🌿 The Different Forms of ABPA

Understanding Your Diagnosis and What It Means

Allergic Bronchopulmonary Aspergillosis (ABPA) is a condition where your immune system overreacts to a fungus called Aspergillus fumigatus, which can be found in air, soil, and compost. This allergic reaction happens mostly in people with asthma or bronchiectasis.

But not everyone with ABPA has the same experience. Doctors now recognise that ABPA can appear in several different forms or stages, depending on how far it has progressed and what’s happening in your lungs.

Here’s a simple guide to help you understand where you might fit — and what it means for your care.

---

✅ 1. ABPA-S (Serologic ABPA) — The early stage

This is the mildest form of ABPA. It means your immune system is reacting to Aspergillus, but your lungs haven’t been damaged yet.

What’s usually found:

• High levels of IgE (allergy antibodies)

• Positive test for Aspergillus-specific IgE

• Normal or near-normal scans (X-ray or CT)

• Asthma or mild chest symptoms

🟢 This form is often picked up with blood tests before any permanent changes in the lungs happen.

---

🟠 2. ABPA-CB — ABPA with Central Bronchiectasis

This is a more typical form of ABPA, where the ongoing allergic reaction has started to damage your airways. “Bronchiectasis” means some airways have become widened and scarred.

What’s usually found:

• All of the features above plus

• Changes on a CT scan showing central bronchiectasis

• More mucus, coughing, or breathlessness

🟠 This form may need regular treatment to reduce inflammation and protect the lungs.

---

🔴 3. Severe ABPA — ABPA with frequent flares

This isn’t a separate type, but a more active or harder-to-control version of ABPA.

What’s usually happening:

• Frequent flare-ups (exacerbations)

• Need for ongoing steroids or antifungals

• Possible use of biologic medicines (e.g. Xolair/omalizumab)

• More serious asthma symptoms

🔴 This form can still be well-managed, but needs close monitoring and a good treatment plan.

---

⚠️ 4. ABPA-CPF — ABPA with Lung Scarring (Fibrosis)

This is the late stage of ABPA, where ongoing inflammation over many years has caused permanent damage to the lungs. It’s now much rarer thanks to earlier diagnosis and treatment.

What’s usually found:

• Extensive scarring or fibrosis on lung scans

• Breathlessness or tiredness

• May overlap with another condition called chronic pulmonary aspergillosis (CPA)

⚠️ This stage needs careful support, but many people can still manage symptoms and improve quality of life.

---

📈 How doctors track your ABPA

Some doctors will also use stages to describe how your ABPA is behaving, though this does not comply with the most recent guidelines (ISHAM 2024):

• Stage 0 – No symptoms, but abnormal blood test

• Stage 1 – Newly diagnosed (active symptoms)

• Stage 2 – Responding to treatment

• Stage 3 – In remission (no active disease)

• Stage 4 – Flare-up

• Stage 5 – Long-term lung damage (fibrosis)

---

🩺 Why this matters to you

Knowing what form of ABPA you have helps you and your healthcare team:

• Choose the right treatments

• Decide how often you need scans or blood tests

• Spot early signs of flare-ups

• Protect your lungs from long-term damage

---

💬 Final message:

No matter which form you have, there are treatments that work. Many people with ABPA live full lives with the right support.
If you’re unsure what form of ABPA you have, ask your doctor — it can help you understand what to expect and how to take care of your lungs.