The ideal criteria for diagnosing allergic bronchopulmonary aspergillosis (ABPA) remains unknown because of the lack of a gold standard. Latent class analysis (LCA) using a probabilistic modeling technique can circumvent the need for a reference standard.
To compare the diagnostic performance of various criteria used for evaluating ABPA.
We prospectively enrolled consecutive cases of bronchial asthma and performed a series of investigations used for the diagnosis of ABPA. We used LCA to analyze the performance of various existing and novel diagnostic criteria.
Of the 543 subjects (mean age, 37 years; 319 women), 338 (62.2%), and 205 (37.8%) were labeled as ‘mild-to-moderate’ and ‘severe’ asthma, respectively. The subjects with severe asthma had a longer duration of asthma and a higher number of exacerbations in the previous year. The prevalence of Aspergillus fumigatus sensitization was 41% and 30%, using the A.fumigatus-specific IgE and skin test, respectively. The prevalence of ABPA was 16%, using both the Rosenberg-Patterson and the ISHAM-ABPA working group criteria. The ISHAM criteria were slightly more sensitive (99% vs. 98%) and specific (89% versus 81%) than the Patterson criteria. We obtained optimal diagnostic performance by altering the existing ISHAM criteria (serum total IgE >500 IU/mL, excluding the skin test, and using CT thorax instead of chest radiograph).
The ISHAM-ABPA working group criterion was only marginally better than the Patterson criteria in diagnosing ABPA among asthmatics <66 years of age. The diagnostic performance however improved by modifying the prevailing ISHAM criteria, but with increased cost.
Copyright © 2020. Published by Elsevier Inc.