Proximal bronchiecstasis and segmental collapse in a patient with chronic persistent asthma should make us suspect

BPA results from allergic pulmonary reaction to inhaled spores to Aspergillus fumigatus and occasionally other Aspergillus species. A skin prick test for A.fumigatus is always positive but serum Aspergillus precipitins are low or undetectable. Characteristically, there are fleeting eosinophilic infiltrates in the lungs, paicularly in the upper lobes. Airways become blocked with mucoid plugs rich in eosinophils, and patient may coughup brown plugs and have hemoptysis. BPA may result in bronchiectasis, paicularly affecting central airways, if not suppressed by, coicosteroids. Treatment with oral antifungal itraconazole is beneficial in preventing exacerbations. Asthma is controlled in the usual way by ICS, but it is necessary to give a course of OCS if any sign of worsening or pulmonary shadowing if found. Ref Davidson edition23rd pg 569