Chronic Pulmonary Aspergillosis and Allergic Bronchopulmonary Aspergillosis Diagnosis

Key Distinguishing Features

The European Respiratory Society recommends that chronic pulmonary aspergillosis (CPA) is characterized by chronic cavitary disease, fungal balls, and progressive lung destruction over at least 3 months in patients with underlying structural lung disease 1, 2
The American Thoracic Society notes that the immunologic profile of CPA shows elevated Aspergillus-specific IgG antibodies (positive in >90% of cases), but peripheral eosinophilia is not a feature 1, 3
The Infectious Diseases Society of America states that CPA occurs in non-immunocompromised patients and represents a chronic infection rather than an allergic response 4

The American College of Chest Physicians defines ABPA by peripheral blood eosinophilia as a core diagnostic criterion 5, 6
The European Respiratory Society notes that ABPA results from immune-mediated inflammation in response to inhaled Aspergillus fumigatus antigen, causing pulmonary infiltrates, mucus plugging, and marked eosinophilia 5, 6
Essential diagnostic criteria for ABPA include: asthma or cystic fibrosis, immediate cutaneous reactivity to Aspergillus, elevated total serum IgE (>417 IU/L), elevated Aspergillus-specific IgG and IgE, and peripheral blood eosinophilia 5

The American College of Chest Physicians recommends that treatment for ABPA requires systemic corticosteroids as first-line therapy with antifungals as adjunctive treatment 5
The European Respiratory Society states that CPA requires prolonged antifungal therapy (at least 6 months) without routine corticosteroid use 1
The Infectious Diseases Society of America warns that using corticosteroids in CPA patients can worsen infection and potentially lead to invasive aspergillosis 1

When encountering a patient with suspected pulmonary aspergillosis and peripheral eosinophilia, the American Thoracic Society recommends checking for asthma or cystic fibrosis history, as ABPA occurs almost exclusively in these populations 5
The European Respiratory Society suggests measuring total serum IgE, with levels >417 IU/L supporting ABPA; CPA does not cause IgE elevation 5, 6
The American College of Chest Physicians recommends reviewing imaging for pattern, with central bronchiectasis, mucus plugging, and infiltrates suggesting ABPA, and cavities with fungal balls and pleural thickening suggesting CPA 1, 2, 5, 6