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

Solidoro, Paolo; Nicola, Stefania; Ridolfi, Irene; Bucca, Caterina; Heffler, Enrico; Bagnasco, Diego; Canonica, Giorgio Walter; Blasi, Francesco; Paggiaro, Pierluigi; Rolla, Giovanni; Brussino, Luisa

doi:10.1016/j.jaip.2021.04.011

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…However, a quarter of the patients received no benefit from 1 year of biologic therapy, in agreement with the results of recent studies [30,31]. Still, the anthropometric characteristics and prevalence of comorbidities in these NR patients were similar to those in the responders [32], apart from a higher prevalence of former smokers (23% vs. 4%). Indeed, in the first 6 months of therapy, a slight although not significant improvement in AE and ACT score was observed also in NR patients, but they showed no further improvement after 1 year of treatment.…”

Section: Discussionsupporting

confidence: 90%

Biologics in Severe Eosinophilic Asthma: Three-Year Follow-Up in a SANI Single Center

et al. 2022

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Introduction: Biologic drugs have dramatically improved severe eosinophilic asthma (SEA) outcomes. Our aim was to evaluate the long-term efficacy of biological therapy in SEA in a real-life setting and to identify the predictors for switching to another biological drug in patients with poor asthma control. The outcomes for efficacy were decreased annual exacerbations (AE) and improved asthma control test (ACT). Methods: In 90 SEA patients being treated with a biological drug, clinical examination, ACT, blood eosinophils count and spirometry were assessed before (T0) and after 6 (T1), 12 (T2), 24 (T3) and 36 (T4) months from the start of biological therapy. Patients were considered responders (R) or non-responders (NR) to biologics depending on whether or not they had less than two AE and a 20% increase in the ACT after 12 months of treatment. Results: 75% of the patients were R, 25% NR. In R patients, biological therapy add-on was followed by significant improvement in AE and ACT throughout the whole follow-up period. The percentage of patients on oral corticosteroids (OCS) dropped from 40% to 12%. By contrast, the NR patients were shifted to another biological drug after 12 months of therapy, as they still had high AE and nearly unchanged ACT; 40% of them still needed OCS treatment. The predictors of switching to another biological drug were three or more AE, ACT below 17, nasal polyposis and former smoking (p < 0.05). In NR, the shift to another biological drug was followed by a significant decrease in AE and an increase in the ACT. Discussion: This real-life study confirms the long-term efficacy of biologics in most SEA patients and indicates that even in non-responders to a first biological drug, it is worth trying a second one. It is hoped that the availability of additional biologics with different targets will help improve the personalization of SEA therapy.

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Section: Discussionsupporting

confidence: 90%

Biologics in Severe Eosinophilic Asthma: Three-Year Follow-Up in a SANI Single Center

et al. 2022

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“…Of the approximately 10% of clinical asthma categorized as severe by American Thoracic Society/European Respiratory Society or Global Initiative for Asthma definitions [ 14 , 15 ], epidemiologic surveys have reported that 20–50% are associated with fungal sensitization phenotypes along this spectrum [ 16 , 17 , 18 ]. Clinically, there is now extensive international evidence that Af sensitization in particular is associated with a more severe and recalcitrant asthma phenotype, including greater airflow limitation, bronchiectasis, mucus plugging, clinical morbidity, diagnosed SAFS and ABPA, in both children and adults [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

Section: The Allergic Fungal Airways Disease Conceptmentioning

confidence: 99%

Severe Fungal Asthma: A Role for Biologics and Inhaled Antifungals

Moss

2023

JoF

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Allergic asthma has traditionally been treated with inhaled and systemic glucocorticosteroids. A continuum of allergic fungal airways disease associated with Aspergillus fumigatus colonization and/or atopic immune responses that encompasses fungal asthma, severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis is now recognized along a phenotypic severity spectrum of T2-high immune deviation lung disease. Oral triazoles have shown clinical, anti-inflammatory and microbiologic efficacy in this setting; in the future inhaled antifungals may improve the therapeutic index. Humanized monoclonal antibody biologic agents targeting T2-high disease also show efficacy and promise of improved control in difficult cases. Developments in these areas are highlighted in this overview.

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“…Recent data show variable prevalence of ABPA in asthmatic patients depending on geographical area with studies from Australia, UK, India, Italy, and Africa displaying results between 3.2 and 24.3% [14][15][16] (Table 1). Various factors contribute to A. fumigatus sensitization and the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in asthma patients.…”

Section: Epidemiological Overview Of Allergic Bronchopulmonary Asperg...mentioning

confidence: 99%

Epidemiology of the relationship between allergic bronchopulmonary aspergillosis and asthma

Maule,

Vitte,

Ambrosani

et al. 2024

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Allergic bronchopulmonary aspergillosis (ABPA) can complicate the natural history of asthmatic patients, especially the more severe ones, worsening disease control and increasing the need for therapies, steroids in particular, and medical care. The aim of the present review is to summarize the latest epidemiological data related to the relationship between asthma and ABPA and to offer a summary of the most recent strategies that could potentially facilitate in the identification of ABPA in asthmatic patients. Recent findings In the last years, great efforts have been made by researchers worldwide to provide reliable epidemiological data on fungal sensitization and ABPA, especially in severe asthma patients both in adult and pediatric population. Data differ depending on the geographical area and population studied, but pooled data show a concerning 11% of severe asthma patients having ABPA and one out of four asthmatic patients being sensitized to fungi, Aspergillus fumigatus in particular. Summary Reliable epidemiological data and advances in the diagnostic procedures can facilitate the detection of ABPA among asthmatic patients, improving the management of a still under-recognized and challenging condition.

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

Cited by 7 publications

References 15 publications

Biologics in Severe Eosinophilic Asthma: Three-Year Follow-Up in a SANI Single Center

Biologics in Severe Eosinophilic Asthma: Three-Year Follow-Up in a SANI Single Center

Severe Fungal Asthma: A Role for Biologics and Inhaled Antifungals

Epidemiology of the relationship between allergic bronchopulmonary aspergillosis and asthma

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