Allegic Bronchopulmonary Aspergillosis

I am 64 years old and have had Asthma since the age of 2.  I was told today that I had Allergic Bronchopulmonary Aspergillosis.  I was also told that a very samll sac has formed in the upper right lung.  The doctor told me that he wanted to watch it for a year to make sure it does not grow.  He is not sure how long I have had this problem.  I did read today that this could cause death.  I was surprised that the doctor did not tell me to take any medicine.  I am not sure what to do.  

[National Jewish Health]

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.

Good luck.