Burden of Allergic Bronchopulmonary Aspergillosis (ABPA) in the India bronchiectasis registry

Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a severe allergic inflammatory response to Aspergillus fumigatus and is often an unrecognized cause for bronchiectasis. Aims and Objectives: In this study, we aim to examine the burden of ABPA in the India bronchiectasis registry, the screening test perform and the phenotype characterization. Material and Methods: Among the 2197 cases of bronchiectasis enrolled in the Indian bronchiectasis registry, we examined the number of patients screened for ABPA and the proportion of screened positive ABPA cases. We also looked for phenotypic characterization using HRCT features, total IgE, eosinophil count, IgE and IgG specific to aspergillus and by skin prick test. Results: Out of 2197 cases of bronchiectasis cases register at 31 sites, only 387 (17%) cases were screened for ABPA 190 (49.1%) at 24 sites. Among these 190 cases, 99(52.1%) of all ABPA cases were male (mean age 44.85 ± 15.09 yr). 62.03% had the bronchiectasis for more than five years. Serum eosinophil count was raised in 115(60.5%) out of 146 (76.84%) cases. Raised IgG level was observed in 71 (74.74%) out of 95 (50%) cases. Specific IgE to aspergillus was raised in 117 (84.17%) out of 139 (73.16%) cases. Aspergillus skin prick test was tested positive in 83 (83%) out of 100 (52.63%) cases. Total IgE count was raised in 97 (54.19%) cases out of 179 (94.2%). Obstructive airways disease was found in 74 (52.5%) out of 141 (74.21%) cases tested by spirometry. The right middle lobe was involved in 66.32% cases in HRCT. Conclusion: Despite the universal screening for ABPA recommended by the ERS, only 17% were screened for ABPA of which 50% showed evidence of underline ABPA.