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ABPA
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ABPA

I was told on Thursday that I had ABPA and also a fungus ball.  I have had asthma since I was 2 years old.  My asthma has been under controlled for the last 30 years.  I can not remember the last time I had an attack of asthma.  I was very shocked to find out that I had ABPA.  The doctor said he just wanted to watch it and did not give me any new medicine.  I am taking Flovent  2 puffs in the AM and two puffs at night.  I am also taking Serevent 1 puff in the AM and 1 puff at night.  I also take Pro Air for emergency.  I walk and hike when I have a chance.  I am 64 years old.  I was wondering if I should be doing anything for the ABPA?  Should I expect my asthma to get worse.  Is there any medicine I should be taking.  The doctor is not sure how long I have had this condition.  Back in 2003 and before that some things showed up in X rays.  This past month I had a ct and blood test done.  The resuts was that I had ABPA. in the upper part of my right lung.


Thank you for your help.

PJ
Tags: fungus
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This is an excellent question but also a complex question that cannot be answered definitively, in this forum.  Aspergilla as a cause of lung or sinus disease, is generally categorized in one of 2 ways:  invasive or allergic/non-invasive.  The invasive form is always a very serious matter that requires treatment with antifungal agents.  The allergic form, called allergic bronchopulmonary aspergillosis (ABPA) in its mildest form is relatively benign.  When severe, it can cause bronchiectasis or, as a result of severe inflammation, result in destruction of airways and other lung tissue.  The distinction between the invasive and the non-invasive forms is usually fairly clear, but not always.

You say that your doctor described the formation of “a small sac “ in the upper portion of the right lung and his advice that it be carefully observed is sound.  It would be most important to determine if the “small sac” is evidence of bronchiectasis or indicative of an aspergillosis cavity, seen with invasive disease.  This may require direct consultation of your physician with the radiologist and/or consultation with a lung specialist, also known as a pulmonologist.  It is important to note that blood tests, called antigen-based assays, are now available to facilitate the diagnosis of probable invasive aspergillosis and obviate the need for an invasive surgical procedure.  You should ask your doctor if he is familiar with the spectrum of disease caused by Aspergilla and has had experience with the management of it.  If not, both he and you might want to opt for additional consultation, as noted above, now.  The consultants to be considered might include an infectious disease specialist.

The additional information that you have a fungus ball puts your statement about a “sac” in a different light.  A fungus ball is not an invasive form of Aspergilla and is generally deemed to be benign.  In many cases, the fungus ball is opportunistic.  That is, it grows in a pre-existing cyst, also benign, that was not caused by the Aspergilla, but by another disease process.

Fungous balls ordinarily do not call for either surgical or medical therapy.

ABPA is often associated with worsening of one’s asthma.  That is one reason to increase the asthma therapy.  There are other well established criteria to treat or not to treat ABPA with systemic corticosteroids; criteria that your doctor or pulmonologist would be familiar with.

Good luck.
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