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

Abstract

Background: Allergy and Aspergillus hypersensitivity (AH) were shown to be associated with severe symptoms or worse lung function in COPD patients. The prevalence of elevated total IgE (T-IgE) and its association with clinical symptoms and lung function in COPD have not been studied. The prevalence of AH and its correlation with clinical characteristics in a COPD cohort of larger sample size is also lacking. Methods: 273 patients with COPD were evaluated by respiratory symptoms, blood test, chest HRCT, lung function, serum detection of T-IgE and Aspergillus specific IgE. Patients with T-IgE ≥ 1000 KU/L were further investigated for allergic bronchopulmonary aspergillosis (ABPA). Results: The prevalence of elevated T-IgE and AH in patients with COPD was 47.3% and 15.0%, respectively. Eight patients (2.9%) met the diagnostic criteria for ABPA. Compared with the normal T-IgE group, patients with elevated T-IgE had a longer history of dyspnea (p < 0.01), an earlier onset of dyspnea after chronic cough/expectoration (p < 0.01), and were more likely to wheeze (p < 0.01). They also showed worse lung functions and more severe GOLD staging (p < 0.01). Analysis of the clinical data in male patients with smoking as the risk factor showed the same results. To evaluate the clinical characteristics of COPD with AH, patients with elevated T-IgE were further divided into subgroups with and without AH. When compared with the normal T-IgE group, both the two subgroups showed longer history of dyspnea (p < 0.01), an earlier onset of dyspnea (p < 0.01) and a worse status of lung function (p < 0.05). Correlation analysis demonstrated that T-IgE was correlated positively with the time length of dyspnea (r = 0.401, p < 0.001), and the ratio of duration of dyspnea to that of chronic cough/expectoration (r = 0.59, p < 0.001), but negatively with FEV1/ FVC% (r = −0.194, p = 0.001), and FEV1%predicted (r = −0.219, p < 0.001).

Aspergillus sensitisation in bidi smokers with and without chronic obstructive lung disease

“…In an earlier study, we found the prevalence of Aspergillus sensitisation of about 8.5% in patients with COPD using Aspergillus skin test . Subsequently, the prevalence of Aspergillus sensitisation was found ranging from 13 to 15% in two different studies using A. fumigates ‐specific IgE . Recently, Agarwal et al .…”

“…One study found the growth of A. fumigatus in sputum of 37% of the COPD subjects at baseline . Recent studies have also described the presence of Aspergillus sensitisation in COPD patients . We had previously described the presence of Aspergillus sensitisation in 8.5% of subjects with COPD .…”

The role of fungal sensitisation in clinical presentation in patients with chronic obstructive pulmonary disease

“…Furthermore, the authors concluded that the patients with raised total IgE but not sensitised to Apergillus spp. display a similar clinical behaviour as by their Aspergillus ‐sensitised COPD counterparts . Therefore, it is imperative that the symptoms in the former subset of patients may be attributable to allergens other than those of the Aspergilli .…”

The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD

“…117 Up to 8-15% of COPD patients have hypersensitivity to Aspergillus, with associated reduced lung function. 118,119 Whether the use of antifungals may mitigate such declines in pulmonary function remains to be studied. Isolation of Aspergillus in the airway may represent temporary passage, benign carriage or be an early sign of invasive pulmonary aspergillosis (IPA), especially with high steroid use for recurrent exacerbations conferring host immunosuppression.…”