What is the typical course of treatment with systemic glucocorticoids for ABPA flares?

The treatment of allergic bronchopulmonary aspergillosis (ABPA) with systemic glucocorticoids typically involves starting with an initial dose that is sufficient to control the inflammatory response associated with the condition, followed by a slow taper. This approach is essential because it allows for the management of inflammation effectively while minimizing potential side effects from prolonged high dose use of steroids.

In the context of ABPA, glucocorticoids help to reduce airway inflammation and improve lung function. Upon starting treatment, it is crucial to administer an adequate initial dose to achieve therapeutic benefits, which may vary based on the severity of the flare. After achieving control of symptoms and inflammation, a slow taper is employed to reduce the dosage gradually while monitoring for a return of symptoms or exacerbation of the condition. This is necessary to avoid adrenal insufficiency and withdrawal symptoms that might occur with abrupt cessation.

Using high doses of systemic glucocorticoids for an extended period without tapering, as seen in some alternative approaches, can lead to significant adverse effects. Continuous therapy without tapering is not standard practice due to the potential for complications and the risks associated with prolonged steroid use. Short courses during initial diagnosis only overlook the need for ongoing management of flares, particularly in