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Allergic bronchopulmonary aspergillosis (ABPA) complicates asthma and may lead to chronic pulmonary aspergillosis (CPA) yet global burdens of each have never been estimated. Antifungal therapy has a place in the management of ABPA and is the cornerstone of treatment in CPA, reducing morbidity and probably mortality. We used the country-specific prevalence of asthma from the Global Initiative for Asthma (GINA) report applied to population estimates to calculate adult asthma cases. From five referral cohorts (China, Ireland, New Zealand, Saudi Arabia and South Africa), we estimated the prevalence of ABPA in adults with asthma at 2.5% (range 0.72-3.5%) (scoping review). From ABPA case series, pulmonary cavitation occurred in 10% (range 7-20%), allowing an estimate of CPA prevalence worldwide using a deterministic scenario-based model. Of 193 million adults with active asthma worldwide, we estimate that 4,837,000 patients (range 1,354,000-6,772,000) develop ABPA. By WHO region, the ABPA burden estimates are: Europe, 1,062,000; Americas, 1,461,000; Eastern Mediterranean, 351,000; Africa, 389,900; Western Pacific, 823,200; South East Asia, 720,400. We calculate a global case burden of CPA complicating ABPA of 411,100 (range 206,300-589,400) at a 10% rate with a 15% annual attrition. The global burden of ABPA potentially exceeds 4.8 million people and of CPA complicating ABPA ˜ 400,000, which is more common than previously appreciated. Both conditions respond to antifungal therapy justifying improved case detection. Prospective population and clinical cohort studies are warranted to more precisely ascertain the frequency of ABPA and CPA in different locations and ethnic groups and validate the model inputs.

Chronic pulmonary aspergillosis (CPA) may complicate pulmonary sarcoidosis. We re-estimated the global burden of sarcoidosis and the burden of CPA complicating sarcoidosis.We searched the literature and reference lists of retrieved papers to identify all published sarcoidosis incidence and prevalence data. We estimated the frequency of CPA from 11 papers relating to .3,000 patients with sarcoidosis to derive CPA patient numbers. We applied an annual attrition rate of 15% (range 10-25%) to estimate the global burden of CPA.We estimate that the annual incidence of sarcoidosis is 344,000 patients worldwide and the prevalence is ,1,238,000 cases, distributed as follows: 165,979 in Europe, 224,000 in the Americas, 492,892 in Africa, 80,023 in the Eastern Mediterranean, 41,660 in the West Pacific and 234,010 in Southeast Asia. CPA complicates sarcoidosis in 3-12% of cases. Using a 6% frequency, we estimate a global burden of 71,907 (range 35,954-143,815 (3-12%)) CPA cases complicating sarcoidosis, with 24% and 37% of cases estimated to be present in the Americas and Africa, because of the higher incidence of sarcoidosis in black people.As CPA responds to long-term antifungal therapy, which may prevent life-threatening haemoptysis, screening periodically for CPA in those with pulmonary sarcoidosis may be important, especially in patients requiring corticosteroid therapy.

suggest that the A 2A receptor is the major subtype accounting for adenosine-induced mast cell tPA activity. Finally, the supernatant from HMC-1 cells treated with adenosine (24h) significantly increased fibrin clot lysis, while ZM241385, an A 2A receptor antagonist, abolished this effect. This study provides the first data to demonstrate the potentiating effect of adenosine on mast cell tPA activity and fibrin clot lysis. Background ABPA may complicate asthma in some patients. The potential global ABPA burden remains unknown, limiting its prioritisation for both population and clinical responses. Methods We estimated the number of adults with asthma, using the GINA statistics as the baseline dataset and this derived equation: Adult Prevalence (AP) ¼ total prevalence 3 adult population/(0.88 paediatric population + adult population). This method provided results which were compatible with more direct sources on Scotland (Ananadan, 2010), North Africa (Nafti, 2009) and the USA (CDC stats, 2008). Two period prevalence rates available on ABPA in asthmatic patients are 0.72% (Ireland; Donnelly, 1991) and 3.5% (New Zealand; Eaton, 2000) (eliminating the non-classical cases from both papers) so we used a mean of 2.1% (range 0.72e3.5%). We estimated case burdens by WHO region and for the UK and USA. Conclusions ABPA is probably more common globally than has been appreciated. A lack of sufficient population research using current fungal diagnostic approaches and clinical research on antifungal therapy effects on the course of ABPA among different populations, limits our estimates' utility. P183

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