The Clinical Implications of Aspergillus Fumigatus Sensitization in Difficult-To-Treat Asthma Patients

• Published in: The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 9; no. 12; p. 4254
• Main Authors: Mistry, Heena, Ajsivinac Soberanis, Hilda Maria, Kyyaly, Mohammad Aref, Azim, Adnan, Barber, Clair, Knight, Deborah, Newell, Colin, Haitchi, Hans Michael, Wilkinson, Tom, Howarth, Peter, Seumois, Grégory, Vijayanand, Pandurangan, Arshad, S Hasan, Kurukulaaratchy, Ramesh J
• Format: Journal Article
• Language: English
• Published: United States 01.12.2021
• Subjects: Aspergillosis, Allergic Bronchopulmonary - diagnosis; Aspergillosis, Allergic Bronchopulmonary - epidemiology; Aspergillus fumigatus; Asthma - diagnosis; Asthma - drug therapy; Asthma - epidemiology; Bronchiectasis; Humans; Immunoglobulin E; Male; Difficult asthma; Fungal sensitization; Lung function; ABPA; Aspergillus fumigatus; SAFS
• ISSN: 2213-2201
• DOI: 10.1016/j.jaip.2021.08.038

Fungal sensitivity has been associated with severe asthma outcomes. However, the clinical implication of Aspergillus fumigatus sensitization in difficult-to-treat (or difficult) asthma is unclear. To characterize the clinical implications of A fumigatus sensitization in a large difficult asthma cohort. Participants who underwent both skin prick and specific IgE testing to A fumigatus (n = 318) from the longitudinal real-life Wessex AsThma CoHort of difficult asthma, United Kingdom, were characterized by A fumigatus sensitization (either positive skin prick test result or specific IgE) and allergic bronchopulmonary aspergillosis status using clinical/pathophysiological disease measures. A fumigatus sensitization was found in 23.9% (76 of 318) of patients with difficult asthma. Compared with A fumigatus nonsensitized subjects, those with sensitization were significantly more often male (50% vs 31%), older (58 years) with longer asthma duration (33 years), higher maintenance oral corticosteroid (39.7%) and asthma biologic use (27.6%), raised current/maximum log total IgE+1 (2.43/2.72 IU/L), worse prebronchodilator airflow obstruction (FEV 62.2% predicted, FEV /forced vital capacity 61.2%, forced expiratory flow between 25% and 75% exhalation 30.9% predicted), and frequent radiological bronchiectasis (40%), but had less psychophysiologic comorbidities. Allergic bronchopulmonary aspergillosis diagnosis was associated with higher treatment needs and stronger eosinophilic signals. Factors independently associated with A fumigatus sensitization in difficult asthma included maintenance oral corticosteroid use (odds ratio [OR], 3.34) and maximum log total IgE+1 (OR, 4.30), whereas for allergic bronchopulmonary aspergillosis included maintenance oral corticosteroid use (OR, 6.98), maximum log total IgE+1 (OR, 4.65), and radiological bronchiectasis (OR, 4.08). A fumigatus sensitization in difficult asthma identifies a more severe form of airways disease associated with greater morbidity, treatment need, and airways dysfunction/damage, but fewer psychophysiologic comorbidities. Screening of A fumigatus status should be an early element in the comprehensive assessment of patients with difficult asthma.