Asthmatic pulmonary eosinophilia, also known as asthmatic eosinophilia, bronchocentric granulomatosis, or bronchopulmonary aspergillosis, is characterized by recurrent asthma attacks. Most patients have a personal or family history of allergies, with onset typically occurring between the ages of 40 and 60, and it is more common in women.

bubble_chart Etiology

Most patients are allergic to Aspergillus fumigatus, while some are allergic to Candida, Mongolian snakegourd root, or certain medications. Approximately 80% of patients test positive for Aspergillus fumigatus in skin tests, and elevated IgE and IgG precipitating antibodies can be detected in their serum. When bronchial provocation tests are conducted using Aspergillus fumigatus extracts, a dual antagonistic response may occur, suggesting that the disease involves both type I and type III hypersensitivity reactions. Some also believe that type IV hypersensitivity plays a role.

bubble_chart Pathological Changes

There are plasma cells, monocytes, and a large number of eosinophils infiltrating around the bronchi and alveolar septa. The bronchial mucous glands and goblet cells are hyperplastic, the terminal bronchioles are dilated and filled with sputum, and fungal hyphae can sometimes be found.

bubble_chart Clinical Manifestations

It mostly occurs in middle age and is more common in women. Its clinical symptoms are similar to endogenous asthma, and some patients may expectorate small mucus plugs or bronchial casts containing large numbers of eosinophils and/or fungal hyphae. As the disease progresses, five clinical stages can be observed: ① Acute stage, primarily manifested as asthma, with IgE often greater than 2500 ng/ml, positive skin tests, and chest X-ray changes. ② Stage of remission, with clinical alleviation, normal IgE levels, and X-ray findings. ③ Exacerbation stage, with symptoms similar to the acute stage, or only elevated IgE and new pulmonary infiltrates. ④ Steroid-dependent stage, where asthma symptoms require steroid control, and IgE levels remain elevated. ⑤ Fibrotic stage, often presenting with refractory dyspnea due to fibrosis.

Sputum examination may reveal pale yellow plugs containing Aspergillus fumigatus hyphae and eosinophil mucus. IgE is elevated. Aspergillus fumigatus skin tests and bronchial provocation tests are often positive.

Pulmonary function tests show significant obstructive ventilation dysfunction. Compared to typical bronchial asthma, the reversibility of obstruction in this condition is poorer, making the asthma symptoms more persistent.

bubble_chart Diagnosis

The diagnosis is primarily based on the presence of bronchial asthma manifestations, pulmonary infiltrative changes or accompanying proximal bronchiectasis, increased eosinophils in sputum and blood, positive skin tests for antigens such as Aspergillus fumigatus, and elevated IgE levels or the presence of precipitating antibodies in the blood.

bubble_chart Treatment Measures

Once the diagnosis is confirmed, corticosteroids should be administered immediately, with prednisone at 20-30mg/d until asthma symptoms are relieved and lung shadows disappear. Long-term maintenance therapy can prevent fibrosis, with a common dosage of 7.5mg-15mg/d. Some also use locally inhaled steroids for maintenance treatment, but its effectiveness remains to be determined. Avoid desensitization with Aspergillus fumigatus extracts, as it can cause adverse local reactions and exacerbate symptoms.