Aspergillus fumigatus during stable state and exacerbations of COPD

Abstract

Bacteria are often isolated in stable chronic obstructive pulmonary disease (COPD). Whether fungi are also commonly present and associated with clinical and pathological features of disease is uncertain. We investigated the frequency of filamentous fungal culture and IgE sensitisation to Aspergillus fumigatus and the relationship to clinical outcomes in COPD subjects.COPD subjects were recruited to enter a 1-year observational study. Assessments of lung function, allergen testing and sputum analysis for inflammation, bacteria and fungus were undertaken in COPD subjects and healthy smoking and nonsmoking controls.Filamentous fungi were cultured at baseline in 49% (63 out of 128) of COPD subjects, of which 75% (47 out of 63) were A. fumigatus. Fungus was cultured in three out of 22 controls (two were A. fumigatus). The total sputum cell count and inhaled corticosteroid dosage were significantly increased in COPD patients with a positive filamentous fungal culture at baseline (p,0.05). Sensitisation to A. fumigatus was present in 13% of COPD subjects and was associated with worse lung function (forced expiratory volume in 1 s 39% predicted versus 51% predicted; p50.01), but not related to filamentous fungal culture.A. fumigatus sensitisation is related to poor lung function. Positive filamentous fungal culture is a common feature of COPD. The clinical significance of this remains uncertain. @ERSpublications A. fumigatus sensitisation links to poor COPD lung function; clinical significance of positive fungal culture is unclear

The Prevalence of Increased Serum IgE and Aspergillus Sensitization in Patients With COPD and Their Association With Symptoms and Lung Function

“…One earlier study showed that the median time to recovery was 6 d (1-14) for peak expiratory flow rate (PEFR) and 7d (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) for symptoms, but recovery of PEFR to baseline values was complete in only 75.2% of exacerbations at 35d [34]. In our study, 18% (51/273) of the COPD patients were enrolled within 2~4 weeks after an exacerbation, when the lung functions were still recovering at least in some of the patients.…”

The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis

“…16,17,27,28 We therefore explored the relationship of Af-stimulated CD203c levels with lung function (forced expiratory volume in the first second, FEV 1 ) and body mass index (BMI), both established determinants of mortality in CF. 29 We observed a significant correlation of Af-stimulated CD203c levels with declining FEV 1 in Af-sensitized patients (n = 16, r 2 = 0.6409, P = 0.0002; Figure 3A).…”

Concomitant presence of Aspergillus fumigatus and Stenotrophomonas maltophilia in the respiratory tract: a new risk for patients with liver disease?

“…This fungus is traditionally isolated in samples from patients with haematological diseases, stem cell or solid organ transplant, or on long-term corticotherapy, thus causing invasive infections (De Pauw et al, 2008). Recent studies have described A. fumigatus colonization in patients with chronic lung diseases, especially chronic obstructive pulmonary disease (COPD) and cystic fibrosis (CF), probably due to lung structural changes and the heavy courses of antibiotics (Bafadhel et al, 2014;Sabino et al, 2014). Furthermore, co-morbidities such as alcoholism, diabetes, malnutrition and liver cirrhosis are often associated with this A. fumigatus colonization (Prodanovic et al, 2007).…”