Epidemiology

Allergic bronchopulmonary aspergillosis (ABPA) occurs worldwide and can be an indolent disease with a protracted course.

ABPA most often affects patients with cystic fibrosis (CF) and asthma, with higher rates observed in adults compared with children, and significant associations with other concomitant atopic conditions.[10]​ The precise global burden of ABPA remains unclear, with significant variability in reported prevalence rates among older studies depending on the diagnostic criteria used, geographic region of the study, and population characteristics. In adult patients with asthma, the overall prevalence of ABPA was estimated to be around 2.5% based on global pooled data from the Global Initiative for Asthma (GINA) reports in 2013, though a subsequent large meta-analysis in 2023 reported a pooled prevalence of as high as 11.3%.[3][11]​​

The reported prevalence of ABPA has been similarly variable, and the diagnosis can be challenging given overlapping clinical, radiographic, and immunologic features for patients with CF.[12] Older studies have reported a prevalence ranging from 2% (based on the Epidemiologic Study of Cystic Fibrosis registry from the US/Canada) to 7.8% (based on the Epidemiologic Registry of CF from Europe), and as high as 13.5% to 25.0% in some smaller studies.[12][13]​​​[14]​​​​​[15]​ A subsequent large systematic review in 2015 reported an 8.9% pooled prevalence of ABPA in patients with CF, and as high as 39% prevalence of Aspergillus sensitization. Notably there was significant statistical heterogeneity, differences in criteria used, and publication bias among the studies.[16]

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