Environmental fungal sensitisation associates with poorer clinical outcomes in COPD

Tiew, Pei Yee and San Ko, Fanny Wai and Pang, Sze Lei and Matta, Sri Anusha and Sio, Yang Yie and Poh, Mau Ern and Lau, Kenny J. X. and Mac Aogain, Micheal and Jaggi, Tavleen Kaur and Ivan, Fransiskus Xaverius and Gaultier, Nicolas E. and Uchida, Akira and Drautz-Moses, Daniela and Xu, Huiying and Koh, Mariko Siyue and Hui, David Shu Cheong and Tee, Augustine and Abisheganaden, John Arputhan and Schuster, Stephan C. and Chew, Fook Tim and Chotirmall, Sanjay H. (2020) Environmental fungal sensitisation associates with poorer clinical outcomes in COPD. European Respiratory Journal, 56 (2). ISSN 09031936, DOI https://doi.org/10.1183/13993003.00418-2020.

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Introduction: Allergic sensitisation to fungi such as Aspergillus are associated to poor clinical outcomes in asthma, bronchiectasis and cystic fibrosis; however, clinical relevance in COPD remains unclear. Methods: Patients with stable COPD (n=446) and nondiseased controls (n=51) were prospectively recruited across three countries (Singapore, Malaysia and Hong Kong) and screened against a comprehensive allergen panel including house dust mites, pollens, cockroach and fungi. For the first time, using a metagenomics approach, we assessed outdoor and indoor environmental allergen exposure in COPD. We identified key fungi in outdoor air and developed specific-IgE assays against the top culturable fungi, linking sensitisation responses to COPD outcomes. Indoor air and surface allergens were prospectively evaluated by metagenomics in the homes of 11 COPD patients and linked to clinical outcome. Results: High frequencies of sensitisation to a broad range of allergens occur in COPD. Fungal sensitisation associates with frequent exacerbations, and unsupervised clustering reveals a ``highly sensitised fungal predominant'' subgroup demonstrating significant symptomatology, frequent exacerbations and poor lung function. Outdoor and indoor environments serve as important reservoirs of fungal allergen exposure in COPD and promote a sensitisation response to outdoor air fungi. Indoor (home) environments with high fungal allergens associate with greater COPD symptoms and poorer lung function, illustrating the importance of environmental exposures on clinical outcomes in COPD. Conclusion: Fungal sensitisation is prevalent in COPD and associates with frequent exacerbations representing a potential treatable trait. Outdoor and indoor (home) environments represent a key source of fungal allergen exposure, amenable to intervention, in ``sensitised'' COPD.

Item Type: Article
Funders: Ageing Research Institute for Society and Education (Grant No. ARISE/2017/6), Biological and Environmental Life Sciences, Nanyang Technological University, Singapore (Grant No. NIM/03/2018), Singapore Ministry of Health‟s National Medical Research Council (Grant No. MOH-000141), Ministry of Education - Singapore (Grant No. 2016-T1-001-050, MOE 2013-T3-1-013), Nanyang Technological University, NTU Integrated Medical, Biological and Environmental Life Sciences
Uncontrolled Keywords: Aspergillus; COPD; Environment; Fungi; Sensitization
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms Zaharah Ramly
Date Deposited: 31 Dec 2023 00:52
Last Modified: 31 Dec 2023 00:52
URI: http://eprints.um.edu.my/id/eprint/36529

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