High frequency of allergic bronchopulmonary aspergillosis in bronchiectasis-COPD overlap

Tiew, Pei Yee and Lim, Albert Yick Hou and Keir, Holly R. and Dicker, Alison J. and Mac Aogain, Micheal and Pang, Sze Lei and Low, Teck Boon and Hassan, Tidi Maharani and Poh, Mau Ern and Xu, Huiying and Ong, Thun How and Koh, Mariko Siyue and Abisheganaden, John Arputhan and Tee, Augustine and Chew, Fook Tim and Chalmers, James D. and Chotirmall, Sanjay H. (2022) High frequency of allergic bronchopulmonary aspergillosis in bronchiectasis-COPD overlap. Chest, 161 (1). pp. 40-53. ISSN 0012-3692, DOI https://doi.org/10.1016/j.chest.2021.07.2165.

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BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) is associated with frequent exacerbations and poor outcomes in chronic respiratory disease, but remains under-diagnosed. The role of fungal sensitization in bronchiectasis-COPD overlap (BCO) is unknown. RESEARCH QUESTION: What is the occurrence and clinical relevance of Aspergillus sensitization and ABPA in BCO when compared with individuals with COPD or bronchiectasis without overlap? STUDY DESIGN: Prospective, observational, cross-sectional study. METHODS: We prospectively recruited 280 patients during periods of clinical stability with bronchiectasis (n = 183), COPD (n = 50), and BCO (n = 47) from six hospitals across three countries (Singapore, Malaysia, and Scotland). We assessed sensitization responses (as specific IgE) to a panel of recombinant Aspergillus fumigatus allergens and the occurrence of ABPA in relationship to clinical outcomes. RESULTS: Individuals with BCO show an increased frequency and clinical severity of ABPA compared with those with COPD and bronchiectasis without overlap. BCO-associated ABPA is associated with more severe disease, higher exacerbation rates, and lower lung function when compared with ABPA occurring in the absence of overlap. BCO with a severe bronchiectasis severity index (BSI; > 9) is associated significantly with the occurrence of ABPA that is unrelated to underlying COPD severity. CONCLUSIONS: BCO demonstrates a high frequency of ABPA that is associated with a severe BSI (> 9) and poor clinical outcomes. Clinicians should maintain a high index of suspicion for the potential development of ABPA in patients with BCO with high BSI.

Item Type: Article
Uncontrolled Keywords: ABPA; Aspergillus; BCO; Bronchiectasis-COPD overlap; Sensitization
Subjects: Q Science > QM Human anatomy
Q Science > QP Physiology
R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine > School of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 28 Jul 2022 23:58
Last Modified: 28 Jul 2022 23:58
URI: http://eprints.um.edu.my/id/eprint/33610

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