With the promotion of standardized asthma treatment in recent years, most asthma patients can have their conditions satisfactorily controlled as long as they follow regular treatment as prescribed by their doctors: no asthma attacks, no interference with activities, no suffocating sleep at night, and even their lung function will reach normal. However, there are still many asthma patients in the clinic who have recurrent attacks even after active treatment. This is when doctors need to think whether it is other diseases or the presence of comorbidities; among them, allergic bronchopulmonary aspergillosis (ABPA) is easily misdiagnosed as asthma. asthma caused by ABPA is often not easily cured if it is treated according to the general principles of asthma treatment. Recently, doctors from the Department of Respiratory Medicine of Beijing Tongren Hospital summarized five cases of ABPA treated in recent years. Five patients with confirmed ABPA, two males and three females; aged 71-85 years. All patients’ diagnosis was confirmed by detailed history, peripheral blood eosinophil count, observation of sputum nature, sputum smear for fungus and fungal culture, total IgE and specific Aspergillus IgE determination, Aspergillus fumigatus antigen skin test, chest X-ray and lung CT examination, and pulmonary function test. One of the patients underwent CT-guided percutaneous lung tissue biopsy. Symptoms and signs Two cases had a diagnosis of bronchial asthma, one case had a diagnosis of bronchiectasis, and two cases had a diagnosis of chronic obstructive pulmonary disease. 5 cases had a history of cough and sputum, and one patient had a brown sputum plug. All of them had chest tightness and wheezing during the attack. All 5 cases had a history of croup and moisture woven into the sputum and all 5 cases had negative sputum smears for fungus. 2272 U/L, with increased specific Aspergillus IgE (grade 2-4), and all positive Aspergillus fumigatus allergens skin tests. all 5 cases had negative PPD skin tests. Imaging chest X-ray and CT examination showed scattered infiltrative shadows with uniform density, typically with orbital, “toothpaste” or “fingerstick”-like shadows, and patchy shadows in the upper, middle and lower lung fields of both lungs; serial chest films and lung CT were observed. All 5 cases showed central bronchiectasis on CT examination of the lungs. （All 5 patients showed obstructive ventilation dysfunction with FEV1/FVC 55-67%, FEV1% expected value 24-75%, and 14-23% improvement in reversible test. Diagnosis and treatment Five patients were hospitalized repeatedly for the last 2 years, 3-4 times/year. Four cases were treated with oral glucocorticoids or combined with itraconazole after definitive diagnosis of ABPA without recurrence. one case was an elderly patient with poor underlying lung function and co-infection with bacteria, who died of respiratory failure 2 months after diagnosis.