Chronic necrotizing pulmonary aspergillosis. Some patients also have reactive airways disease. Only some of the people with either of these risk factors develop the disease. Sputum is grossly purulent during exacerbations and mucoid in between.
Some patients develop hypoxemia, hypercapnia, erythrocytosis, and right heart failure.
Patients with primarily emphysema develop gradual onset of dyspnea on exertion. Hyperinflation with enlargement of the chest cavity and flattening of the diaphragm may develop. Serial measurements show a more rapid decline in FEV 1 than that which occurs with aging. There may be a modest response to bronchodilators. A combination of clinical history, radiographic findings, and PFTs are used to make the diagnosis.