الفهرس 
Bronchial asthmaOnly 14 pages are availabe for public view
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Abstract
Asthma is defined as a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation (GINA, 2014).
Fungal sensitization is common in asthma ; however, if the asthma is well controlled, the patients are classified as asthma associated with fungal sensitization .( Agarwal 2011)
Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus that complicates the course of patients with asthma and cystic fibrosis (CF). (Agarwal etal.2009, Hogan 2011)
It presents with varied clinical and radiological manifestations usually with uncontrolled asthma, recurrent pulmonary infiltrates with or without bronchiectasis.(Shah 2007, Moss 2002, Greenberger etal 1993)
the prevalence of ABPA in patients with asthma ranged from 2.5% to 22.3% with a pooled prevalence of 8.4%.(Agrawal R 2011, Sarkar etal 2010).
The original criteria for the diagnosis of ABPA included bronchial asthma, immediate skin test reactivity to AF, elevated total and AF-specific serum immunoglobulin E (IgE), pulmonary opacities, central bronchiectasis, peripheral blood eosinophilia and positive serum precipitins (IgG) against AF.(Rosenberg 1993 ,Patterson 1986)
According to the existing diagnostic criteria, the most important step in the diagnosis of ABPA is to determine the positive immediate cutaneous reactivity to AF in patients with asthma at an early stage. (Agarwal etal 2009, Agarwal &Chakrabarti A 2013).
Our study is a prospective study conducted on 52 consecutive with bronchial asthma attending the Allergy and Immunology clinic at Ain Shams University hospitals.
Our aim of this study was to determine the prevalence of ABPA in patients with bronchial asthma and to study the clinical ,radiological and laboratory profile in these patient.
We report a prevalence of 21.2% of ABPA patients among all asthma patients included in the study as A. fumigatus skin test positivity in 27 patients, and 11 fulfilled four criteria for diagnosis of ABPA by using skin test rather than serum specific IgE.
Our patients with ABPA did not have higher incidence of associated allergic conditions (urticarial and/or allergic rhinitis) than non- ABPA patients.Also We found that Patients with ABPA can present with normal HRCT of the chest. CB cannot be considered a characteristic feature of ABPA , also bronchiectasis ,nodules may be found in non-ABPA.
In our study cut off value for total IgE was 417 IU/ml. The Patterson criteria, which is still considered as the most frequently used yardstick for diagnosis of ABPA (Rosenberg et al., 1977; Patterson et al., 1986), uses a minimum concentration for total IgE of 1000 IU/ml. However, a recent latent class analysis that evaluated the diagnostic performance of various tests employed in ABPA diagnosis reported that sensitivity and specificity of employing a cut-off value of 417 IU/ml for total IgE is 95.8% and 23.7% respectively (Agarwal et al., 2013b).
Nonetheless, although IgE level demonstrates low specificity in diagnosing ABPA, it is by far the most reliable test used for follow up of patients with ABPA (Agarwal et al., 2010), and a 50% increase in IgE levels may signify an impending exacerbation (Agarwal & Chakrabati, 2013). Our study demonstrates a significantly higher level of total IgE in ABPA patients in comparison to non-ABPA asthmatics.
In conclusion, our study shows the prevelance of ABPA is 21.2% of all asthmatics included in the study, patients with ABPA did not have higher incidence of associated allergic conditions (urticarial and/or allergic rhinitis) than non- ABPA patients and finally Patients with ABPA can present with normal chest Xray or HRCT of the chest.