Respiratory Flashcards
(36 cards)
What is ABPA characterised by?
ABPA is characterised by an exaggerated immune response (hypersensitivity reaction) to the fungus Aspergillus, most commonly Aspergillus fumigatus.
In which populations does ABPA occur most often?
ABPA occurs most often in people with asthma or cystic fibrosis (CF).
Where are Aspergillus spores commonly found?
Aspergillus spores are ubiquitous in soil and are commonly found in the sputum of healthy individuals.
What spectrum of diseases is Aspergillus fumigatus responsible for?
Aspergillus fumigatus is responsible for a spectrum of pulmonary diseases called aspergilloses.
What does ABPA cause in the airways?
ABPA causes airway inflammation, leading to bronchiectasis.
How do Aspergillus spores affect the respiratory system in healthy individuals?
In healthy individuals, innate and adaptive immune responses are triggered, leading to mucociliary clearance and successful phagocytosis of the spores, clearing the infection.
What factors increase the risk of ABPA in individuals with predisposing lung diseases?
Factors include the presence of asthma, CF, chronic granulomatous disease, or Hyper-IgE syndrome.
What clinical history raises suspicion of ABPA?
Worsening asthma or CF symptoms, along with episodic fever, cough, and mucus plugging.
What immunological tests are useful for diagnosing ABPA?
Elevated IgE, Aspergillus-specific IgE and IgG, and eosinophilia.
What radiological findings are indicative of ABPA?
Fleeting or migratory pulmonary infiltrates and central bronchiectasis on CT scans.
What is the significance of sputum testing in ABPA diagnosis?
Sputum cultures may show Aspergillus growth, though it is not always definitive for ABPA.
What are the ISHAM criteria for diagnosing ABPA?
Elevated total IgE, positive Aspergillus IgE, radiological findings, and evidence of central bronchiectasis.
What are common symptoms of ABPA in patients with asthma?
Wheezing, coughing, dyspnoea, and exercise intolerance.
What symptoms suggest bronchiectasis in moderate and severe cases of ABPA?
Thick sputum production (often containing brown mucus plugs), pleuritic chest pain, and fever.
When should ABPA be suspected in patients with asthma?
When patients have symptoms of ongoing infection that do not respond to antibiotic treatment.
What are the stages of ABPA?
Stage 1 (Acute), Stage 2 (Remission), Stage 3 (Exacerbation/Relapse), Stage 4 (Corticosteroid-Dependent), and Stage 5 (Fibrotic).
What characterises Stage 1 (Acute) of ABPA?
Symptoms and signs of inflammation, elevated IgE, and lung infiltrates.
What happens in Stage 5 (Fibrotic) of ABPA?
Permanent lung damage, including bronchiectasis and fibrosis, leading to chronic respiratory failure.
What are the primary goals of ABPA treatment?
To reduce lung inflammation, prevent exacerbations, and halt disease progression.
What is the mainstay of treatment for ABPA?
Oral corticosteroids (e.g., prednisone).
What role do antifungal agents play in ABPA treatment?
They reduce the fungal load in the lungs, lowering the antigenic stimulus for the immune system.
What is the use of biologic therapy in ABPA?
Monoclonal antibodies, such as omalizumab, are used in refractory cases to target specific parts of the immune response and reduce inflammation.
How are bronchodilators used in ABPA management?
Regular use of inhaled bronchodilators helps improve airflow and manage bronchoconstriction in patients with asthma.
What is the prognosis for ABPA with early diagnosis and proper management?
Many patients can achieve long-term remission and maintain good lung function.
