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PubMed This is a summary of 87 peer-reviewed journal articles Updated
Pulmonology

Allergic Bronchopulmonary Aspergillosis: A Patient Guide

At a Glance

ABPA is an allergic immune reaction to Aspergillus mold in the airways, usually affecting people with asthma or cystic fibrosis. Early diagnosis and treatment of both inflammation and mold can help prevent permanent lung damage.

Allergic Bronchopulmonary Aspergillosis (ABPA) is a complex lung condition that occurs when your immune system overreacts to a common environmental mold called Aspergillus fumigatus. Unlike a typical infection where a fungus or bacteria invades and damages your body’s tissues, ABPA is fundamentally a hypersensitivity response—an allergy that has become persistent and aggressive [1][2]. In people with ABPA, the immune system views the presence of this mold in the airways as a severe threat, launching an inflammatory response that can lead to significant lung damage if left unmanaged [3].

What ABPA is Not

  • It is not contagious. You cannot pass ABPA or the mold to family members or friends.
  • It is not an invasive infection. The mold lives in the airway mucus; it does not usually invade the lung tissue or spread throughout the body.

This condition is usually associated with individuals who already live with chronic lung diseases, most commonly asthma or cystic fibrosis [4][5]. Because the symptoms—such as wheezing, shortness of breath, and a productive cough—look exactly like a worsening of these underlying diseases, ABPA is frequently misdiagnosed as “poorly controlled” or “refractory” asthma for many years [6][7]. One of the most distinctive signs of this specific allergic battle is the production of thick, rubbery, and often brownish mucus plugs, which can block the small airways and appear as moving shadows on chest X-rays [8][9].

Managing ABPA requires a targeted approach: calming the immune system’s overreaction, reducing the fungal “trigger” in the airways, or sometimes both [2][10]. This typically involves medications to dampen inflammation alongside antifungal treatments to lower the amount of mold living in the lung’s mucus [11][12]. Because ABPA is a relapsing condition, treatment is rarely a one-time event; instead, it is a long-term strategy designed to keep the immune system in check and prevent the disease from flaring back up [6][13].

The most critical goal of long-term care is the prevention of permanent structural damage to the lungs, such as bronchiectasis (widened, scarred airways, which is common if uncontrolled) or, less commonly, fibrosis (thickened lung tissue) [14][1]. Regular monitoring—including blood tests to track allergy markers and breathing tests to check lung function—allows your care team to identify flares and adjust treatment to reduce the risk of irreversible scarring [10][13]. While the prospect of a chronic, relapsing condition can be daunting, an accurate diagnosis is the first step toward a targeted plan that moves beyond simply managing asthma symptoms to addressing the root cause of the allergic response.

In this guide

6 chapters

01

Building Your Understanding of ABPA

Learn what allergic bronchopulmonary aspergillosis (ABPA) is, how Aspergillus triggers lung inflammation, who is at risk, and why mucus plugs may develop.

02

Symptoms, Misdiagnoses, and When to Seek Urgent Care

Learn ABPA symptoms, common misdiagnoses like pneumonia or asthma flares, and when blood in sputum, fever, or severe breathing trouble needs urgent medical care.

03

Testing and the New Diagnostic Standards

Learn how ABPA testing works under the 2024 ISHAM criteria, including IgE, eosinophils, Aspergillus antibodies, CT scans, and what high-attenuation mucus means.

04

Managing Your Treatment and Reducing Steroid Risks

Learn how allergic bronchopulmonary aspergillosis is treated with prednisolone, itraconazole, or biologics, plus monitoring, steroid risks, and safe tapering.

05

Long-Term Monitoring and Preventing Relapse

Learn how allergic bronchopulmonary aspergillosis monitoring prevents relapse through total IgE trends, spirometry, follow-up testing, and a written flare plan.

06

Daily Management and Medication Safety

Learn safety tips for allergic bronchopulmonary aspergillosis, including steroid monitoring, itraconazole instructions, drug interactions, and warning signs.

Common questions in this guide

Is allergic bronchopulmonary aspergillosis an infection or an allergy?
ABPA is mainly an allergic immune reaction to Aspergillus mold in the mucus of the airways, rather than a typical infection. It is not contagious, and the mold usually does not invade lung tissue or spread through the body.
Who is most likely to develop ABPA?
ABPA is most often associated with people who have asthma or cystic fibrosis. A clinician may consider ABPA when breathing symptoms remain difficult to control despite usual treatment.
What symptoms can ABPA cause?
ABPA can cause wheezing, shortness of breath, and a productive cough, so it may look like worsening asthma. Thick, rubbery mucus plugs that may be brownish are a particularly distinctive clue.
How do doctors check for ABPA?
Doctors may combine blood tests that track allergy markers, breathing tests that measure lung function, and chest imaging. Imaging can show mucus plugging or widened airways, and your clinician interprets these findings together with your symptoms and medical history.
How is ABPA treated?
Treatment usually has two goals: calm the immune system’s excessive reaction and reduce the amount of Aspergillus in the airway mucus. Clinicians may use anti-inflammatory medicines and antifungal treatment, with the plan adjusted over time because ABPA can flare again.
Can ABPA cause lasting lung damage?
Uncontrolled ABPA can lead to bronchiectasis, in which airways become widened and scarred, and less commonly to fibrosis, or thickened lung tissue. Ongoing treatment and monitoring can help identify flares and lower the risk of permanent damage.

Questions For You

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Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Does my case follow the classic pattern of hypersensitivity to Aspergillus, or is there any sign of tissue infection?
  2. 2.How do my asthma or cystic fibrosis treatments need to change now that we have identified an allergic reaction to mold?
  3. 3.What is my baseline IgE level, and how often will we monitor it to catch a potential flare-up before my symptoms get worse?
  4. 4.Do I already have signs of bronchiectasis or mucus plugging on my scans, and how will our treatment plan address those?
  5. 5.Which part of my treatment is meant to reduce the fungus, and which part is meant to calm my immune system?

References

References (14)
  1. 1

    A Case of Allergic Bronchopulmonary Aspergillosis With Bronchial Asthma.

    Rajpopat PB, Desai BN, Abro S, et al.

    Cureus 2022; (14(9)):e29552 doi:10.7759/cureus.29552.

    PMID: 36312634
  2. 2

    The Triad of Pathogenesis in Allergic Bronchopulmonary Aspergillosis: Interactions among <italic>Aspergillus fumigatus</italic>, Epithelium, and Immunity.

    Wang Y, Zhang L, Sun Y, Zhang Y

    International archives of allergy and immunology 2025; 1-14 doi:10.1159/000547550.

    PMID: 40738023
  3. 3

    Medical algorithm: Aspergillus fumigatus components in the diagnosis of allergic bronchopulmonary aspergillosis.

    Lukaszewicz R, Mahay G, Boyer O, Martinet J

    Allergy 2022; (77(1)):327-330 doi:10.1111/all.15001.

    PMID: 34252208
  4. 4

    Prevalence of Aspergillus sensitization and allergic bronchopulmonary aspergillosis in cystic fibrosis: systematic review and meta-analysis.

    Maturu VN, Agarwal R

    Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology 2015; (45(12)):1765-78 doi:10.1111/cea.12595.

    PMID: 26177981
  5. 5

    Is the Prevalence of Allergic Bronchopulmonary Aspergillosis Greater in Severe Asthma?

    Sehgal IS, Saxena P, Dhooria S, et al.

    The journal of allergy and clinical immunology. In practice 2024; (12(12)):3269-3273.e1 doi:10.1016/j.jaip.2024.09.002.

    PMID: 39265659
  6. 6

    Clinical Characteristics and Prognosis of Allergic Bronchopulmonary Aspergillosis: A Retrospective Cohort Study.

    Zeng Y, Xue X, Cai H, et al.

    Journal of asthma and allergy 2022; (15()):53-62 doi:10.2147/JAA.S345427.

    PMID: 35046669
  7. 7

    [Allergic bronchopullmonary aspergillosis (ABPA) - an Update].

    Joest M, Klein J, Kütting D, Skowasch D

    Pneumologie (Stuttgart, Germany) 2024; (78(3)):204-214 doi:10.1055/a-1854-3006.

    PMID: 38417459
  8. 8

    Prevalence and Risk Factors of Allergic Bronchopulmonary Aspergillosis and Aspergillus Sensitization in Children with Poorly Controlled Asthma.

    Kumari J, Jat KR, Lodha R, et al.

    Journal of tropical pediatrics 2020; (66(3)):275-283 doi:10.1093/tropej/fmz066.

    PMID: 31580457
  9. 9

    A Case of Endobronchial Aspergilloma Coexisting With Lung Adenocarcinoma.

    El Hage H, Fagel L

    Cureus 2020; (12(11)):e11736 doi:10.7759/cureus.11736.

    PMID: 33403168
  10. 10

    2024 imaging criteria for allergic bronchopulmonary aspergillosis: which diagnostic cut-offs? Are chest radiograph and CT comparable?

    Dournes G, Benlala I, Berger P

    The European respiratory journal 2025; (65(4)) doi:10.1183/13993003.00089-2025.

    PMID: 40180359
  11. 11

    Clinical Manifestation and Treatment of Allergic Bronchopulmonary Aspergillosis.

    Agarwal R, Muthu V, Sehgal IS

    Seminars in respiratory and critical care medicine 2024; (45(1)):114-127 doi:10.1055/s-0043-1776912.

    PMID: 38154470
  12. 12

    A randomised trial of voriconazole and prednisolone monotherapy in acute-stage allergic bronchopulmonary aspergillosis complicating asthma.

    Agarwal R, Dhooria S, Sehgal IS, et al.

    The European respiratory journal 2018; (52(3)) doi:10.1183/13993003.01159-2018.

    PMID: 30049743
  13. 13

    [Development in diagnostic criteria for allergic bronchopulmonary aspergillosis].

    Ma YF, Ma YL, Chen X, et al.

    Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases 2023; (46(6)):624-631 doi:10.3760/cma.j.cn112147-20221124-00925.

    PMID: 37278181
  14. 14

    Clinical characteristics of allergic bronchopulmonary aspergillosis in patients with and without bronchiectasis.

    Wang S, Zhang J, Zhang C, Shao C

    The Journal of asthma : official journal of the Association for the Care of Asthma 2022; (59(6)):1162-1168 doi:10.1080/02770903.2021.1904979.

    PMID: 33730986

This patient guide is for informational purposes only and does not constitute medical advice. A pulmonologist or other clinician should interpret your symptoms, test results, and treatment plan.