Abstract

Background: Airway mycobiomes in COPD demonstrating increased Aspergillus, Curvularia and Penicillium associated with poorer clinical outcomes, however, their relationship to environmental exposure in the home remains unexplored. Methods: Patients with stable COPD (n=43) and healthy participants (n=28) were prospectively recruited and underwent clinical data collation and home studies including deep shotgun metagenomic assessment of host (sputum), indoor air (bedroom), outdoor air (balcony) and surface dust (fan or air-conditioner filter) (4 metagenomes per home; Total 284 metagenomes). Results: Shotgun metagenomics reveals increased Aspergillus fumigatus, Pseudomonas alcaligenes and Brevibacterium luteolum in indoor air (bedroom) and Malassezia restrica and Aspergillus spp. in surface dust and outdoor air (balcony) in the homes of individuals with COPD. Relative abundance of indoor air Aspergillus fumigatus positively correlates with exacerbation frequency in COPD (r=0.4, p=0.009) however no differences were observed in symptom burden or lung function. Conclusion: Aspergillus spp., present at increased levels in the home environment is associated to COPD exacerbations. Environmental exposures in the home represent a source of Aspergillus-related outcomes in COPD. Funding: Singapore Ministry of Health?s NMRC under its Clinician Scientist Award (CSA) (MOH-000710) (S.H.C) & Singapore Ministry of Education under its AcRF Tier 1 Grant (RT1/22) (S.H.C).