Introduction

It has been suggested that Aspergillus fumigatus sensitization (AFS) in severe asthma patients is associated with increased risk of progressive lung damage and worse clinical outcomes (Denning DW et al, ERJ 2006). Despite this, real-world clinical data on patients with AFS are limited.

Aims and objectives

To compare clinical, functional, inflammatory and radiographic characteristics between AFS and non-AFS in a Slovenian cohort of severe asthma patients.

Methods

Of 75 patients included in the Slovenian section (site University Medical Centre Ljubljana) of the ERS Severe Asthma Registry (SHARP), 15 (20%) had AFS assessed by either skin prick test or specific IgE to Aspergillus. Demographics, maintenance oral corticosteroid (OCS) use, severe asthma exacerbation (SAE) rate, FEV1, total IgE, blood eosinophils, exhaled NO, and radiology data were were compared cross-sectionally  between AFS and non-AFS patients.

Results

AFS patients had higher serum IgE (median 403 IU/ml; IQR 234-892 IU/ml) vs non AFS patients (median 145 IU/ml; IQR 67-367 IU/ml; p=0.008) and higher prevalence of bronchiectasis (8 (53%) vs 9 (18%), respectively (p=0.005)). There were no significant differences between AFS and non AFS patients in maintanance OCS use (p=0.17), FEV1 % predicted (p= 0.28), level of exhaled NO (p= 0.19), level of blood eosinophils (p=0.70) and SAE/year (p=0.49).

Conclusion

The higher prevalence of bronchiectasis in AFS severe asthma patients confirms previous data, but this is not true for FEV1 and maintenance OCS use. These results call for larger-scale multinational research into this under-recognised comorbidity, which the pan-European SHARP consortium can provide.