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 rangi...
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| Veröffentlicht in: | The journal of allergy and clinical immunology in practice (Cambridge, MA) MA), 2021-07, Vol.9 (7), p.2920-2922.e2 |
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| creator | Solidoro, Paolo Nicola, Stefania Ridolfi, Irene Bucca, Caterina Heffler, Enrico Bagnasco, Diego Canonica, Giorgio Walter Blasi, Francesco Paggiaro, Pierluigi Rolla, Giovanni Brussino, Luisa |
| description | 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) |
| doi_str_mv | 10.1016/j.jaip.2021.04.011 |
| format | Article |
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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)1 0.11 (0.06)2 4.9 (6.60)1 20.6 (39.6) IgG-ASP (U/mL), mean (SD) 12.4 (7.8)3-6 11.0 (6.5)6 74.9 (73)1,6 66.0 (90)1 47.4 (55)1,6 177.3 (90)1-3,5 AE (n/y), mean (SD) 2.3 (1.3)4,6 2.0 (0.9)6 2.6 (1.2)6 4.0 (2.9)1 2.5 (1.2) 4.2 (1.7)1-3,5 VC (% pred), mean (SD) 85.0 (16)4 90.7 (3.1)4 79.5 (18) 65.0 (12)1,2 80.5 (24) 82.7 (17) FEV1 (% pred), mean (SD) 71.0 (16)4,6 76.5 (12)3,4,6 63.0 (7)2 52.8 (9)1,2 59.3 (21) 54.8 (15)1,2 FEV1/VC%, mean (SD) 63.9 (11)5,6 66.7 (19)5 61.6 (14) 61.5 (11) 51.6 (11)1,2 52.8 (4.5)1 FEV1 PB %, mean (SD) 17.3 (11) 15.0 (10) 20.3 (9) 11.5 (10) 20.5 (14) 24.8 (10) Bronchiectasis, n (%) 5 (13)3,4,6 0 (0) 6 (75)1 3 (75)1 4 (33) 6 (100)1 CRSwNP, n (%) 19 (50) 2 (33) 2 (25) 1 (25) 8 (67) 4 (67) OCS, n (%) 14 (37) 2 (33) 1 (13) 3 (75) 5 (42) 5 (83) Biologic therapy, n (%) 26 (68) 3 (50) 5 (63) 3 (75) 7 (58) 6 (100) Table I . Characteristics of patients by Aspergillus-related disease∗ Variable ASP-related disease groups 3, 4, 5, 6 (n = 30) No ASP-related disease groups 1, 2 (n = 44) P Patients (number) 30 44 Age (y), mean (SD) 61.6 (12) 60.6 (12) NS BMI, mean (SD) 24.9 (5.5) 25.0 (4.1) NS Females, n (%) 18 (60) 33 (75) NS Mold exposure index, mean (SD) 3.43 (1.1) 0.55 (1.1) <.001 IgG-ASP (U/mL), mean (SD) 83.2 (84.1) 12.2 (7.6) <.001 Total IgE (U/mL), mean (SD) 2433 (5322) 302.7 (341.2) <.001 IgE-ASP</description><identifier>ISSN: 2213-2198</identifier><identifier>EISSN: 2213-2201</identifier><identifier>DOI: 10.1016/j.jaip.2021.04.011</identifier><identifier>PMID: 33892172</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Airway management ; Allergic bronchopulmonary aspergillosis ; Aspergillosis ; Aspergillus ; Aspergillus fumigatus ; Asthma ; Atopy ; Bronchiectasis ; Colonization ; Computed tomography ; Cough ; Cytokines ; Fungi ; Germination ; Hyphae ; Immunocompetence ; Immunoglobulin E ; Immunoglobulin G ; Inflammation ; Leukocytes (eosinophilic) ; Lung diseases ; Mold ; Serology ; Spores ; Thorax ; Tomography</subject><ispartof>The journal of allergy and clinical immunology in practice (Cambridge, MA), 2021-07, Vol.9 (7), p.2920-2922.e2</ispartof><rights>2021 American Academy of Allergy, Asthma & Immunology</rights><rights>2021. American Academy of Allergy, Asthma & Immunology</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-a1e7d0dc48357172976c145f3638fea886097f32a4e4451e7b318556b9cd0c2a3</citedby><cites>FETCH-LOGICAL-c384t-a1e7d0dc48357172976c145f3638fea886097f32a4e4451e7b318556b9cd0c2a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33892172$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Solidoro, Paolo</creatorcontrib><creatorcontrib>Nicola, Stefania</creatorcontrib><creatorcontrib>Ridolfi, Irene</creatorcontrib><creatorcontrib>Bucca, Caterina</creatorcontrib><creatorcontrib>Heffler, Enrico</creatorcontrib><creatorcontrib>Bagnasco, Diego</creatorcontrib><creatorcontrib>Canonica, Giorgio Walter</creatorcontrib><creatorcontrib>Blasi, Francesco</creatorcontrib><creatorcontrib>Paggiaro, Pierluigi</creatorcontrib><creatorcontrib>Rolla, Giovanni</creatorcontrib><creatorcontrib>Brussino, Luisa</creatorcontrib><title>Aspergillus-related diseases in a cohort of patients with severe asthma: A SANI single-center report</title><title>The journal of allergy and clinical immunology in practice (Cambridge, MA)</title><addtitle>J Allergy Clin Immunol Pract</addtitle><description>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)1 0.11 (0.06)2 4.9 (6.60)1 20.6 (39.6) IgG-ASP (U/mL), mean (SD) 12.4 (7.8)3-6 11.0 (6.5)6 74.9 (73)1,6 66.0 (90)1 47.4 (55)1,6 177.3 (90)1-3,5 AE (n/y), mean (SD) 2.3 (1.3)4,6 2.0 (0.9)6 2.6 (1.2)6 4.0 (2.9)1 2.5 (1.2) 4.2 (1.7)1-3,5 VC (% pred), mean (SD) 85.0 (16)4 90.7 (3.1)4 79.5 (18) 65.0 (12)1,2 80.5 (24) 82.7 (17) FEV1 (% pred), mean (SD) 71.0 (16)4,6 76.5 (12)3,4,6 63.0 (7)2 52.8 (9)1,2 59.3 (21) 54.8 (15)1,2 FEV1/VC%, mean (SD) 63.9 (11)5,6 66.7 (19)5 61.6 (14) 61.5 (11) 51.6 (11)1,2 52.8 (4.5)1 FEV1 PB %, mean (SD) 17.3 (11) 15.0 (10) 20.3 (9) 11.5 (10) 20.5 (14) 24.8 (10) Bronchiectasis, n (%) 5 (13)3,4,6 0 (0) 6 (75)1 3 (75)1 4 (33) 6 (100)1 CRSwNP, n (%) 19 (50) 2 (33) 2 (25) 1 (25) 8 (67) 4 (67) OCS, n (%) 14 (37) 2 (33) 1 (13) 3 (75) 5 (42) 5 (83) Biologic therapy, n (%) 26 (68) 3 (50) 5 (63) 3 (75) 7 (58) 6 (100) Table I . Characteristics of patients by Aspergillus-related disease∗ Variable ASP-related disease groups 3, 4, 5, 6 (n = 30) No ASP-related disease groups 1, 2 (n = 44) P Patients (number) 30 44 Age (y), mean (SD) 61.6 (12) 60.6 (12) NS BMI, mean (SD) 24.9 (5.5) 25.0 (4.1) NS Females, n (%) 18 (60) 33 (75) NS Mold exposure index, mean (SD) 3.43 (1.1) 0.55 (1.1) <.001 IgG-ASP (U/mL), mean (SD) 83.2 (84.1) 12.2 (7.6) <.001 Total IgE (U/mL), mean (SD) 2433 (5322) 302.7 (341.2) <.001 IgE-ASP</description><subject>Airway management</subject><subject>Allergic bronchopulmonary aspergillosis</subject><subject>Aspergillosis</subject><subject>Aspergillus</subject><subject>Aspergillus fumigatus</subject><subject>Asthma</subject><subject>Atopy</subject><subject>Bronchiectasis</subject><subject>Colonization</subject><subject>Computed tomography</subject><subject>Cough</subject><subject>Cytokines</subject><subject>Fungi</subject><subject>Germination</subject><subject>Hyphae</subject><subject>Immunocompetence</subject><subject>Immunoglobulin E</subject><subject>Immunoglobulin G</subject><subject>Inflammation</subject><subject>Leukocytes (eosinophilic)</subject><subject>Lung diseases</subject><subject>Mold</subject><subject>Serology</subject><subject>Spores</subject><subject>Thorax</subject><subject>Tomography</subject><issn>2213-2198</issn><issn>2213-2201</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kU9P3DAQxa2qqCDgC_SALHHpJcH_kjiolxVqAQnBoe3Z8toT1lE2ST0OqN--Xi1w4MBcZg6_9zR6j5CvnJWc8fqiL3sb5lIwwUumSsb5J3IkBJeFEIx_fr15qw_JKWLP8mjeMMW-kEMpdSt4I46IX-EM8TEMw4JFhMEm8NQHBIuANIzUUjdtppjo1NHZpgBjQvoc0oYiPEEEajFttvaSruiv1f0txTA-DlC4zEGkEeasPSEHnR0QTl_2Mfnz88fvq5vi7uH69mp1VzipVSosh8Yz75SWVZO_a5vacVV1spa6A6t1zdqmk8IqUKrK8FpyXVX1unWeOWHlMfm2953j9HcBTGYb0MEw2BGmBY2ouBai4UJm9Pwd2k9LHPN3mVK6lUK0babEnnJxQozQmTmGrY3_DGdmV4Ppza4Gs6vBMGVyDVl09mK9rLfg3ySvoWfg-x6AnMVTgGjQ5Vwd-BDBJeOn8JH_f-jcluM</recordid><startdate>20210701</startdate><enddate>20210701</enddate><creator>Solidoro, Paolo</creator><creator>Nicola, Stefania</creator><creator>Ridolfi, Irene</creator><creator>Bucca, Caterina</creator><creator>Heffler, Enrico</creator><creator>Bagnasco, Diego</creator><creator>Canonica, Giorgio Walter</creator><creator>Blasi, Francesco</creator><creator>Paggiaro, Pierluigi</creator><creator>Rolla, Giovanni</creator><creator>Brussino, Luisa</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20210701</creationdate><title>Aspergillus-related diseases in a cohort of patients with severe asthma: A SANI single-center report</title><author>Solidoro, Paolo ; Nicola, Stefania ; Ridolfi, Irene ; Bucca, Caterina ; Heffler, Enrico ; Bagnasco, Diego ; Canonica, Giorgio Walter ; Blasi, Francesco ; Paggiaro, Pierluigi ; Rolla, Giovanni ; Brussino, Luisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-a1e7d0dc48357172976c145f3638fea886097f32a4e4451e7b318556b9cd0c2a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Airway management</topic><topic>Allergic bronchopulmonary aspergillosis</topic><topic>Aspergillosis</topic><topic>Aspergillus</topic><topic>Aspergillus fumigatus</topic><topic>Asthma</topic><topic>Atopy</topic><topic>Bronchiectasis</topic><topic>Colonization</topic><topic>Computed tomography</topic><topic>Cough</topic><topic>Cytokines</topic><topic>Fungi</topic><topic>Germination</topic><topic>Hyphae</topic><topic>Immunocompetence</topic><topic>Immunoglobulin E</topic><topic>Immunoglobulin G</topic><topic>Inflammation</topic><topic>Leukocytes (eosinophilic)</topic><topic>Lung diseases</topic><topic>Mold</topic><topic>Serology</topic><topic>Spores</topic><topic>Thorax</topic><topic>Tomography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Solidoro, Paolo</creatorcontrib><creatorcontrib>Nicola, Stefania</creatorcontrib><creatorcontrib>Ridolfi, Irene</creatorcontrib><creatorcontrib>Bucca, Caterina</creatorcontrib><creatorcontrib>Heffler, Enrico</creatorcontrib><creatorcontrib>Bagnasco, Diego</creatorcontrib><creatorcontrib>Canonica, Giorgio Walter</creatorcontrib><creatorcontrib>Blasi, Francesco</creatorcontrib><creatorcontrib>Paggiaro, Pierluigi</creatorcontrib><creatorcontrib>Rolla, Giovanni</creatorcontrib><creatorcontrib>Brussino, Luisa</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of allergy and clinical immunology in practice (Cambridge, MA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Solidoro, Paolo</au><au>Nicola, Stefania</au><au>Ridolfi, Irene</au><au>Bucca, Caterina</au><au>Heffler, Enrico</au><au>Bagnasco, Diego</au><au>Canonica, Giorgio Walter</au><au>Blasi, Francesco</au><au>Paggiaro, Pierluigi</au><au>Rolla, Giovanni</au><au>Brussino, Luisa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Aspergillus-related diseases in a cohort of patients with severe asthma: A SANI single-center report</atitle><jtitle>The journal of allergy and clinical immunology in practice (Cambridge, MA)</jtitle><addtitle>J Allergy Clin Immunol Pract</addtitle><date>2021-07-01</date><risdate>2021</risdate><volume>9</volume><issue>7</issue><spage>2920</spage><epage>2922.e2</epage><pages>2920-2922.e2</pages><issn>2213-2198</issn><eissn>2213-2201</eissn><abstract>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)1 0.11 (0.06)2 4.9 (6.60)1 20.6 (39.6) IgG-ASP (U/mL), mean (SD) 12.4 (7.8)3-6 11.0 (6.5)6 74.9 (73)1,6 66.0 (90)1 47.4 (55)1,6 177.3 (90)1-3,5 AE (n/y), mean (SD) 2.3 (1.3)4,6 2.0 (0.9)6 2.6 (1.2)6 4.0 (2.9)1 2.5 (1.2) 4.2 (1.7)1-3,5 VC (% pred), mean (SD) 85.0 (16)4 90.7 (3.1)4 79.5 (18) 65.0 (12)1,2 80.5 (24) 82.7 (17) FEV1 (% pred), mean (SD) 71.0 (16)4,6 76.5 (12)3,4,6 63.0 (7)2 52.8 (9)1,2 59.3 (21) 54.8 (15)1,2 FEV1/VC%, mean (SD) 63.9 (11)5,6 66.7 (19)5 61.6 (14) 61.5 (11) 51.6 (11)1,2 52.8 (4.5)1 FEV1 PB %, mean (SD) 17.3 (11) 15.0 (10) 20.3 (9) 11.5 (10) 20.5 (14) 24.8 (10) Bronchiectasis, n (%) 5 (13)3,4,6 0 (0) 6 (75)1 3 (75)1 4 (33) 6 (100)1 CRSwNP, n (%) 19 (50) 2 (33) 2 (25) 1 (25) 8 (67) 4 (67) OCS, n (%) 14 (37) 2 (33) 1 (13) 3 (75) 5 (42) 5 (83) Biologic therapy, n (%) 26 (68) 3 (50) 5 (63) 3 (75) 7 (58) 6 (100) Table I . Characteristics of patients by Aspergillus-related disease∗ Variable ASP-related disease groups 3, 4, 5, 6 (n = 30) No ASP-related disease groups 1, 2 (n = 44) P Patients (number) 30 44 Age (y), mean (SD) 61.6 (12) 60.6 (12) NS BMI, mean (SD) 24.9 (5.5) 25.0 (4.1) NS Females, n (%) 18 (60) 33 (75) NS Mold exposure index, mean (SD) 3.43 (1.1) 0.55 (1.1) <.001 IgG-ASP (U/mL), mean (SD) 83.2 (84.1) 12.2 (7.6) <.001 Total IgE (U/mL), mean (SD) 2433 (5322) 302.7 (341.2) <.001 IgE-ASP</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33892172</pmid><doi>10.1016/j.jaip.2021.04.011</doi></addata></record> |
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| subjects | Airway management Allergic bronchopulmonary aspergillosis Aspergillosis Aspergillus Aspergillus fumigatus Asthma Atopy Bronchiectasis Colonization Computed tomography Cough Cytokines Fungi Germination Hyphae Immunocompetence Immunoglobulin E Immunoglobulin G Inflammation Leukocytes (eosinophilic) Lung diseases Mold Serology Spores Thorax Tomography |
| title | Aspergillus-related diseases in a cohort of patients with severe asthma: A SANI single-center report |
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