Treatment of ABPA Without Bronchiectasis When Asthma Control Remains Poor

This protocol addresses patients with allergic bronchopulmonary aspergillosis who do not have bronchiectasis (serological ABPA, ABPA-S) but continue to have poor asthma control or recurrent exacerbations despite optimal asthma management.

Clinical Scenario

ABPA-S refers to patients with ABPA without bronchiectasis. In this subgroup, systemic treatment is indicated specifically when asthma control is inadequate or when exacerbations recur despite optimised asthma therapy — not routinely in all ABPA-S patients.

Treatment Approach (Partial)

When systemic therapy is warranted in ABPA-S, the approach involves a class of oral agents targeting either the inflammatory response or the fungal burden. Specific selection, dosing, and duration require the full structured regimen.

Full protocol details — including agent selection, sequencing, and monitoring — are available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1183/13993003.00061-2024

ABPA-S refers to patients of ABPA without bronchiectasis, while ABPA-B includes patients with bronchiectasis.
ABPA-S should be treated with systemic therapy only if there is poor asthma control (LoC: 79.4%) or recurrent exacerbations despite asthma therapy (LoC: 85.3%).
However, oral glucocorticoids or azoles may be required in those with poor asthma control or recurrent exacerbations despite optimal asthma management.

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