Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management

Denning, David W., Cadranel, Jacques, Beigelman-Aubry, Catherine, Ader, Florence, Chakrabarti, Arunaloke, Blot, Stijn, Ullmann, Andrew J., Dimopoulos, George and Lange, Christoph (2016) Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. European Respiratory Journal, 47 1: 45-68. doi:10.1183/13993003.00583-2015

Author Denning, David W.
Cadranel, Jacques
Beigelman-Aubry, Catherine
Ader, Florence
Chakrabarti, Arunaloke
Blot, Stijn
Ullmann, Andrew J.
Dimopoulos, George
Lange, Christoph
Title Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management
Journal name European Respiratory Journal   Check publisher's open access policy
ISSN 0903-1936
Publication date 2016-01-01
Sub-type Article (original research)
DOI 10.1183/13993003.00583-2015
Open Access Status Not Open Access
Volume 47
Issue 1
Start page 45
End page 68
Total pages 24
Place of publication Lausanne, Switzerland
Publisher European Respiratory Society
Language eng
Formatted abstract
Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ∼240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up.
Keyword Allergic bronchopulmonary aspergillosis
Long-term outcomes
Georges respiratory questionnaire
Bronchial artery embolization
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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