American Board of Internal Medicine (ABIM) Certification Practice Exam

Which drug is used for the treatment of allergic bronchopulmonary aspergillosis?

1. Caspofungin

2. Micafungin

3. Voriconazole

4. Itraconazole

The correct answer is: Itraconazole

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction associated with the presence of the fungus Aspergillus, particularly Aspergillus fumigatus, in the bronchial tree. It primarily occurs in patients with asthma or cystic fibrosis and can lead to significant lung inflammation and damage. Itraconazole, an antifungal medication, is commonly utilized in treating ABPA due to its ability to inhibit the growth of Aspergillus species and reduce the fungal burden in the lungs. It works by interfering with the synthesis of ergosterol, an essential component of fungal cell membranes, leading to cell death. In ABPA, itraconazole not only helps to control the fungal component of the disease but also alleviates symptoms by reducing inflammation. Furthermore, it is often used as a step-down therapy for patients who have shown improvement with steroids, as long-term steroid use can have substantial side effects. In contrast, the other drugs listed—caspofungin, micafungin, and voriconazole—are not typically first-line treatments for ABPA. While voriconazole can be used for certain fungal infections and has activity against Aspergillus, it is less effective than itraconazole for