title: An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus.
abstract: OBJECTIVE
  Allergic bronchopulmonary aspergillosis (ABPA) is classified radiologically based on the findings of central bronchiectasis (CB) and other radiologic features (ORF). However, the long-term clinical significance of these classifications remains unknown. We hypothesized that the immunological activity and outcomes of ABPA could be predicted on HRCT chest finding of high-attenuation mucus (HAM), a marker of inflammatory activity. In this study, we evaluate the severity and clinical outcomes of ABPA with different radiological classifications.
  
  
  METHODS
  PATIENTS WERE CLASSIFIED BASED ON CT CHEST FINDINGS AS: (a) serologic ABPA (ABPA-S) and ABPA-CB; (b) ABPA-S, ABPA-CB, and ABPA-CB-ORF; and, (c) ABPA-S, ABPA-CB and ABPA-CB-HAM. The clinical, spirometric and serological (total and A fumigatus specific IgE levels, eosinophil count) severity of the disease and clinical outcomes in various classifications were analyzed.
  
  
  RESULTS
  Of the 234 (123 males, 111 females; mean age, 34.1 years) patients, 55 (23.5%) had normal HRCT, 179 (76.5%) had CB, 49 (20.9%) had HAM, and 27 (11.5%) had ORF. All immunological markers were consistently higher in the HAM classification, while in other classifications these findings were inconsistent. On multivariate analysis, the factors predicting frequent relapses were presence of HAM (OR 7.38; 95% CI, 3.21-17.0) and CB (OR 3.93; 95% CI, 1.63-9.48) after adjusting for ORF.
  
  
  CONCLUSIONS
  The classification scheme based on HAM most consistently predicts immunological severity in ABPA. Central bronchiectasis and HAM are independent predictors of recurrent relapses in ABPA. Hence, HAM should be employed in the radiological classification of ABPA.
authors.affiliation: Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India. riteshpgi@gmail.com
authors.forename: Ritesh
authors.initials: R
authors.lastname: Agarwal
authors.forename: Ajmal
authors.initials: A
authors.lastname: Khan
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Gupta
authors.forename: Ashutosh N
authors.initials: AN
authors.lastname: Aggarwal
authors.forename: Akshay K
authors.initials: AK
authors.lastname: Saxena
authors.forename: Arunaloke
authors.initials: A
authors.lastname: Chakrabarti
mesh_terms: D000328:Adult; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis* / Q000276:immunology*; D001232:Aspergillus fumigatus / Q000378:metabolism; D005260:Female; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009093:Mucus / Q000000981:diagnostic imaging; D015272:Pulmonary Medicine / Q000379:methods; D012008:Recurrence; D013147:Spirometry / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome