{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:55:53Z","timestamp":1789646153029,"version":"4.0.0"},"reference-count":51,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Whether allergic bronchopulmonary aspergillosis (ABPA) causes bronchiectasis or merely represents\n                    <jats:styled-content style=\"fixed-case\">\n                      <jats:italic>Aspergillus fumigatus<\/jats:italic>\n                    <\/jats:styled-content>\n                    colonisation of damaged airways remains debated. Establishing causality is challenging because airway damage is predominantly driven by host immune responses rather than by direct fungal invasion. We systematically evaluate four competing hypotheses: (i) ABPA causes bronchiectasis, (ii) reverse causation, with bronchiectasis predisposing to ABPA, (iii) a shared underlying factor independently producing both conditions and (iv) a spurious association. We evaluate radiological, pathological, immunological, temporal and therapeutic evidence in relation to these hypotheses. The characteristic radiological phenotype (central bronchiectasis and high\u2010attenuation mucus), eosinophil\u2010dominant histopathology and disease\u2010specific immunological profile (typically absent in other forms of bronchiectasis despite\n                    <jats:italic>Aspergillus<\/jats:italic>\n                    colonisation) distinguish ABPA from incidental colonisation. Randomised controlled trials demonstrating that antifungal treatment or anti\u2010inflammatory therapy (glucocorticoids and biological agents) improve clinical and immunological outcomes argue against a purely spurious association. Temporal observations indicate that ABPA precedes bronchiectasis in many cases. While uncertainty remains and host susceptibility is likely essential, the available evidence suggests that ABPA contributes to bronchiectasis through antigen\u2010driven immune injury, supporting the use of appropriate antifungal and immunomodulatory therapy in selected patients.\n                  <\/jats:p>","DOI":"10.1111\/cea.70299","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T03:38:32Z","timestamp":1775533112000},"page":"498-505","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Does\n                    <scp>ABPA<\/scp>\n                    Contribute to Bronchiectasis? A Structured Evaluation of Competing Hypotheses"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2547-7668","authenticated-orcid":false,"given":"Ritesh","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6505-6019","authenticated-orcid":false,"given":"Inderpaul Singh","family":"Sehgal","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0410-8468","authenticated-orcid":false,"given":"Valliappan","family":"Muthu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER)  Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9596-574X","authenticated-orcid":false,"given":"Philip","family":"Bardin","sequence":"additional","affiliation":[{"name":"Monash Lung Sleep Allergy &amp; Immunology Monash University and Medical Centre  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"key":"e_1_2_18_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2021.12.002"},{"key":"e_1_2_18_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2023.04.009"},{"key":"e_1_2_18_4_1","doi-asserted-by":"publisher","DOI":"10.3109\/13693786.2012.738312"},{"key":"e_1_2_18_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0114745"},{"key":"e_1_2_18_6_1","doi-asserted-by":"publisher","DOI":"10.1159\/000547550"},{"key":"e_1_2_18_7_1","doi-asserted-by":"publisher","DOI":"10.1128\/jb.33.1.1-12.1937"},{"key":"e_1_2_18_8_1","doi-asserted-by":"publisher","DOI":"10.1177\/003591576505800503"},{"key":"e_1_2_18_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2011.07.009"},{"key":"e_1_2_18_10_1","doi-asserted-by":"publisher","DOI":"10.4103\/0971-3026.90680"},{"key":"e_1_2_18_11_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2025-1548"},{"key":"e_1_2_18_12_1","doi-asserted-by":"publisher","DOI":"10.4329\/wjr.v2.i1.41"},{"key":"e_1_2_18_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2017.07.048"},{"key":"e_1_2_18_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alit.2017.08.002"},{"key":"e_1_2_18_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2018.02346"},{"key":"e_1_2_18_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/0091-6749(88)91044-5"},{"key":"e_1_2_18_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.70148"},{"key":"e_1_2_18_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2024.06.3843"},{"key":"e_1_2_18_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13229"},{"key":"e_1_2_18_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.alit.2023.08.004"},{"key":"e_1_2_18_21_1","doi-asserted-by":"publisher","DOI":"10.2147\/JIR.S546322"},{"key":"e_1_2_18_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.13566"},{"key":"e_1_2_18_23_1","doi-asserted-by":"publisher","DOI":"10.1177\/003591576806100539"},{"key":"e_1_2_18_24_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.52.0069"},{"key":"e_1_2_18_25_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.173.4.10511153"},{"key":"e_1_2_18_26_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201001-0087OC"},{"key":"e_1_2_18_27_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200003163421102"},{"key":"e_1_2_18_28_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01475-2015"},{"key":"e_1_2_18_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31767-7"},{"key":"e_1_2_18_30_1","doi-asserted-by":"publisher","DOI":"10.1086\/376525"},{"key":"e_1_2_18_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12595"},{"key":"e_1_2_18_32_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2025-1548"},{"key":"e_1_2_18_33_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3003.2000.016003464.x"},{"key":"e_1_2_18_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkz075"},{"key":"e_1_2_18_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myz015"},{"key":"e_1_2_18_36_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.06.00074705"},{"key":"e_1_2_18_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11882-011-0217-4"},{"key":"e_1_2_18_38_1","doi-asserted-by":"publisher","DOI":"10.3109\/13693786.2010.504752"},{"key":"e_1_2_18_39_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0015346"},{"key":"e_1_2_18_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13223-016-0152-y"},{"key":"e_1_2_18_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11046-024-00834-5"},{"key":"e_1_2_18_42_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-018-06148-7"},{"key":"e_1_2_18_43_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01159-2018"},{"key":"e_1_2_18_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2018.01.005"},{"key":"e_1_2_18_45_1","doi-asserted-by":"publisher","DOI":"10.1067\/mai.2003.1388"},{"key":"e_1_2_18_46_1","article-title":"A Phase 2, Dose\u2010Finding Study of Inhaled Itracaonazole in ABPA\u2010Complicating Asthma","author":"Agarwal R.","year":"2025","journal-title":"European Respiratory Journal"},{"key":"e_1_2_18_47_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01787-2021"},{"key":"e_1_2_18_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2022.12.012"},{"key":"e_1_2_18_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-024-00717-y"},{"key":"e_1_2_18_50_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.2025.211.Abstracts.A5230"},{"key":"e_1_2_18_51_1","doi-asserted-by":"publisher","DOI":"10.1093\/mmy\/myw071"},{"key":"e_1_2_18_52_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.169.2.3174990"}],"container-title":["Clinical &amp; 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