Inhaled corticosteroids and Aspergillus fumigatus isolation in cystic fibrosis

Abstract

Aspergillus fumigatus isolation in cultures from respiratory specimens of patients with cystic fibrosis (CF) is quite common; however, the role of A. fumigatus as a pathogen and whether its presence is associated with progression of pulmonary disease remain unclear. We investigated the association between inhaled corticosteroids and the recovery of A. fumigatus by performing a retrospective cohort study of CF patients born between 1988 and 1996. The patients' medical records from their first visit to the CF Center until December 2010 were reviewed. Outcomes were the occurrence of A. fumigatus first isolation, chronic colonization, or the last visit at the CF Center. A number of possible confounders were included in the multivariate logistic regression analysis in order to identify an independent association between inhaled corticosteroids and colonization status. A total of 121 patients were included in the study. Thirty-nine patients (32.2%) had at least one positive culture and 14 (11.6%) developed chronic colonization. Multivariate logistic regression analysis was used to determine the independent effect of inhaled corticosteroids on the odds of first isolation (odds ratio [OR], 1.165; 95% confidence interval [CI], 1.015-1.337; P = 0.029) and chronic colonization (OR, 1.180; 95% CI, 1.029-1.353; P = 0.018). In conclusion, A. fumigatus first isolation and chronic colonization are associated with the duration of inhaled corticosteroid treatment.

Risk factors and impact of allergic bronchopulmonary aspergillosis in Pseudomonas aeruginosa‐negative CF patients

“…In accordance with Noni et al, who reported a possible link between inhaled corticosteroids and ABPA, we found significantly more patients on inhaled corticosteroids in the pre‐index period for the ABPA group; therefore, immunomodulation favoring Af colonization could be involved. Although wheezing as an early sign of ABPA could have induced the use of inhaled corticosteroids, the higher use during the pre‐index years favors a possible immunologic link.…”

Studies of Pseudomonas aeruginosa Mutants Indicate Pyoverdine as the Central Factor in Inhibition of Aspergillus fumigatus Biofilm

“…fumigatus struggles and may help explain why A. fumigatus appears in CF airways later in the course of the disease (5,6,9,10,13,14,16). Evolution of P. aeruginosa may act in concert with other factors favoring A. fumigatus colonization, including repeated antibacterial courses and inhaled corticosteroids (76).…”

Evaluation of clinical characteristics and prognosis of chronic pulmonary aspergillosis depending on the underlying lung diseases: Emphysema vs prior tuberculosis

“…Other than underlying pulmonary condition by itself, undergoing treatments, particularly ICS, which was used in our PE group might also promote Aspergillus colonization in the airways. ICS increased the rate of isolation and sensitization of Aspergillus in COPD [17] and cystic fibrosis [18] and high dose prescription was a risk of IPA [19,20], ICS may increase Aspergillus loads in the lung tissue and contribute to more invasive and subacute clinical courses like bacterial pneumonia.…”