The University of Southampton
University of Southampton Institutional Repository
Warning ePrints Soton is experiencing an issue with some file downloads not being available. We are working hard to fix this. Please bear with us.

The clinical implications of Aspergillus Fumigatus sensitization in difficult-to-treat asthma patients

The clinical implications of Aspergillus Fumigatus sensitization in difficult-to-treat asthma patients
The clinical implications of Aspergillus Fumigatus sensitization in difficult-to-treat asthma patients

Background: fungal sensitivity has been associated with severe asthma outcomes. However, the clinical implication of Aspergillus fumigatus sensitization in difficult-to-treat (or difficult) asthma is unclear.

Objectives: to characterize the clinical implications of A fumigatus sensitization in a large difficult asthma cohort.

Methods: participants who underwent both skin prick and specific IgE testing to A fumigatus (n = 318) from the longitudinal real-life Wessex AsThma CoHort of difficult asthma, United Kingdom, were characterized by A fumigatus sensitization (either positive skin prick test result or specific IgE) and allergic bronchopulmonary aspergillosis status using clinical/pathophysiological disease measures.

Results: a fumigatus sensitization was found in 23.9% (76 of 318) of patients with difficult asthma. Compared with A fumigatus nonsensitized subjects, those with sensitization were significantly more often male (50% vs 31%), older (58 years) with longer asthma duration (33 years), higher maintenance oral corticosteroid (39.7%) and asthma biologic use (27.6%), raised current/maximum log10 total IgE+1 (2.43/2.72 IU/L), worse prebronchodilator airflow obstruction (FEV1 62.2% predicted, FEV1/forced vital capacity 61.2%, forced expiratory flow between 25% and 75% exhalation 30.9% predicted), and frequent radiological bronchiectasis (40%), but had less psychophysiologic comorbidities. Allergic bronchopulmonary aspergillosis diagnosis was associated with higher treatment needs and stronger eosinophilic signals. Factors independently associated with A fumigatus sensitization in difficult asthma included maintenance oral corticosteroid use (odds ratio [OR], 3.34) and maximum log10 total IgE+1 (OR, 4.30), whereas for allergic bronchopulmonary aspergillosis included maintenance oral corticosteroid use (OR, 6.98), maximum log10 total IgE+1 (OR, 4.65), and radiological bronchiectasis (OR, 4.08).

Conclusions: a fumigatus sensitization in difficult asthma identifies a more severe form of airways disease associated with greater morbidity, treatment need, and airways dysfunction/damage, but fewer psychophysiologic comorbidities. Screening of A fumigatus status should be an early element in the comprehensive assessment of patients with difficult asthma.

ABPA, Aspergillus fumigatus, Difficult asthma, Fungal sensitization, Lung function, SAFS
2213-2198
Mistry, Heena
c3d0c984-b38f-4e2e-8415-269750a05fc5
Ajsivinac Soberanis, Hilda Maria
37a27f93-05fb-4426-820b-54b21b310e1f
Kyyaly, Mohammad Aref
7bd69b33-fec8-405c-9f40-b7157f0242f0
Azim, Adnan
87c31e0e-c9bf-4258-9ae9-889e2382e7ba
Barber, Clair
ff31b460-34c3-466c-90e4-f70b3e954c82
Knight, Deborah
4f44f912-5106-4fb5-9cf2-b4f86440523c
Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Haitchi, Hans Michael
68dadb29-305d-4236-884f-e9c93f4d78fe
Wilkinson, Tom
8c55ebbb-e547-445c-95a1-c8bed02dd652
Howarth, Peter
ff19c8c4-86b0-4a88-8f76-b3d87f142a21
Seumois, Grégory
0be7d3d6-5526-458c-aa5c-cce52410a2ed
Vijayanand, Pandurangan
79514f33-66cf-47cc-a8fa-46bbfc21b7d1
Arshad, S Hasan
917e246d-2e60-472f-8d30-94b01ef28958
Kurukulaaratchy, Ramesh J
9c7b8105-2892-49f2-8775-54d4961e3e74
Mistry, Heena
c3d0c984-b38f-4e2e-8415-269750a05fc5
Ajsivinac Soberanis, Hilda Maria
37a27f93-05fb-4426-820b-54b21b310e1f
Kyyaly, Mohammad Aref
7bd69b33-fec8-405c-9f40-b7157f0242f0
Azim, Adnan
87c31e0e-c9bf-4258-9ae9-889e2382e7ba
Barber, Clair
ff31b460-34c3-466c-90e4-f70b3e954c82
Knight, Deborah
4f44f912-5106-4fb5-9cf2-b4f86440523c
Newell, Colin
fd859e4b-b3a6-4722-b1de-2e52c8633899
Haitchi, Hans Michael
68dadb29-305d-4236-884f-e9c93f4d78fe
Wilkinson, Tom
8c55ebbb-e547-445c-95a1-c8bed02dd652
Howarth, Peter
ff19c8c4-86b0-4a88-8f76-b3d87f142a21
Seumois, Grégory
0be7d3d6-5526-458c-aa5c-cce52410a2ed
Vijayanand, Pandurangan
79514f33-66cf-47cc-a8fa-46bbfc21b7d1
Arshad, S Hasan
917e246d-2e60-472f-8d30-94b01ef28958
Kurukulaaratchy, Ramesh J
9c7b8105-2892-49f2-8775-54d4961e3e74

Mistry, Heena, Ajsivinac Soberanis, Hilda Maria, Kyyaly, Mohammad Aref, Azim, Adnan, Barber, Clair, Knight, Deborah, Newell, Colin, Haitchi, Hans Michael, Wilkinson, Tom, Howarth, Peter, Seumois, Grégory, Vijayanand, Pandurangan, Arshad, S Hasan and Kurukulaaratchy, Ramesh J (2021) The clinical implications of Aspergillus Fumigatus sensitization in difficult-to-treat asthma patients. Journal of Allergy and Clinical Immunology: In Practice. (doi:10.1016/j.jaip.2021.08.038).

Record type: Article

Abstract

Background: fungal sensitivity has been associated with severe asthma outcomes. However, the clinical implication of Aspergillus fumigatus sensitization in difficult-to-treat (or difficult) asthma is unclear.

Objectives: to characterize the clinical implications of A fumigatus sensitization in a large difficult asthma cohort.

Methods: participants who underwent both skin prick and specific IgE testing to A fumigatus (n = 318) from the longitudinal real-life Wessex AsThma CoHort of difficult asthma, United Kingdom, were characterized by A fumigatus sensitization (either positive skin prick test result or specific IgE) and allergic bronchopulmonary aspergillosis status using clinical/pathophysiological disease measures.

Results: a fumigatus sensitization was found in 23.9% (76 of 318) of patients with difficult asthma. Compared with A fumigatus nonsensitized subjects, those with sensitization were significantly more often male (50% vs 31%), older (58 years) with longer asthma duration (33 years), higher maintenance oral corticosteroid (39.7%) and asthma biologic use (27.6%), raised current/maximum log10 total IgE+1 (2.43/2.72 IU/L), worse prebronchodilator airflow obstruction (FEV1 62.2% predicted, FEV1/forced vital capacity 61.2%, forced expiratory flow between 25% and 75% exhalation 30.9% predicted), and frequent radiological bronchiectasis (40%), but had less psychophysiologic comorbidities. Allergic bronchopulmonary aspergillosis diagnosis was associated with higher treatment needs and stronger eosinophilic signals. Factors independently associated with A fumigatus sensitization in difficult asthma included maintenance oral corticosteroid use (odds ratio [OR], 3.34) and maximum log10 total IgE+1 (OR, 4.30), whereas for allergic bronchopulmonary aspergillosis included maintenance oral corticosteroid use (OR, 6.98), maximum log10 total IgE+1 (OR, 4.65), and radiological bronchiectasis (OR, 4.08).

Conclusions: a fumigatus sensitization in difficult asthma identifies a more severe form of airways disease associated with greater morbidity, treatment need, and airways dysfunction/damage, but fewer psychophysiologic comorbidities. Screening of A fumigatus status should be an early element in the comprehensive assessment of patients with difficult asthma.

Text
Accepted WATCH Fungal Paper JACiP 090821_Clean - Accepted Manuscript
Restricted to Repository staff only until 14 September 2022.
Request a copy
Text
Accepted WATCH Fungal Paper JACIiP Supplementary Data090821
Restricted to Repository staff only
Request a copy

More information

Accepted/In Press date: 27 August 2021
e-pub ahead of print date: 14 September 2021
Published date: 14 September 2021
Additional Information: Funding Information: The Wessex AsThma CoHort of difficult asthma (WATCH) study has been supported by the National Institute for Health Research Southampton Biomedical Research Centre and Clinical Research Facility at University Hospital Southampton National Health Service Foundation Trust, United Kingdom. The WATCH study itself is not externally funded. Funding assistance for database support for the WATCH study was initially obtained from a nonpromotional grant from Novartis (£35,000). Funding assistance for patient costs (eg, parking) was initially provided by a charitable grant (£3500) from the Asthma, Allergy & Inflammation Research Charity . The WATCH study is registered through ClinicalTrials.gov ; Identifier: NCT03996590 . Funding Information: We thank the patients who are participating in this study. We also acknowledge the contributions of the wider WATCH study team including Matthew Harvey, Mae Felongco, Helen Wheeler, June Law, Yvette Thirlwall, Kim Bentley, Laura Presland, Frances Mitchell, Yueqing Cheng, Josune Olza Meneses, Paddy Dennison, Anna Freeman, Wei Chern Gavin Fong, Kerry Day, David Hill, and Ratko Djukanovic. We also acknowledge the support of the Southampton National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) and Clinical Research Facility . The Clinical Research Facility and BRC are funded by NIHR Southampton and are a partnership between the University of Southampton and University Hospital Southampton NHS Foundation Trust . We also acknowledge funding support from Novartis and the Asthma Allergy and Inflammation Research Charity . Publisher Copyright: © 2021 American Academy of Allergy, Asthma & Immunology Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: ABPA, Aspergillus fumigatus, Difficult asthma, Fungal sensitization, Lung function, SAFS

Identifiers

Local EPrints ID: 451450
URI: http://eprints.soton.ac.uk/id/eprint/451450
ISSN: 2213-2198
PURE UUID: 1b2c25c9-43c3-4647-a975-7091826ffaf1
ORCID for Mohammad Aref Kyyaly: ORCID iD orcid.org/0000-0002-1684-9207
ORCID for Clair Barber: ORCID iD orcid.org/0000-0001-5335-5129
ORCID for Hans Michael Haitchi: ORCID iD orcid.org/0000-0001-8603-302X
ORCID for Ramesh J Kurukulaaratchy: ORCID iD orcid.org/0000-0002-1588-2400

Catalogue record

Date deposited: 28 Sep 2021 16:35
Last modified: 26 Nov 2021 03:08

Export record

Altmetrics

Contributors

Author: Heena Mistry
Author: Hilda Maria Ajsivinac Soberanis
Author: Adnan Azim
Author: Clair Barber ORCID iD
Author: Deborah Knight
Author: Colin Newell
Author: Tom Wilkinson
Author: Peter Howarth
Author: Grégory Seumois
Author: Pandurangan Vijayanand
Author: S Hasan Arshad

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×