The diagnostic criteria for allergic bronchopulmonary aspergillosis in children with poorly controlled asthma need to be re-evaluated

Abstract

Aim: The aim of this study was to examine the association between allergic bronchopulmonary aspergillosis (ABPA) and poorly controlled asthma in children and appraise the diagnostic criteria.

Methods: The study included 100 children with poorly controlled asthma. We diagnosed ABPA using the Aspergillus skin test, pulmonary function test, total and specific immunoglobulin E (IgE) to Aspergillus fumigatus, chest radiograph and high-resolution computed tomography. Patients were diagnosed and classified according to the Rosenberg-Patterson criteria for ABPA. The cut-off value for total serum IgE was calculated by receiver operating characteristics curve analysis.

Results: Of 100 children with poorly controlled asthma, 26 patients were ABPA positive. There was a significant difference in the forced expiratory volume in 1-sec/forced vital capacity ratio between ABPA positive (0.78 ± 0.14) and negative (0.87 ± 0.15) children (p = 0.008). ABPA positive children were categorised as seropositive, central bronchiectasis and other radiological findings. The receiver operating characteristics curve was constructed, and a value of 1200 IU/mL of total IgE was observed, with 88.5% sensitivity and 70.5% specificity.

Conclusion: This study showed an association between ABPA and poorly controlled asthma in children and suggests a higher cut-off value of total IgE for the diagnosis of ABPA.

Keywords: Airway inflammation; Allergy; Asthma.