Allergic Bronchopulmonary Aspergillosis in Acute Severe Asthma-A Cross-sectional Study

Introduction: The prevalence of Allergic Bronchopulmonary Aspergillosis (ABPA) is sparingly studied among asthmatics in Southern India. Aim: To assess the occurrence of ABPA in patients with Acute Severe Asthma and to describe the clinical spectrum of ABPA among them. Materials and Methods: This was a cross-sectional analytical study performed on 150 patients of acute severe asthma, who attended Pulmonary Medicine Department and Emergency Medical Services department in a government tertiary care institute in Southern India; from January 2016 to December 2017 over a period of two years. Patients were evaluated for ABPA using Rosenberg-Patterson criteria. The distribution of data for the categorical variables such as gender of patients, signs and symptoms, radiological parameters etc., was expressed as frequencies and percentages. The comparison of these variables between the groups was carried out by using Chi-square or Fishers-Exact test. The comparison of these variables between the groups was carried out by using independent Students t-test or Mann-Whitney U test whichever was appropriate. All statistical analysis was carried out at 5% level of significance and p-value <0.05 was considered significant. Results: There were 49 males and 101 females (mean age 40.25 +/- 12.8 years). As per Rosenberg Paterson criteria, 31.3% had ABPA-Central Bronchiectasis and 10% ABPA-Seropositive. The occurrence of Aspergillus Hypersensitivity (AH) was 54% (81/150) and occurrence of ABPA was 41.3% (62/150) in acute severe asthma. Conclusion: The study reflects high occurrence of AH and ABPA in severe asthmatics. Such alarming values calls for the use of Skin prick test as a screening tool for evaluation of patients with severe asthma. There is a pressing need for early diagnosis and timely treatment to protect the patients from irreversible lung damage.