Allergic Bronchopulmonary Aspergillosis: Causes, Symptoms, and Treatment

Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.

What kind of doctor treats Allergic Bronchopulmonary Aspergillosis?

An allergist (a doctor who treats allergies) or a pulmonologist (a lung doctor) usually treats ABPA. ABPA is often found when asthma keeps getting worse despite treatment. Testing usually involves blood tests and chest scans. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.

What is Allergic Bronchopulmonary Aspergillosis?

Allergic bronchopulmonary aspergillosis, or ABPA, is an allergic reaction to a common mold called Aspergillus fumigatus. This mold lives in soil and on decaying plants. Most people breathe it in without any problem. In some people with asthma or cystic fibrosis, the mold grows in the airways. Then the immune system overreacts and inflames the airways. This can damage the lungs over time.

ABPA is not an infection that spreads from person to person. It is an allergic reaction that needs long-term monitoring and sometimes prolonged treatment.

Symptoms

ABPA usually shows up as asthma that keeps getting worse. Other signs include:

  • Wheezing and shortness of breath.
  • A cough that brings up thick, brown mucus plugs.
  • Coughing up blood.
  • Fever and general weakness.
  • Chest pain.

Causes and who gets it

The cause is an allergic reaction to the mold Aspergillus fumigatus. It grows in soil and on decaying plants. ABPA happens when the immune system overreacts to this mold in the airways. It most often affects people with asthma or cystic fibrosis. Many people with asthma react to the mold on testing, but only some of them develop ABPA. Doctors diagnose it more often in adults than in children.

How doctors diagnose it

No single test confirms ABPA. Doctors look at symptoms, blood tests, and chest scans together. Blood tests check for high levels of IgE, an allergy antibody. Doctors also count eosinophils, cells that rise as part of an allergic reaction. Skin testing shows whether the immune system reacts to the mold. A CT scan, a detailed picture of the chest, may show mucus plugs and bronchiectasis. Bronchiectasis means the breathing tubes stay widened and damaged. Doctors also check lung function with spirometry, a simple breathing test.

Treatment

The first-line treatment is a steroid pill, such as prednisone or prednisolone. Steroids calm the airway swelling and help prevent lung damage. For people who keep having flares, doctors may add itraconazole. This antifungal pill lowers the amount of mold in the airways. It can harm the liver and it interacts with other medicines, so doctors monitor it closely.

A shot called omalizumab blocks IgE and helps some people with severe ABPA. It is approved for allergic asthma, not for ABPA itself. Inhaled steroids may help control asthma, but they do not replace the steroid pills. Doctors track blood IgE levels over time, because rising levels may signal a flare. Avoiding damp, moldy places may also help. Both kinds of medicine can have side effects, so doctors watch you closely during treatment.

When to see a doctor

Call 911 or go to the emergency room if you have trouble breathing, chest pain or discomfort lasting two minutes or more, or you cough up blood. Tell a doctor right away if you cough up thick brown mucus plugs or your asthma symptoms keep getting worse. Also see a doctor if your asthma is getting worse even with treatment. If you are diagnosed with ABPA, regular follow-up helps prevent damage to your lungs.

How a direct primary care or concierge doctor fits in

A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This doctor can check your breathing and blood tests between specialist visits. They can also coordinate your care with an allergist or a pulmonologist.

Common questions

Can ABPA spread to other people?

No. ABPA is an allergic reaction to a mold, not an infection that passes from person to person. You will not catch it from another person.

Can ABPA cause permanent lung damage?

Yes. Without treatment, the swelling and mucus can lead to bronchiectasis and scarring that does not heal. Finding it early and treating it may help protect the lungs.

How is ABPA treated?

Doctors use steroid pills first to calm the swelling. Some people also take an antifungal pill. A biologic shot can help some people with severe disease.

Will ABPA come back?

Yes, it can. ABPA often runs a long course. Many people reach remission with treatment, but flares can return. Doctors check IgE levels and lung function to catch flares early.

Sources

  1. NIH NCBI Bookshelf - Allergic Bronchopulmonary Aspergillosis (StatPearls)
  2. American Academy of Allergy, Asthma and Immunology - Allergic Bronchopulmonary Aspergillosis (ABPA)

Medical Disclaimer

This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.