Aspergillus-related diseases in a cohort of patients with severe asthma: A SANI single-center report

Strong evidence links Aspergillus exposure with severe asthma (SA), in which defective clearance of spores allows their germination into hyphae that damage airways by producing proteases and inducing inflammatory cytokines release.1 Fungal colonization produces various clinical manifestations2 ranging from simple allergic Aspergillus sensitization (SAFS) to overt allergic bronchopulmonary aspergillosis (ABPA). Severe asthma was diagnosed according to European Respiratory Society/American Thoracic Society (ERS/ATS) criteria.4 All the patients released their informed consent, according to the SANI registry (“Area Vasta Nord-Ovest Toscana,” Ethics Committee protocol number 73714, study number 1245/2016). The remaining 8 patients (11%; group 3) had features that did not fit with any of these groups, having only modest increase in total immunoglobulin E (IgE), Aspergillus fumigatus–specific IgG (IgG-ASP), and/or IgE-ASP inconsistent with ABPA, and having no high-resolution chest computed tomography scan (HRCT) sign of CPA. Because they complained of chronic productive cough, reported heavy mold exposure, and 6 of them had bronchiectasis, they were empirically classified as Aspergillus-bronchitis6 (ASP-B(?), with question mark). Serological screening tests for Aspergillus fumigatus are crucial for diagnosing Aspergillus-related disease and should be routinely performed, together with HRCT, in asthmatic patients, particularly in those with severe and/or difficult to treat asthma.Online Repository Variable No-ASP group 1 SAFS group 2 ASP-B(?) group 3 CPA group 4 ABPA group 5 ABPA + CPA group 6 Number (%) 38 (51.5) 6 (8) 8 (11) 4 (5.5) 12 (16) 6 (8) Women, n (%) 28 (74) 5 (83) 6 (75) 3 (75) 7 (58) 2 (33) Age (y), mean (SD) 60.8 (13) 59.3 (11) 59.5 (9) 61.3 (10) 66.0 (12) 56.0 (15) Never-smoker, n (%) 28 (74) 5 (83) 5 (63) 3 (75) 6 (50) 2 (33) Atopy, n (%) 21 (55) 6 (100) 7 (88) 4 (100) 12 (100) 6 (100) ACT score mean (SD) 17.8 (5) 18.2 (1.5) 16.6 (3.1) 19.8 (2.2) 18.1 (3.5) 15.7 (4.9) Mold exposure index, mean (SD) 0.53 (1.1)3-6 0.67 (1.0)3-6 3.25 (1.4)1,2 3.75 (0.5)1,2 3.17 (1.3)1,2 4.00 (0.0)1,2 FeNO (ppb), mean (SD) 42.4 (37)6 35.7 (32.9) 28.9 (24.4) 15.3 (11.1) 30.8 (36.1) 93.8 (108)1 Eosinophils, cells/mL 477.5 (393)6 423.3 (263) 292.5 (224)5 320.0 (230) 568.5 (267) 1,258 (1,390)1,3 Total IgE (U/mL), mean (SD) 262 (314)2,5,6 560.5 (422)1 297.8 (221) 268.5 (338) 2,906 (3,595)1 5,779 (10,522)1 IgE-ASP,IU/ml mean (SD) 0.06 (0.04)2,3,5,6 0.70 (0.47)1,4 0.38 (0.31)