Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults

Abstract

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.

Identifying rare diseases using electronic medical records: the example of allergic bronchopulmonary aspergillosis

“…This proportion is much lower than the prevalence of ABPA observed in a series of case studies (range: 0.72–4.10%) 7, 8, 9, 10, 11, 12. However, when mentioned, the term ‘ABPA’ coincided with other terms also indicative of ABPA, which is suggestive that the mention of ABPA may have represented a true diagnosis.…”

“…However, in a previous study using data from five referral cohort studies (China, Ireland, New Zealand, Saudi Arabia and South Africa), the prevalence of ABPA in adults with asthma was estimated at 2.5% (range: 0.72–3.50%) 7, 8, 9, 10, 11, 12. In another case series study in Iran, the prevalence of ABPA among asthmatic patients was estimated at 4.1% 13.…”

Serious fungal infections in Ecuador

“…The risk of allergic bronchopulmonary aspergillosis (ABPA) was estimated at 2.5% based on previous studies [23]. The rate of severe asthma with fungal sensitization (SAFS) was estimated as the worst 10% of the total asthma population of whom at least 33% have fungal sensitization [24].…”

Calcineurin Orchestrates Lateral Transfer of Aspergillus fumigatus during Macrophage Cell Death

“…Organ transplant recipients are at high risk of PA, with lung transplant recipients being particularly susceptible and having a mortality greater than 40% (8,9). There are an estimated 3 million individuals with chronic PA and 4.5 million with allergic bronchopulmonary aspergillosis globally (10,11). Af has also been implicated in the pathogenesis of asthma, chronic obstructive airways disease, and bronchiectasis (11)(12)(13).…”