Isolation of filamentous fungi from sputum in asthma is associated with reduced post-bronchodilator FEV1.pdf (141.74 kB)
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Isolation of filamentous fungi from sputum in asthma is associated with reduced post-bronchodilator FEV1.

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journal contribution
posted on 24.10.2012, 08:55 by J. Agbetile, A. Fairs, D. Desai, B. Hargadon, M. Bourne, K. Mutalithas, R. Edwards, J. P. Morley, W. R. Monteiro, N. S. Kulkarni, R. H. Green, I. D. Pavord, P. Bradding, C. E. Brightling, A. J. Wardlaw, C. H. Pashley
Background Fungal sensitization is common in severe asthma, but the clinical relevance of this and the relationship with airway colonization by fungi remain unclear. The range of fungi that may colonize the airways in asthma is unknown. Objective To provide a comprehensive analysis on the range of filamentous fungi isolated in sputum from people with asthma and report the relationship with their clinico-immunological features of their disease. Methods We recruited 126 subjects with a diagnosis of asthma, 94% with moderate-severe disease, and 18 healthy volunteers. At a single stable visit, subjects underwent spirometry; sputum fungal culture and a sputum cell differential count; skin prick testing to both common aeroallergens and an extended fungal panel; specific IgE to Aspergillus fumigatus. Fungi were identified by morphology and species identity was confirmed by sequencing. Four patients had allergic bronchopulmonary aspergillosis. Results Forty-eight percent of asthma subjects were IgE-sensitized to one fungal allergen and 22% to ≥ 2. Twenty-seven different taxa of filamentous fungi were isolated from 54% of their sputa, more than one species being detected in 17%. This compared with 3 (17%) healthy controls culturing any fungus (P < 0.01). Aspergillus species were most frequently cultured in isolation followed by Penicillium species. Post-bronchodilator FEV 1 (% predicted) in the subjects with asthma was 71(± 25) in those with a positive fungal culture vs. 83 (± 25) in those culture-negative, (P < 0.01). Conclusion and Clinical Relevance Numerous thermotolerant fungi other than A. fumigatus can be cultured from sputum of people with moderate-to-severe asthma; a positive culture is associated with an impaired post-bronchodilator FEV 1, which might be partly responsible for the development of fixed airflow obstruction in asthma. Sensitization to these fungi is also common.

Funding

This study was supported by the Midlands Asthma and Allergy Research Association (CHP, AJW, AF, REE), Asthma UK, Wellcome Trust Senior Fellowship (CEB) and the European Regional Development Fund (ERDF 05567). AJW has received grant funding from Pfizer Ltd for a clinical trial of voriconazole in fungal allergy-associated asthma.

History

Citation

Clinical and Experimental Allergy, 2012, 42 (5), pp. 782-791

Version

VoR (Version of Record)

Published in

Clinical and Experimental Allergy

Publisher

Blackwell

eissn

1365-2222

Copyright date

2012

Available date

24/10/2012

Publisher version

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2012.03987.x/abstract

Language

eng