Allergic bronchopulmonary aspergillosis describes a reaction to an infection with fungus in the respiratory tract. The fungus subsequently triggers chronic reactions that lead to recurrent inflammation of the lungs. The condition occurs predominantly in people with chronic lung conditions, such as asthma and cystic fibrosis.
What is allergic bronchopulmonary aspergillosis?
Allergic bronchopulmonary aspergillosis is a disease of the lungs caused by molds of the genus Aspergillus. Allergic bronchopulmonary aspergillosis is a disease of the lungs caused by molds of the genus Aspergillus. Among the most common allergy-causing molds is the type Aspergillus fumigatus. Very often, allergic bronchopulmonary aspergillosis occurs as a complication of cystic fibrosis. Here, 10 to 15 percent of patients are affected, preferably in the second decade of life. Allergic bronchopulmonary aspergillosis is classified into different stages:
- Stage I: initial manifestation (first appearance of the disease).
- Stage II: remission (symptomatology temporarily recedes).
- Stage III: Exacerbation – renewed deterioration of the clinical picture.
- Stage IV: severe asthma
- Stage V: lung tissue shows irreversible fibrotic changes.
Allergic bronchopulmonary aspergillosis is divided into five stages, but these are not stages, because the affected person may already be in the fifth stage when first diagnosed. In addition, regression from a higher to a lower stage is possible.
Causes
Allergic bronchopulmonary aspergillosis affects up to 25 percent of cystic fibrosis patients. It is also common in people who suffer from asthma. The triggering allergens are components of mold spores, especially Aspergillus species. The most important sources include flower potting soil, aquariums, damp places in the house, hydroponics, organic waste, humidifiers, air conditioners, and animals with fur and feathers and their surroundings. Depending on the wind direction, animal stalls, barns with hay and straw, ponds, silos are also a source of danger. Mold spores, for example, occur on the ground, in dust and water, are transported very far by the wind and can be inhaled very easily, which can trigger allergic bronchopulmonary aspergillosis.
Symptoms, complaints and signs
Allergic bronchopulmonary aspergillosis triggers several symptoms. Bronchospasm, mucosal swelling, and increased mucus production in the bronchi occur. Another consequence is a loss of function in the alveoli as well as in the interstitial tissue of the lungs. The following additional symptoms may occur: Fever, coughing up of mucus and brownish discolored sputum, as well as chest pain. Shortness of breath and weight loss may also occur. According to the symptoms, the disease is easily confused with tuberculosis. In addition, the symptoms are similar to those of cystic fibrosis and asthma, so those who suffer from it often do not recognize allergic bronchopulmonary aspergillosis.
Diagnosis and course
Because the symptoms are very similar to those of cystic fibrosis and asthma, it can be difficult to diagnose allergic bronchopulmonary aspergillosis. Other possible causes, such as pneumonia, must first be ruled out. The physician has the following examinations at his or her disposal: X-ray of the chest, computed tomography, blood test, sputum culture and a skin test. The earlier allergic bronchopulmonary aspergillosis is detected and treatment is initiated, the more favorable the course of the disease. Allergic bronchopulmonary aspergillosis can be treated well with medication, but the lungs must be examined regularly because the disease can worsen. In severe cases, allergic bronchopulmonary aspergillosis can permanently affect the central airways so that they become wider, leading to bronchiectasis. In addition, this disease can cause severe breathing problems or heart failure. These serious complications are more common in patients with advanced cystic fibrosis.Without treatment of allergic bronchopulmonary aspergillosis, chronic bronchial asthma and fibrosis (scarred lung districts) develop, making them unavailable for gas exchange.
Complications
Allergic bronchopulmonary aspergillosis refers to an infectious reaction of the respiratory tract areas due to fungal spores. It is a recurrent symptom that predominantly affects young people with chronic lung conditions such as cystic fibrosis or asthma. There are a total of five stages of the symptom: initial manifestation, followed by temporary regression of symptoms, renewed exacerbation, asthma flare-up, irreversible lung dysfunction, and finally fibrosis. Various allergens can cause the symptom at any time. These include specifically Aspergillus species as well as the components of mold spores. These are found in air conditioning systems, organic waste, fur-bearing animals, near silos, and in house dust, among other places. If allergic bronchopulmonary aspergillosis is left untreated, serious complications develop, especially for cystic fibrosis patients. In addition to accompanying symptoms such as weight loss, fever flares, and chest pain, chronic bronchial asthma or bronchospasm may develop. The function of the lungs is increasingly impaired and there is a risk of scarring in the interstitial tissue. As the disease progresses, acute respiratory problems develop, culminating in cardiovascular failure. Allergy sufferers and persons at risk should take advantage of various testing possibilities in good time on the basis of a differential diagnosis in order to specifically reduce the fungal infestation of the respiratory tract. Cortisone as well as anti-inflammatory anti-allergic drugs are administered as emergency preparations. Depending on the severity of the case, secondary complications may result. In some cases, affected individuals require lifelong drug therapy with regular pulmonary function monitoring.
When should you see a doctor?
In allergic bronchopulmonary aspergillosis, prompt treatment by a physician is necessary. If the disease is not treated, there is usually no spontaneous improvement and the affected person may die from this disease in the worst case. Since it is characterized mainly by breathing difficulties and shortness of breath, a doctor should be consulted immediately when these symptoms occur. As a rule, either the general practitioner or an ENT specialist can be consulted. In acute emergencies, the patient should call an ambulance or go to the hospital. Furthermore, weight loss is also a common symptom of this disease. Pneumonia and fever continue to occur. It is not uncommon to experience chest pain, which should also be examined by a physician. If there is a twinge in the chest, an emergency doctor should be called immediately in any case, as this may be due to heart problems. The affected person may die of heart failure in this case. Treatment is therefore essential.
Treatment and therapy
In the initial phase, prolonged cortisone treatment is usually necessary. Treatment is sometimes supported with an antifungal agent to reduce the extent of exposure to molds in the bronchial tubes. Anti-allergic medications may further curb inflammation. The doctor may also prescribe an asthma medication, if necessary, to help open the airways and thereby make it easier to cough up the mucus. Furthermore, this helps to clear the fungus from the airways. The primary goal of therapy for allergic bronchopulmonary aspergillosis is to reduce symptoms when flare-ups occur and to prevent further flare-ups by combating the fungal infection of the airways. This is intended to prevent an exacerbation of the disease. In addition, the immediate avoidance of the allergen as far as possible is crucial, as otherwise the fungal infestation cannot be stopped. Even if the symptoms improve before the recommended duration of use, the medication should only be discontinued after medical consultation. This will allow for comprehensive treatment and reduce the risk of recurrence.
Outlook and prognosis
In general, this disease causes various respiratory symptoms. In this case, the affected person suffers from recurrent inflammation and infections, and asthma may also develop. The patient’s quality of life is significantly limited and reduced by this disease.Likewise, certain activities in everyday life can no longer be carried out without further ado and the resilience of the affected person drops significantly. Furthermore, there is often swelling of the mucous membranes. Those affected also suffer from fever and gasping for breath. Weight loss may also occur. Patients often suffer from pneumonia, which in the worst case can be fatal. The undersupply of oxygen can also cause damage to the internal organs, which can also affect the heart and brain. If the heart is damaged, cardiac death may occur. If the brain is damaged, irreversible secondary damage can occur. As a rule, the disease is limited with the help of medication. However, not all symptoms can be treated in every case. Existing infections are treated with the help of antibiotics. With successful treatment of this disease, life expectancy is not reduced.
Prevention
Allergic bronchopulmonary aspergillosis is difficult to prevent because the causative fungus is present in the normal environment. But it is possible to counteract recurrent episodes if prescribed medications are taken as directed by a physician. In addition, once the diagnosis has been made, it is important to avoid the allergen. This means staying away from possible sources of infection from the environment. This is also the reason that visitors are not allowed to bring potted plants into the hospital with potting soil, as this is one of the various sources of danger. At home, it is recommended to avoid contact with soil, compost and organic waste as much as possible. Allergic bronchopulmonary aspergillosis usually affects people who already have a history of bronchial asthma. Cystic fibrosis may also favor the development of a hypersensitivity reaction to Aspergillus spores. This complication complicates treatment and follow-up of the underlying disease.
Follow-up
Colonization of the respiratory tract of pre-diseased patients with Aspergillus spores can have serious consequences if left untreated. Therefore, follow-up after acute treatment is urgently needed. Asthma and fibrosis patients require regular follow-up anyway. If necessary, drug doses must be adjusted. With regard to allergic bronchopulmonary aspergillosis, the decisive factor is at what stage it is. In asthma patients treated with long-term corticosteroid therapies, the question of the side effects of this therapy arises for follow-up. There may be subsequent cataracts, hyperglycemia, or osteoporosis due to the corticosteroids. Therefore, part of the follow-up may be to prevent these sequelae-for example, by administering prophylactic drugs for bone mineralization or to prevent a certain type of pneumonia. The extent to which immunological function can be strengthened varies from individual to individual. What is precarious in allergic bronchopulmonary aspergillosis is that the existing asthma disease can only be treated to a limited extent. As a consequence, recurrent pulmonary infiltrates occur. Therapy and follow-up measures must be individually tailored to the patient. To date, there is no standard treatment.
What you can do yourself
For self-help, the affected person should inform himself comprehensively about where the pathogen is native and how it is spread. It is helpful if he develops an appropriate sensitivity for his environment, where the fungus is often located, in order to avoid danger zones in time. In some cases, a change in one’s lifestyle or a move is necessary to alleviate the symptoms in the long term. In addition, it is necessary to strengthen and stabilize one’s own immune system. Only in this way can it produce sufficient defenses in dealing with pathogens. To optimize the functioning of the immune system, a healthy lifestyle is needed. This includes a balanced diet, sufficient exercise and the avoidance of harmful substances. Harmful substances include nicotine, alcohol or drugs. Toxins such as paints, chemical cleaning agents or building materials should also not be inhaled. Maintaining the ideal weight is also helpful to avoid putting additional stress on the respiratory system. Heavy physical work should be avoided and sports activities should be adapted to the available possibilities.In addition, sufficient periods of regeneration help to promote health. If there is a shortage of breath, breaks should be taken immediately and prescribed medication should be taken. If anxiety occurs as a result of breathing problems, seeking therapy may help.
