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
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- 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
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