Information de reference pour ce titreAccession Number: | 00002953-200007000-00018.
|
Author: | Eaton, Tam MB, ChB; Garrett, Jeffrey MB, ChB; Milne, David MB, ChB; Frankel, Anthony MB, ChB; Wells, Athol U. MB, ChB
|
Institution: | *From the Green Lane Hospital, Auckland, New Zealand.
|
Title: | Allergic Bronchopulmonary Aspergillosis in the Asthma Clinic*: A Prospective Evaluation of CT in the Diagnostic Algorithm.[Article]
|
Source: | Chest. 118(1):66-72, July 2000.
|
Abstract: | Objective: Allergic bronchopulmonary aspergillosis (ABPA) occurs in cases of atopic asthma and may result in important lung disease. Early diagnosis is essential as this disease is responsive to steroids. However, while asthma is common, ABPA is infrequently diagnosed. CT allows precision in the diagnosis of central bronchiectasis (which is virtually pathognomonic of ABPA) and may enable earlier diagnosis.
Design: A prospective evaluation of 255 patients with asthma for ABPA, using skin prick testing (SPT) for Aspergillus fumigatus (AF) as a screening tool and incorporating CT into the diagnostic algorithm.
Setting: Asthma clinic, Green Lane Hospital, Auckland, New Zealand.
Participants: Patients with asthma.
Interventions: ABPA was diagnosed using "essential" criteria (ie, asthma, SPT positivity to AF, elevated serum total IgE, elevated serum AF-specific IgE, and pulmonary infiltrates seen on chest radiography or central bronchiectasis seen on CT scan) and "minimal essential" criteria (ie, asthma, SPT positivity, and central bronchiectasis).
Measurements and results: Two hundred fifty-five consecutive patients with asthma who consented to SPT were studied: 218 of 255 patients (86.8%) were atopic; and 47 of 255 patients (21.6%) were AF-positive, of whom 35 accepted further evaluation including CT scanning. A secure diagnosis of ABPA, satisfying all essential criteria, was evident in 9 of 35 patients (25.7%), a proportion that increased to 13 of 35 patients (37.1%) by using the minimal essential diagnostic criteria.
Conclusions: SPT positivity to AF was present in approximately 20% of patients in the asthma clinic. A diagnosis of ABPA is disclosed by CT in 25 to 40% of SPT-positive patients, depending on the selection of diagnostic criteria. These findings support the use of SPT as a screening tool in the asthma clinic and indicate that a routine CT scan is warranted in SPT-positive patients.
Copyright (C) 2000 by the American College of Chest Physicians
|
Author Keywords: | allergic bronchopulmonary aspergillosis; asthma; CT; skin prick testing.
|
References: | 1 Greenberger PA, Patterson R. Allergic bronchopulmonary aspergillosis and the evaluation of the patient with asthma [editorial]. J Allergy Clin Immunol 1988; 81:646-650
2 Schwartz HJ, Greenberger PA. The prevalence of allergic bronchopulmonary aspergillosis in patients with asthma, determined by serological and radiological criteria in patients at risk. J Lab Clin Med 1991; 117:138-142
3 Greenberger PA, Miller TP, Roberts M, et al. Allergic bronchopulmonary aspergillosis in patients with and without evidence of bronchiectasis. Ann Allergy 1993; 70:333-338
4 Rosenberg M, Patterson R, Mintzer R, et al. Clinical and immunological criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med 1977; 86:405-414
5 Greenberger P, Patterson R. Diagnosis and management of allergic bronchopulmonary aspergillosis. Ann Allergy 1986; 56:444-448
6 Scadding JG. The bronchi in allergic aspergillosis. Scand J Respir Dis 1967; 48:372-377
7 McCarthy DS, Simon G, Hargreave FE. The radiological appearances in allergic bronchopulmonary aspergillosis. Clin Radiol 1970; 21:366-375
8 Currie DC, Goldman JM, Cole PJ, et al. Comparison of narrow section computed tomography and plain chest radiography in chronic allergic bronchopulmonary aspergillosis. Clin Radiol 1987; 38:593-596
9 Neeld DA, Goodman LR, Gurney JW, et al. Computerized tomography in the evaluation of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis 1990; 142:1200-1205
10 Angus RM, Davies M-L, Cowan MD, et al. Computed tomographic scanning of the lung in patients with allergic bronchopulmonary aspergillosis and in asthmatic patients with a positive skin test to Aspergillus fumigatus. Thorax 1994; 49:586-589
11 Grenier P, Maurice F, Musset D, et al. Bronchiectasis: assessment by thin-section CT. Radiology 1986; 161:95-99
12 Hansell DM, Wells AU, Rubens MB, et al. Bronchiectasis: functional significance of areas of increased transradiancy on expiratory computed tomography. Radiology 1994; 193:369-374
13 Reiff DB, Wells AU, Carr DH, et al. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. AJR Am J Roentgenol 1995; 165:261-267
14 Wang JLF, Patterson R, Rosenberg M, et al. Serum IgE and IgG antibody activity against Aspergillus fumigatus as a diagnostic aid in allergic bronchopulmonary aspergillosis. Am Rev Respir Dis 1978; 117:917-927
15 Ricketti AJ, Greenberger PA, Patterson R. Immediate-type reactions in patients with allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol 1983; 71:541-545
16 American Thoracic Society. Definitions and classification of chronic bronchitis, asthma and pulmonary emphysema. 1962; 85:762-768
17 Safirsten BH, D'Souza MF, Simon G, et al. Five year follow-up of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis 1973; 108:450-459
18 Patterson R, Greenberger PA, Lee TM, et al. Prolonged evaluation of patients with corticosteroid-dependent asthma stage of allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol 1987; 80:663-668
19 Benatar SR, Keen GA, Du Toit Naude W. Aspergillus hypersensitivity in asthmatics in Cape Town. Clin Allergy 1980; 10:285-291
20 Schwartz HJ, Citron KM, Chester EH, et al. A comparison of the prevalence of sensitization to aspergillus antigens among asthmatics in Clevedon and London. J Allergy Clin Immunol 1978; 62:9-14
21 Wang JL, Patterson R, Roberts M, et al. The management of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis 1979; 120:87-92
22 Kauffman HF, Tomee JFC, van der Werf TS, et al. Review of fungus-induced asthmatic reactions. Am J Respir Crit Care Med 1995; 151:2109-2116
|
Language: | English.
|
Document Type: | Clinical Investigations: Asthma.
|
Journal Subset: | Clinical Medicine.
|
ISSN: | 0012-3692
|
NLM Journal Code: | 0231335, d1c
|
Annotation(s) | |
|
|