for ABPA in different situations, taking into account the available evidence from recent clinical trials 5.
• The aim of treatment is to improve symptoms, prevent disease progression, and minimize the risk of complications such as pulmonary fibrosis and bronchiectasis 6.

Medications Used

• Oral prednisone is a commonly used medication for treating ABPA, with a typical dosage of 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.
• Itraconazole is an antifungal agent that can be used in combination with oral prednisone to treat ABPA, especially in patients with cystic fibrosis 3.
• Biological agents such as omalizumab may be used in patients with severe disease or glucocorticoid dependence 4.