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Allergic bronchopulmonary aspergillosis in

Allergic Bronchopulmonary Aspergillosis in
Cystic Fibrosis (ABPA)

What is ABPA?

Aspergillus species is a fungus that often lives in the airways of adolescents and young adults
with cystic fibrosis (CF). When people develop an allergic reaction to aspergillus, it is called
Allergic BronchoPulmonary Aspergillosis. ABPA affects about 2-11% of the people with CF. It
causes inflammation in the lungs and, if untreated, can cause further scarring and fibrosis.
What are the symptoms?

While the symptoms of ABPA are similar to CF symptoms, your health often gets worse
without a reason.
This includes:
Wheezing

How is it diagnosed?

The diagnosis of ABPA in CF is difficult. It may often take longer because many of the criteria
used to diagnose ABPA are the same as the usual symptoms of CF. Below is a list of the criteria.

1. Symptoms that are not related to other problems (see above)
2. Total serum IgE is greater than 500 IU/ml.
3. Immediate positive skin test to Aspergillus species
4. Positive laboratory test (Precipitin to Aspergillus fumigatus or IgG antibody against
Abnormal chest X-ray or change from previous exam 5. Peripheral blood eosinophilia

What factors are linked to with ABPA and CF?

ABPA is more common in males and adolescents. It is also common in people who:
o Are positive for Pseudomonas species What is the treatment for ABPA?

Treatment for ABPA involves prevention and treatment of acute (flare up) episodes. There are
two parts in the treatment of ABPA. Inflammation in the lung is treated with corticosteroids.
Fungal colonization is treated with anti-fungal medicines. Although there is little proof that
antifungal agents are useful in CF patients with ABPA flares, reducing the fungal burden in the
respiratory tract may reduce long term risk of disease progression. Further research is needed.
1. Oral corticosteroid pills or liquid

The anti-inflammatory effects of corticosteroids work well in APBA. The course of medicine is much longer than the short courses used for asthma. The steroids may be used for many weeks and slowly weaned while symptoms and lung function studies are checked. Once all the symptoms have gone away, the steroids are often stopped. The side effects of steroids are related to the amount and length of time on steroids.
2. Antifungal
medicines
Itraconazole (Sporanox ) reduces the amount of fungus in the lungs. This may lower the chance of the disease getting worse over time. It is used 1–2 times a day for about 3–6 months or until all symptoms have gone away. It is better absorbed when taken on an empty stomach. If you are on an acid-reducing medicine, you should take Itraconazole with 8 oz. of a cola drink or orange juice to make sure you are able to absorb all of the medicine. Copyright 7/2005. University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing UWH # 5785

Source: http://www.childrenshospitalofillinois.org/pdfs/specialty-services/cf/germs-infection-control/ABPA-Fact-Sheet.pdf

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4.3.1 Estimating the Width of a Room RevisedThe unconditional analysis of the room width estimated by two groups ofstudents in Chapter˜3 led to the conclusion that the estimates in metres areslightly larger than the estimates in feet. Here, we reanalyse these data in aconditional framework. First, we convert metres into feet and store the vectorof observations in a variable y:R> data("ro

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