Allergic Bronchopulmonary Aspergillosis (ABPA): The medical nutrition therapy for ABPA

Dharuniha D¹, Jenifer Theresal J², Soundarya S*³

¹III Year B.Sc. Clinical Nutrition, KMC Institute of Paramedical Sciences, Trichy, Tamil Nadu

²Senior Clinical Dietician, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

³Coordinator of Clinical Nutrition, KMC Institute of Paramedical Sciences, Trichy, Tamil Nadu

*Correspondence

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity lung disorder. The lung is affected by fungus aspergillosis fumigates. It is commonly associated with bronchial asthma and can lead to severe respiratory complications. This case study describes a 20-year-old male with a long history of bronchial asthma who presented with breathing difficulty, thick yellow sputum, and severe weakness. Clinical evaluation and investigations confirmed stage IV ABPA accompanied by hypokalemia and severe malnutrition. Radiological findings showed significant lung involvement affecting bronchioles and alveoli. The patient was managed with appropriate medications including corticosteroids, antibiotics, bronchodilators, and potassium supplementation. Nutritional management focusing on adequate calories, protein, antioxidants, and potassium was recommended to improve nutritional status and immunity. This case highlights the importance of early diagnosis, proper medical treatment, and nutritional support in managing ABPA to improve patient outcomes.

Key words: Allergic bronchopulmonary aspergillosis (ABPA); Aspergillosis fumigates

Introduction

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity lung disorder often seen in patients with asthma or cystic fibrosis. It can cause worsening respiratory symptoms, thick sputum, and, in severe cases, malnutrition and electrolytic imbalances. Early diagnosis, appropriate medical treatment, and nutritional support are required to prevent complications. This case highlights a 20yrs/male with long-standing asthma who developed ABPA , with hypokalemia and severe malnutrition. The article is mainly focused on therapeutic nutritional support of the patient.

Etiology

Aspergillus species are molds that are present ubiquitously in the environment, especially in organic matter. There are over 100 species worldwide, but most illnesses are caused by Aspergillus fumigatus, Aspergillus niger, Aspergillus flavus, and Aspergillus clavatus. Infection by Aspergillus species can cause a broad spectrum of illnesses in humans and depends on the immune status of the host.

Epidemiology

Aspergillosis is present in almost 25% asthmatics and 50% of cystic fibrosis patients, but ABPA is not that prevalent. The prevalence of ABPA in asthma and cystic fibrosis is about 13% and 9%, respectively. Worldwide, more than 4 million people are affected by ABPA.

Possible clinical symptoms that can occur

Allergy: The body’s immune system reacts to Aspergillus fungus, causing airway inflammation and asthma-like symptoms. It may lead to coughing, wheezing, and breathing problems.

Pallor: Pallor means the skin becomes pale due to illness, weakness, or reduced oxygen supply in the body. It may occur when chronic infection or fatigue affects blood circulation.

Muscle wasting: Muscle wasting means loss of muscle mass due to long-term illness, poor nutrition, or chronic infection. Patients may become weak and lose weight.

Breathing difficulty: Breathing difficulty (shortness of breath) occurs when the lungs are affected by fungal infection and cannot supply enough oxygen. This makes breathing hard or uncomfortable.

Wheezing: Wheezing is a high-pitched whistling sound during breathing caused by narrowed or inflamed airways in the lungs. It is common in allergic lung conditions.

Cough with sputum: This means coughing that produces mucus or phlegm from the lungs due to irritation or infection of the respiratory tract.

Fever (in rare cases): Fever is an increase in body temperature as the immune system responds to infection or inflammation in the body.

Medications and treatment of the patient

Drug	Dose	Indications
Inj. Augmentin -	1.2mg	To treat bacterial infection
Inj. Pantocid -	40mg	Reduce ulcer stomach acid secretion
Inj. Corts -	50mg	Treat allergic infection
Tab. Azebe -	250mg	Treat bacterial infection
Tab. Mondeslor -	10mg	Treat itchy, runny nose, sneezing
Cap. Abflosr -	200mg	Prevent symptoms of asthma
Tab.Natelu -	75mg	Treat flu
Syp. Grilinctus	5ml	Treat allergic cough
Neb. Budamate -IRES	-	Treat asthma
Neb. Glycohale -IRES	-	Treat airways e.g(COPD)
Syp. Potassium chloride	15ml	Treat hypokalemia
Note: Mg: Milligram, Ml: Millilitter

Drug and nutrient interaction

Drug	Nutrient interaction
Augmentin	Alters gut flora → ↓ vitamin K
Pantoprazole	↓ Vitamin B12, iron, calcium absorption
Hydrocortisone	↓ potassium, ↓ calcium, sodium retention
Azithromycin	Antacids (Mg, Al) ↓ absorption
Montelukast + Desloratadine	No major nutrient interaction
Ambroxol combination	No significant nutrient interaction
Oseltamivir	Food reduces GI irritation
Grilinctus	Avoid alcohol
Budesonide	↓ calcium with long-term use
Glycopyrrolate	Minimal nutrient interaction
Potassium chloride	Avoid excess potassium foods
Note: Low level of vitamins are called us hypovitaminosis : ↓ vitamin K ( Delayed blood clotting, excess bleeding ) ↓ vitamin B12 : ( Megaloblastic anemia, weakness and fatigue ), ↓ potassium (Hypokalemia ), ↓ calcium (Hypocalcemia), Antacids (Mg, Al) ↓ absorption : Antacids containing Magnesium (Mg) and Aluminum (Al) decrease the absorption of some nutrients or drugs

Biochemical data of the patient

Day 16/2/26 biochemical value	Value	Normal value
Hemoglobin	11.2g/dl	15-17
Sodium	138mmol/l	137-145
Potassium	2.1mmol/l	3.5-5
Urea serum	46mg/dl	10-40
Creatinine	0.95mg/dl	0.66-1.25
Day 17/2/26 biochemical value
Potassium	3.5mmol/l	3.5-5
Day 19/2/26 biochemical value
Potassium	2.2mmol/l	3.5-5
Hemoglobin	10.6g/dl	13-17
Day 20/2/26 Biochemical value
Potassium	2.6mmol/l	3.5-5

Note: Gm/dl: Grams per deciliter, Mmol/l, Millimoles per liter, Mg/dl, Milligrams per deciliter.

Potassium	2.1mmol/l (Hypokalemia)
Urea serum	46mg/dl (Uremia)
Hemoglobin	10.6g/dl (Anemia)

Dietary recall of the patient

Day	Early Morning	Breakfast	Mid-Morning	Lunch	Mid Evening	Dinner
Day 1	Tea	Idli (2) + Sambar	Pomegranate juice	Beef biryani	Protein powder (water)	Idiyappam + Sambar
Day 2	Horlicks	Idli (3) + Sambar + Ulundha vadai	Saathukudi juice	Veg kuska	Tea	Chapathi (2) + Idli (2) + Chutney
Day 3	Horlicks	Idli (3) + Sambar	Boiled peanuts	Sambar sadham	Tea	Dosa + Sambar + Coconut chutney
Day 4	Milk	Pongal	—	Sambar sadham	Milk	Idiyappam + Sambar
Day 5	Horlicks	Dosa (2) + Sambar + Chutney	Banana (2)	—	—	—

Calorie(Kcal)	Protein(gm)	Fat(gm)	Carbohydrate(gm)	Fiber(gm)
Day 1
1160.2	63.6	13.06	188.06	29.1
Day 2
1497.7	66.2	11.06	277.06	47.8
Day 3
1562.2	60.2	35	219.3	39.3
Day 4
1455.2	60.7	11.38	241.3	40.4
Day 5
1099.4	40.8	10.71	201.56	29.6

Note: Day 4 calories are low (1455), the patient doesn’t have a lunch, because patient had a blood test. Day 5 calorie is low (1066) calculated only the early morning, breakfast, mid-morning food, afternoon the patient is ready for discharge.

Principle of diet of the patient

Adequate calorie, moderate carbs, high protein, low fat, low
Mainly focused on high protein (weight gain prevents muscle wasting), antioxidants & anti-inflammatory rich food (Treat inflammation and boost the immunity), potassium rich food (Treat hypokalemia) potassium rich food to be provided after stopping the potassium chloride syrup because, potassium chloride syrup taken along with potassium rich food can lead to hyperkalemia.

Foods to be included

Antioxidant rich fruits and vegetables	Vegetables
Orange, Guava, Papaya, Pomegranate Apple, Berries	Spinach, Broccoli, Carrot, Tomato Capsicum, Beet root

Nuts and others	Healthy omega -3 rich foods
Almond, Walnut, Flax seed, Sunflower seed, green tea, Turmeric, Ginger, Garlic.	Olive oil Chia seed, Fatty fish (salmon, sardine)
Protein rich foods	Potassium rich foods
Chicken breast, Fish (sardine, salmon, tuna) Pulses and legumes Beans, Nuts and seeds, whole grain and soya products	Banana, Pomegranate, Orange, Avocado Papaya, Potato, Sweat potato, Spinach Tomato, Beetroot, Coconut water, Lentil
Good hydration Plenty of water and herbal teas for loosening the mucus Soups and broths can help to soothe airways
Foods to be avoided
Dairy products (The milk contains casein, casein can thicken the mucus) Processed foods like cake, sweets and fried items (trigger inflammation)
Common allergens like (gluten, dairy, nuts, soy) Artificial preservatives
Alcohol and caffeine

Planned menu

Calorie (Kcal)	Protein(gm)	Protein (%)	Fat(gm)	Fat (%)	Carbohydrate(gm)
1312	52.5	16	36	25	164

I have planned a menu for this patient based on the RDA and principles of diet

Time	Menu	Quantity (gm/ml)
Early morning 6–7 AM	Warm water	100 ml
	Amla juice	100 ml

Breakfast 7–8 AM	Oats porridge	100 g
	Banana	100 g
	Soaked almond	6 nos

Mid-morning 10–11 AM	Papaya	50 g
	Pomegranate	50 g

Lunch 12–1 PM	Brown rice	50 g
	Spinach green gram curry	60 g
	Carrot salad	50 g

Mid evening 4–5 PM	Boiled sweet potato	80 g
	Lemon juice	100 ml

Dinner 7–8 PM	Chapathi	2 nos
	Paneer gravy	60 g

Bedtime 10–11 PM	Turmeric milk	100 ml

Nutritive value calculation of the menu

Ingredients	Gm/ml	Kcal (gm)	Protein (gm)	Fat (gm)	Carbs(gm)	Fiber (gm)	Potassium (mg)
Amla	100	58	0	0	14	3	225
Oats	60	233	10.1	4.1	36	6.4	258
Banana	100	89	1.1	0.3	22	2.6	358
Almond	6	36	1.2	3.5	1.2	0.8	45
Papaya	50	16	0.3	0.05	3.9	0.8	91
Pomegranate	50	33	0.8	0.15	7.5	2	118
Brown rice	50	181	3.8	1.3	38	1.7	125
Spinach	150	35	3.0	1	4.4	3.3	837
Onion	60	34	0.7	0.06	5.6	1	88
Garlic	20	26	1.3	0.1	5.8	0.4	80
Green gram	30	104	7.2	0.3	18.9	4.8	372
Green chilli	10	4	0.2	0.02	0.9	0.1	34
Carrot	80	38	0.7	0.16	8.5	2.2	256
Sweet potato	100	86	1.6	0.1	20	3	337
Lemon	100	29	0.4	0.2	9	0.3	105
Wheat flour	80	273	9.5	1.4	57.0	9.7	324
Paneer	50	133	9.1	10.4	1.2	0	52
Turmeric milk	100	67	3.2	4.1	5	0	150
Corriander
leaves	10	2	0.2	0.05	0.36	0.3	52
Curry leaves	10	10	0.6	0.1	1.8	0.6	53
Oil	15	76	1.5	2.8	6.4	2.5	0
Total		1563	56.5	30.19	267.46	45.5	3960
RDA		1312	52.5	36	164	40	4000

Benefits of this diet

Improve immunity

Amla juice, lemon juice, papaya, and pomegranate are rich in vitamin C and
This nutrient help to strengthen the immune system and protect the body from infections and fungal allergens that can worsen ABPA.

Reduces inflammation in airways

Turmeric milk contains curcumin, a natural anti-inflammatory compound. It helps to reduce airway inflammation and irritation in the lungs.

Supports respiratory health

Fruits and vegetables like spinach, carrot, papaya, banana, provide vitamin A, C, and
These nutrients help to protect lung tissue and improve breathing

Provides protein for recovery

Green gram, paneer, almonds, and milk provide protein needed for Tissue repair
Immune cell production
Recovery from infection or inflammation
Muscle growth

Provide potassium and electrolytes

Banana, spinach, sweet potato, papaya, are good sources of
potassium helps to maintain potassium level, muscle and nerve function, including respiratory

Gives sustained energy

Brown rice, oats, chapatti, sweet potato, provide complex
This give steady energy and help to prevent weakness or fatigue during

Improves digestion and gut health

Oats, fruits, vegetables, and whole grain provide dietary
Fiber improves digestion and supports healthy gut bacteria, which can indirectly support

Conclusion

Allergic Bronchopulmonary Aspergillosis (inflammation of the lung) commonly associated with persons who have asthma or cystic fibrosis. It requires proper medical treatment along with nutritional support. A balanced diet rich in protein, antioxidants, and potassium helps improve immunity, reduce lung inflammation, correct nutrient deficiencies, and support recovery. Thus, appropriate medical nutrition therapy plays an important role in improving the health and overall outcome of ABPA patients.

Reference

Mullins, , & O’Neill, S. (2024). Allergic bronchopulmonary aspergillosis. In
StatPearls. StatPearls https://www.ncbi.nlm.nih.gov/books/NBK542329/
Centers for Disease Control and (2024). Aspergillosis: Signs and symptoms. https://www.cdc.gov/aspergillosis/signs-symptoms/index.html
Greenberger, A. (1982). Allergic bronchopulmonary aspergillosis. Journal of Allergy and Clinical Immunology. https://pubmed.ncbi.nlm.nih.gov/7059089/
Agarwal, R., Chakrabarti, A., Shah, A., Gupta, D., Meis, J. F., Guleria, R., Moss, R., & Denning, D. W. (2024). Allergic bronchopulmonary aspergillosis: Review and update. European Respiratory Journal, 63(4). https://publications.ersnet.org/content/erj/63/4/2400061
Aspergillosis Patients & Carers Support (2025). Diet help for patients with ABPA, bronchiectasis & asthma. https://share.google/3SSphh0djjW3xFSn8
Boullata, J. I., & Hudson, L. M. (2018). Drug–nutrient interactions: A broad view with implications for practice. Journal of the Academy of Nutrition and Dietetics, 118(2), 359–370. https://pmc.ncbi.nlm.nih.gov/articles/PMC6109862/

Allergic Bronchopulmonary Aspergillosis (ABPA): The medical nutrition therapy for ABPA

Allergic Bronchopulmonary Aspergillosis (ABPA): The medical nutrition therapy for ABPA

Dharuniha D1, Jenifer Theresal J2, Soundarya S*3

Nightingale Journals

Dharuniha D¹, Jenifer Theresal J², Soundarya S*³