The prevalence of increased serum IgE and Aspergillus sensitization in patients with COPD and their association with symptoms and lung function

Abstract

BackgroundAllergy 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.Methods273 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).ResultsThe 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).ConclusionsThere was a high prevalence of elevated serum T-IgE and AH in patients with COPD. Serum T-IgE level was correlated with symptoms such as dyspnea and impairment of lung function. Allergens other than Aspergillus may have similar effects on disease expression or progression of COPD.

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

“…Recurrent exacerbation of COPD is believed to accelerate disease progression and impairment of pulmonary function, and related to increased disability and mortality [35,36]. Acute exacerbation of COPD can be precipitated by several factors, but the most common causes appear to be viral or bacterial respiratory infections [37]. However, the cause of about one-third of severe exacerbations of COPD cannot be identified [37].…”

“…Acute exacerbation of COPD can be precipitated by several factors, but the most common causes appear to be viral or bacterial respiratory infections [37]. However, the cause of about one-third of severe exacerbations of COPD cannot be identified [37]. Because the allergic phenotype of COPD was shown to have an increased risk of exacerbations [2], whether airway allergy plays a role in the susceptibility to, or is an unidentified trigger for exacerbation is worth further speculating.…”

Factors associated with bronchiectasis in patients with moderate–severe chronic obstructive pulmonary disease

“…The patients were diagnosed to have COPD by the following criteria, as described in our previous study: [8] (i) age >40 years, (ii) history of smoking (smoking index >10 pack-year) and/or exposure to noxious dusts/chemical agents/biomass fuel (mostly coal or wood burning stoves) for >10 years, (iii) chronic cough and/or wheeze for >3 months in each year for two consecutive years, and (iv) irreversible obstructive dysfunction defined by postbronchodilator FEV 1 /FVC < 70% on spirometry. The enrolled patients showed no evidence of parasite infection and no history of food allergy and doctor-diagnosed allergy such as eczema and allergic rhinitis.…”

“…The enrolled patients showed no evidence of parasite infection and no history of food allergy and doctor-diagnosed allergy such as eczema and allergic rhinitis. [8] Patients were excluded from the study if they met any of the following criteria as we previously described: receiving therapy of systemic corticosteroid in the preceding 8 weeks; receiving any other therapy of immunosuppression; with allergic bronchopulmonary mycosis, interstitial lung diseases, active pulmonary tuberculosis, autoimmune diseases, and severe heart failure; previous pulmonary tuberculosis resulting in severe lung damage (“destroyed lung”); doctor-diagnosed bronchiectasis or asthma before diagnosis of COPD; and history of measles or whooping cough during childhood.…”

Approach to Diagnosis and Treatment of Allergy to Alternaria alternata in Patients with Chronic Obstructive Pulmonary Disease and Perennial Allergic Rhinitis

“…Allergy to fungi often appears as type I immediate, IgEmediated hypersensitivity, which manifests various allergic diseases, such as bronchial asthma, most types of sinusitis, allergic rhinitis, and pollinosis. Many studies showed that increased serum total IgE is also a sensitive marker for chronic obstructive pulmonary disease (COPD) patients with higher smoking index, longer duration of illness, more severe lung function impairment [6][7][8][9]. COPD is characterized by persistent airflow limitation, and is a major cause of morbidity and mortality worldwide.…”