IgE Sensitization to Aspergillus fumigatus Is Associated with Reduced Lung Function in Asthma
The importance of Aspergillus fumigatus sensitization and colonization of the airways in patients with asthma is unclear. To define the relationship between the clinical and laboratory features of A. fumigatus-associated asthma. We studied 79 patients with asthma (89% classed as GINA 4 or 5) classif...
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| Published in | American journal of respiratory and critical care medicine Vol. 182; no. 11; pp. 1362 - 1368 |
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| Main Authors | , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
New York, NY
American Thoracic Society
01.12.2010
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| Subjects | |
| Online Access | Get full text |
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| Summary: | The importance of Aspergillus fumigatus sensitization and colonization of the airways in patients with asthma is unclear.
To define the relationship between the clinical and laboratory features of A. fumigatus-associated asthma.
We studied 79 patients with asthma (89% classed as GINA 4 or 5) classified into 3 groups according to A. fumigatus sensitization: (1) IgE-sensitized (immediate cutaneous reactivity > 3 mm and/or IgE > 0.35 kU/L); (2) IgG-only-sensitized (IgG > 40 mg/L); and (3) nonsensitized. These were compared with 14 healthy control subjects. Sputum culture was focused toward detection of A. fumigatus and compared with clinical assessment data.
A. fumigatus was cultured from 63% of IgE-sensitized patients with asthma (n = 40), 39% of IgG-only-sensitized patients with asthma (n = 13), 31% of nonsensitized patients with asthma (n = 26) and 7% of healthy control subjects (n = 14). Patients sensitized to A. fumigatus compared with nonsensitized patients with asthma had lower lung function (postbronchodilator FEV₁ % predicted, mean [SEM]: 68 [±5]% versus 88 [±5]%; P < 0.05), more bronchiectasis (68% versus 35%; P < 0.05), and more sputum neutrophils (median [interquartile range]: 80.9 [50.1-94.1]% versus 49.5 [21.2-71.4]%; P < 0.01). In a multilinear regression model, A. fumigatus-IgE sensitization and sputum neutrophil differential cell count were important predictors of lung function (P = 0.016), supported by culture of A. fumigatus (P = 0.046) and eosinophil differential cell count (P = 0.024).
A. fumigatus detection in sputum is associated with A. fumigatus-IgE sensitization, neutrophilic airway inflammation, and reduced lung function. This supports the concept that development of fixed airflow obstruction in asthma is consequent upon the damaging effects of airway colonization with A. fumigatus. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Supported by Midlands Asthma and Allergy Research Association (AJW, CHP, AF); Wellcome Trust Senior Fellowship (CB); and European Regional Development Fund. Originally Published in Press as DOI: 10.1164/rccm.201001-0087OC on July 16, 2010 Author Disclosure: A.F. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript; J.A. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript; B.H. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript; M.B. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript; W.R.M. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript; C.E.B. has received consultancy fees from MedImmune ($5,001–$10,000); he has received advisory board fees from AstraZeneca (AZ) ($1,001–$5,000), GlaxoSmithKline (GSK) ($1,001–$5,000), Genentech ($1,001–$5,000), and Aerovance ($1,000 or less), lecture fees from AZ, GSK, and Novartis (each $1,000), and industry-sponsored grants from AZ, GSK, and MedImmune (each more than $100,000); P.B. has received consultancy fees from Icagen ($1,001–$5,000), advisory board fees from GSK ($1,000 or less), lecture fees from AZ ($1,001–$5,000), industry-sponsored grants from Genentech, Novartis, and Boehringer Ingelheim (each more than $100,000), and Icagen ($5,001–$10,000), sponsored grants from Wellcome Trust, Medical Research Council, and the British Heart Foundation (each more than $100,000), and Asthma UK ($50,001–$100,000); R.H.G. has received advisory board fees from Nycomed ($1,000 or less); K.M. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript; D.D. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript; I.D.P. has received consultancy fees from Merck Sharp & Dohme Limited (MSD) ($1,001–$5,000), GSK ($1,001–$5,000), and AZ ($5,001–$10,000), lecture fees from GSK ($1,001–$5,000) and AZ ($1,001–$5,000), and industry-sponsored fees from GSK (more than $100,000); A.J.W. has received advisory board fees from GSK ($1,001–$5,000) and MedImmune ($1,001–$5,000), and industry-sponsored grants from GSK (more than $100,000), Pfizer (more than $100,000), AZ ($50,001–$100,000), and Aerovance ($5,001–$10,000); C.H.P. has no financial relationship with a commercial entity that has an interest in the subject of this manuscript. A.F. and J.A. are joint first authors. |
| ISSN: | 1073-449X 1535-4970 1535-4970 |
| DOI: | 10.1164/rccm.201001-0087OC |