What is the first-line treatment for recurrent exacerbations of ABPA?

The first-line treatment for recurrent exacerbations of Allergic Bronchopulmonary Aspergillosis (ABPA) is the use of systemic glucocorticoids. This approach is based on the inflammatory component of ABPA, where the body has an exaggerated immune response to the Aspergillus species, leading to airway inflammation and obstruction.

Systemic glucocorticoids, such as prednisone, are effective because they help to reduce this inflammation, alleviating symptoms and preventing further exacerbations. They act to suppress the immune response, which is essential in cases where frequent exacerbations occur, as it helps manage and control the underlying inflammatory conditions associated with ABPA.

In contrast, while inhaled corticosteroids can be beneficial for various respiratory conditions, they are not as effective in addressing the systemic inflammation seen in ABPA. Oral antibiotics target specific infections and would not address the allergic and inflammatory processes of ABPA. Leukotriene modifiers have limited evidence and efficacy in treating the complexities of ABPA exacerbations.

Using systemic glucocorticoids effectively stabilizes the condition, leading to fewer exacerbations and a better quality of life for affected individuals.