Indian Joumal of Pediatricshttp5/doi.org/10.1007/s12098-023-04592-yORIGINAL ARTICLEEvidence-Based Guidelines for the Management of AllergicBronchopulmonary Aspergillosis(ABPA)in Children and Adolescentswith AsthmaJoseph L.Mathew.Ketan Kumar1.Sheetal Agrawal2.Sanjay Bafna3.Sonia Bhatt.Pallab Chatterjee5.N.S.Chithambaram5.Rashmi Ranjan Das?.Hema Gupta2.Sarika Gupta.Kana Ram Jat9.Pawan Kalyan10.Rashmi Kapoor1.Hardeep Kaur.Jasmeet Kaur12.Satnam Kaur13.Suhas P.Kulkarni14.Amber Kumar15.Sanjiv Singh Rawat16.Vivek Saxena17.Anita Singh18.Somu Sivabalan19.Shetanshu Srivastava20.Anshula TayalReceived:16 February 2023/Accepted:17 March 2023The Author(s),under exclusive licence to Dr.KC Chaudhuri Foundation 2023AbstractBackground Allergic bronchopulmonary aspergillosis(ABPA)frequently complicates asthma.There is urgent need todevelop evidence-based guidelines for the management of ABPA in children.The Evidence Based Guideline DevelopmentGroup(EBGDG)of the Indian Academy of Pediatrics(IAP)National Respiratory Chapter(NRC)addressed this need.Methods The EBGDG shortlisted clinical questions relevant to the management of ABPA in asthma.For each question,the EBGDG undertook a systematic,step-wise evidence search for existing guidelines,followed by systematic reviews,fol-lowed by primary research studies.The evidence was collated,critically appraised,and synthesized.The EBGDG workedthrough the Evidence to Decision (EtD)framework,to formulate recommendations,using the Grading of RecommendationsAssessment,Development and Evaluation(GRADE)approach.Results Seven clinical questions were prioritized,and the following recommendations formulated.(1)Children with poorlycontrolled asthma should be investigated for ABPA (conditional recommendation,moderate certainty of evidence).(2)Lowdose steroid therapy regimen(0.5 mg/kg/d for the first 2 wk,followed by a progressive tapering)is preferable to higherdose regimens (conditional recommendation,very low certainty of evidence).(3)Oral steroid regimens longer than 16 wk(including tapering),should not be used(conditional recommendation,very low certainty of evidence).(4)Antifungals mayor may not be added to steroid therapy as the evidence was neither in favour nor against(conditional recommendation,lowcertainty of evidence).(5)For clinicians using antifungal agents,the EBGDG recommends against using voriconazole insteadof itraconazole(conditional recommendation,very low certainty of evidence).(6)No evidence-based recommendation couldbe framed for using pulse steroid therapy in preference to conventional steroid therapy.(7)Immunotherapy with biologicalsincluding omalizumab or dupilumab is not recommended(conditional recommendation,very low certainty of evidence).Conclusions This evidence-based guideline can be used by healthcare providers in diverse clinical settings.Keywords Asthma.Allergic bronchopulmonary aspergillosis(ABPA).Evidence-based.GuidelineIntroductionsmall subset may demonstrate poor control despite appro-priate therapy
