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* From the Division of Pediatric Pulmonology (Dr. Geller), The Nemours Children's Clinic, Orlando, FL; Medical Affairs (Dr. Kaplowitz), Genentech, Inc, South San Francisco, CA; Division of Pediatric Pulmonology (Dr. Light), The University of California, San Diego, CA; and Division of Pediatric Pulmonology (Dr. Colin), Children's Hospital, Harvard Medical School, Boston, MA.
Correspondence to: David E. Geller, MD, The Nemours Children's Clinic, Division of Pediatric Pulmonology, 83 W Columbia St, Orlando, FL 32806
Objectives: Using the large database from the Epidemiologic Study of Cystic Fibrosis (ESCF), the objectives of this study were to (1) estimate the reported prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (CF); (2) compare reported prevalence rates across geographic regions; (3) compare reported prevalence rates between patient subgroups based on demographic and disease characteristics; and (4) describe the ABPA group with regard to their sex, age, and disease severity.
Study design: All patients 
5 years of age enrolled in
ESCF between December 1993 and May 1996 were eligible. Criteria for the
diagnosis of ABPA were defined by the ESCF guidelines. Prevalence rates
for ABPA were calculated, and potential risk factors for the diagnosis
of ABPA were analyzed, including sex, age, pulmonary function,
diagnosis of asthma, presence of wheeze, and positive respiratory
culture for Pseudomonas.
Results: There were 14,210 eligible patients enrolled in ESCF during this period, and ABPA was diagnosed in 281 patients (2%). Regional prevalence varied from 0.9% in the Southwest to 4.0% in the West. Increased prevalence rates occurred in female patients, the adolescent age group, and subjects with lower lung function, wheeze, asthma, and positive Pseudomonas cultures. Although most ABPA patients had evidence of airway obstruction, 10% had an FEV1 of > 100% of predicted. The rates of wheeze (17%) and asthma (30%) were lower than expected in the ABPA group.
Conclusions: This observational study found a reported prevalence rate of ABPA of 2% of CF patients in a large database. This rate was lower than the 5 to 15% rate reported in smaller studies, suggesting that ABPA is underdiagnosed in the CF population. There was wide regional variation in reported prevalence rates, which is unexplained at this time. The characteristics of the patients with ABPA and the epidemiologic risk factors for diagnosis of ABPA were described. Simplified diagnostic criteria were adapted for ESCF with the intent of increasing awareness of ABPA among the participants in this study.
Key Words: allergic bronchopulmonary aspergillosis • cystic fibrosis • epidemiology
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