Most patients with ABPA present with worsening of their underlying lung disease. Exacerbation of symptoms of asthma, such as increased cough, wheezing, and expectoration of sputum plugs often occurs. Episodic fever and/or hemoptysis may also occur. These symptoms often occur despite aggressive antiasthmatic medications. Over the years, a list of major and minor criteria that combine these symptoms has been created to aide in rendering a diagnosis in those patients with asthma (Table 33.1). Modifications have been made to evaluate other patients (such as those with cystic fibrosis) as well. A subset of patients with ABPA may also have symptoms of chronic sinusitis, which may indicate concurrent allergic fungal sinusitis.

The clinical presentation is divided into five stages (Table 33.2). Stage I is considered the acute phase, characterized by fever, cough, chest pain, hemoptysis, and/or sputum production. Stage II is remission in which the patient is usually asymptomatic or has had stabilization of their asthma. Stage III is exacerbation, where symptoms of the acute phase may return or laboratory/radiologic evidence of the disease is again apparent. In stage IV, there is persistent severe asthma that is corticosteroid dependent. Patients with stage V disease will usually exhibit cyanosis and extreme dyspnea. These end-stage patients will usually also have radiologically or pathologically evident fibrosis.