Treatment of Allergic Bronchopulmonary Aspergillosis During Pregnancy

Managing acute-stage or treatment-dependent ABPA requires careful adaptation when the patient is pregnant. Certain standard therapies used outside pregnancy carry risks and must be reconsidered, making the treatment approach in this population distinct.

Clinical scenario: Allergic bronchopulmonary aspergillosis in a pregnant patient presenting with active (acute-stage) disease or with ongoing treatment-dependent ABPA requiring continued therapy throughout pregnancy.

Treatment approach: Systemic glucocorticoids are the cornerstone of management in this setting. However, important restrictions apply — specific classes of agents commonly considered for ABPA are not used during pregnancy.

The full structured regimen — including agent selection, sequencing, and all relevant restrictions — is available via the complete protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1183/13993003.00061-2024

We recommended using systemic glucocorticoids (in the same doses as for non-pregnant) for managing acute-stage or treatment-dependent ABPA in pregnancy (LoC: 73.0%).

We recommend avoiding the use of biological agents (LoC: 86.5%) or oral azoles (LoC: 100%) for managing acute-stage or treatment-dependent ABPA in pregnancy.

Oral glucocorticoids for the duration and dose required in ABPA are safe in pregnancy, while the use of oral itraconazole is associated with a higher risk of premature births and abortions.

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