This protocol addresses patients with extensive bronchiectasis involving ten or more lung segments resulting from allergic bronchopulmonary aspergillosis (ABPA), further complicated by cor pulmonale or chronic type 2 respiratory failure. This constellation defines advanced ABPA and carries a high cardiopulmonary burden.
Advanced ABPA is characterised by the presence of extensive bronchiectasis alongside type 2 respiratory failure or secondary pulmonary hypertension. This subgroup requires a bronchiectasis-directed treatment strategy that goes beyond standard ABPA management.
The protocol involves nebulised mucolytic therapy preceded by a bronchodilator to reduce bronchospasm risk, with additional targeted measures for patients with frequent infective exacerbations or resting hypoxaemia —
DOI: 10.1183/13993003.00061-2024
Finally, advanced ABPA is defined in patients with extensive bronchiectasis and type 2 respiratory failure or secondary pulmonary hypertension (table 3).
Nebulised hypertonic saline (3–7%, 4–5 mL) can reduce sputum viscosity and ease the expectoration of mucus plugs in bronchiectasis patients.
Treatment should be preceded by nebulised salbutamol to minimise the risk of bronchospasm.
Nebulised antibiotics and long-term azithromycin therapy can improve outcomes in ABPA patients with bronchiectasis and frequent infective exacerbations.
LTOT in those with resting hypoxaemia (arterial oxygen tension (PaO2) ⩽55 mmHg) reduces pulmonary hypertension and improves survival in patients with chronic obstructive lung disease.
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