Table VI.

Treatment protocols for the management of allergic bronchopulmonary aspergillosis (ABPA)

Oral glucocorticoids

Prednisolone: 0.5 mg/kg for 4 wk, 0.25 mg/kg for 4 wk, 0.125 mg/kg for 4 wk, then tapered by 5 mg every wk to continue for a total duration of at least 4 months

Indication: First-line treatment of ABPA, both in acute-stage and during exacerbation

Oral azoles

Itraconazole: 200 mg twice a day for 24 wk Indication: Second exacerbation of ABPA; glucocorticoid-dependent ABPA; alternative to glucocorticoids as first-line treatment of ABPA, especially in those with increased propensity for glucocorticoid-related side effects

Follow up and monitoring

Patients are followed up with history and physical examination, chest radiograph, spirometry and measurement of total IgE levels every 8 wk (to determine the new baseline IgE)

Important points

A 25% decline in serum total IgE along with clinical and/or radiological improvement, indicates a satisfactory response to therapy

A clinical or radiological worsening along with a ≥50% increase in the new baseline IgE points to an ABPA exacerbation

Worsening of symptoms in the absence of radiological or immunological worsening (serum total IgE) suggests an asthma exacerbation

Monitor for adverse effects e.g., hypertension, hyperglycaemia, in case of glucocorticoids; nausea, vomiting, diarrhoea, elevated liver enzymes, in case of azoles

Monitor for drug-drug interactions

Prophylaxis for osteoporosis (with glucocorticoid therapy): oral calcium and bisphosphonates

Source: Adapted with permission from Ref.3