Importance of Aspergillus spp. isolation in Acute exacerbations of severe COPD: prevalence, factors and follow-up: the FUNGI-COPD study

Abstract

BackgroundAcute exacerbations of COPD (AECOPD) are often associated with infectious agents, some of which may be non-usual, including Aspergillus spp. However, the importance of Aspergillus spp. in the clinical management of AECOPD still remains unclear.ObjectivesThe aims of the study were to analyze the prevalence and risk factors associated with Aspergillus spp. isolation in AECOPD, and to investigate the associated clinical outcomes during a 1-year follow-up period.MethodsPatients presenting with an AECOPD requiring hospitalization were prospectively included from four hospitals across Spain. Clinical, radiological and microbiological data were collected at admission and during the follow-up period (1, 6 and 12 months after discharge), and re-admissions and mortality data collected during the follow-up.ResultsA total of 240 patients with severe AECOPD were included. Valid sputum samples were obtained in 144 (58%) patients, and in this group, the prevalence of Aspergillus spp. isolation was 16.6% on admission and 14.1% at one-year follow-up. Multivariate logistic-regression showed that AECOPD in the previous year (OR 12.35; 95% CI, 1.9-29.1; p < 0.001), concurrent isolation of pathogenic bacteria (OR 3.64; 95% CI 1.65-9.45, p = 0.001) and concomitant isolation of Pseudomonas aeruginosa (OR 2.80; 95% IC, 1.81-11.42; p = 0.001) were the main risk factors for Aspergillus spp. isolation.ConclusionsThe main risk factors for Aspergillus spp. isolation were AECOPD in the previous year and concomitant isolation of Pseudomonas aeruginosa. However, although Aspergillus spp. is often isolated in sputum samples from patients with AECOPD, the pathogenic and clinical significance remains unclear.

Emergence ofAspergillus fumigatusazole resistance in azole-naïve patients with chronic obstructive pulmonary disease and their homes

“…The 23% prevalence of A. fumigatus colonization we found during COPD acute exacerbation is similar to the 16.6%‐28% ones that have been reported previously in Spain or in the UK . However, the 42% frequency of A. fumigatus in patient's homes we found in the present study seems high when compared to some other studies (9%‐32%).…”

“…Patients with chronic obstructive pulmonary disease (COPD) are at risk for Aspergillus colonization and invasive aspergillosis (IA), which has a 1.6%‐3.9% prevalence, and is associated with high mortality . Azole‐resistant Aspergillus fumigatus (ARAF) has been reported in the UK in four itraconazole‐treated COPD patients (3 with chronic pulmonary aspergillosis and one with IA), in one patient with IA who had received voriconazole for 2 days in Denmark, and in two azole‐naïve patients colonized with TR 46 /Y121F/T289A A. fumigatus in the Netherlands .…”

The role of acute and chronic respiratory colonization and infections in the pathogenesis of COPD

“…are frequently isolated from the airways of COPD patients during exacerbations (16.6%) and even during follow-up (14.1%). 29,116 In an observational study, positive Aspergillus cultures in COPD patients were associated with increased sputum cell counts. 117 The incidence of AECOPD in the preceding year and concomitant bacterial pathogen isolation were associated with increased Aspergillus detection.…”

The Human Lung Mycobiome in Chronic Respiratory Disease: Limitations of Methods and Our Current Understanding

“…Aspergillus spp. are frequently isolated from the airways of COPD patients during exacerbations (16.6%) [46] and followup (14.1%) [47]. Interestingly, Pneumocystis jiroveccii colonisation is described in one-third of severe COPD patients leading to increased airway obstruction independent of smoking, increased inflammation and emphysema [19,46,[48][49][50].…”