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Allergic Bronchopulmonary Aspergillosis (ABPA)

I was just diagnosed with this disease, which I understand is getting more common among severe asthmatics. It's caused by a common fungus that invades the lungs of those who are immuno-compromised by high steroid use, as many of us are. Its symptoms feel like a really bad asthma attack that doesn't respond to conventional treatments.  I had never heard of this disease until I was diagnosed, but I will say that it resulted in the worse asthma flare I've yet had, and it was not responding to treatment. I am now taking antifungal drugs to treat it, along with prednisone. I understand that the antifungal therapy takes four to six months, and that I have to have regular liver function tests while on the antifungals.

I did a search on the site and did not see a topic addressing this condition, so I thought I'd put something out there for discussion. Since I have been asthmatic for over twenty years, thought I was pretty knowledgeable about asthma in general, and I just learned about this, are there others out there who may need to learn more about ABPA? Is anyone dealing with this, or have they dealt with it in the past? 

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  • Jen

    Brian – While it's nice to have an answer for why your asthma wasn't responding to conventional treatments, having one more thing to deal with isn't always so fun.  How are things going with taking the new medicine?

  • Brian Cushing

    Thanks for responding, Jen. I'm only in my second day of medication, so it's too early to really tell. I'm still on high dose prednisone (60 mgs) and using my nebulizer a lot. But at least I know what I'm dealing with now.

    It's interesting, though, that my allergist never tested me for blood antibodies for this fungus. He was just assuming I was having another severe exacerbation and we were trying to treat it accordingly. When it was clear that the usual treatment wasn't working, he referred me to the pulmonologist, who ran the test. My blood had well over 2.5 times the normal antibodies! The lesson here is that sometimes a second opinion is critical, especially if your asthma stops responding to your normal course of action during a flare. I think that we moderate to severe asthmatics should be aware of this disease or, as just happened to me, the right course of treatment might be delayed, which can result in a more extended period of discomfort and also serious lung damage. 

  • K8sMom2002

    Oh, wow, Brian! This is good to know! I'm really glad you had a pulmo who dug deep and made sure to check under every rock!

    What did the doctor tell you to expect in way of improvement while you're on the anti-fungal medication? Does he expect you'll be able to taper off your prednisone as the anti-fungal meds kick in?

  • Kathy P

    Wow I'm glad the doc decided to check for that when things weren't responding to traditional treatment. I hope the antifungal works quickly. Is this something that can keep flaring in the future or are you cured once the fungal infection is cleared? 

  • Kathy P

    Ok according to this PDF from the American Thoracic Society, the disease can go into remission, but there is no complete cure.

  • Brian Cushing

    Thanks for the article, Kathy. It's very enlightening but also a bit discouraging. I'm hoping it doesn't take 3-6 months to get relief! I've really struggled with this over the past few weeks. I know I have to take the anti-fungal medication for at least four months, and that I have to have weekly blood tests for liver and kidney function for the next four weeks. 

  • Brian Cushing

    I think when they say it only goes into 'remission' they mean that my sensitivity to the aspergillus fungus will never leave me. Since this fungus is pretty much everywhere in the environment, it's pretty hard to avoid. 

  • Kathy P

    I hope it doesn't take that long too! That you'll feel loads better quickly. I know when my son was dealing with chronic sinusitis/infection, was he'd feel mostly better fairly quickly, but would relapse if we didn't keep up with the meds. It seems like this may be similar in that you need to take the meds for an extended time to really make sure things are settled down.Hugs on having to deal with one more thing that needs to be managed.

  • Kathy P

    That's how I read it too. And that's basically what we deal with regarding my son's sinusitis. It's a bacteria that is always there – it stays in check most of the time, but when the "environment is right," meaning he has any kind of inflammation or mucus build up, overgrowth occurs.

  • Shea

    I want to get the blood test to check for this. I have been on steroids a long time, and always have this wheeze on my exhale, and I have worked hard to eliminate triggers in my home, but if I have a fungus in my lungs, I want to kick it out with an antifungal med!!!… That might help me manage on a lower dose of prednisone or even get off completely. Do you know the name of the lab test you had run?.. If not, no big deal, I will ask my doc. Thanks for putting this information on here!

    As far as avoiding fungus in home, I hear tea tree oil and eucalyptus are goid things to regularly clean with and even air diffuse, although you should personally see if it bothers your asthma before doing .. because they are antifungal, antiviral, anti-mold. Also HEPA air purifier may be helpful in the bedroom if you do not have one… because even if you can avoid ut while you sleep and in your home that seems like it should help!

  • K8sMom2002

    Shea, I'm glad you have found another clue to follow up on! Let us know what your doctor says!

  • K8sMom2002

    Brian, how goes the fight against fungals? I'm hoping that the meds are beginning to kick in and you can at least see a little improvement.

    Shea, have you talked to your doctor about checking for this?

  • Shea

    I havent called yet, I have labs scheduled at the end of the month and a followup appointment, so I will call her to see if we can add a test for this too.

  • Brian Cushing

    I'm in the hospital on IV steroids and a antibiotics. I couldn't maintain my pulse ox above 90 at home. Still cannot without supplemental O2. Very sick.,

  • Kathy P

    Oh no @Brian Cushing ! I hope the doctors can quickly get a handle on things. We are thinking of you. Keep fighting.

  • Melanie Carver

    @Brian Cushing I hope the IV treatments have started to make an improvement.  Sending warm, healing thoughts your way. We're here for you. 

  • LyndaM

    Brian, I am so sorry to hear you are so sick! I wish you the best in a quick recovery and to be able to breathe comfortably and to feel better.

    Warmly,

    Lynda

  • Jen

    @Brian Cushing I hope that the meds are starting to help and that you are on the road to feeling better.  Hang in there!

  • Kathy P

    Brian – hoping that you are getting rest and that the meds are beginning to work. Thinking of you. 

  • K8sMom2002

    Brian, hope you're hanging in there and that things are going some better! Sending the absolute best warm wishes and good and big, big prayers!

  • K8sMom2002

    @Brian Cushing, checking on you. How goes the recuperation? Did anything change after your hospital stay?