The presence of Aspergillus fumigatus is associated with worse respiratory quality of life in cystic fibrosis

Abstract

Background: The clinical effects of Aspergillus fumigatus in the cystic fibrosis (CF) airway, with the exception of allergic bronchopulmonary aspergillosis, is unclear. Methods: CF adolescents and adults (age 14 years and older) underwent bacterial and semi-selective fungal culture testing to determine the prevalence of fungi in the CF respiratory tract and the independent association between the presence of Aspergillus fumigatus and clinical characteristics. Results: Aspergillus fumigatus (10.3%) and Candida species (57.8%) were the most common filamentous fungi and yeast seen respectively in the sputa of 206 individuals with CF. Inhaled corticosteroid (ICS) use was more common in Aspergillus fumigatus-positive than Aspergillus fumigatusnegative (100% versus 75.8%, p = .01). Aspergillus fumigatus was significantly associated with lower respiratory domain score (β −8.74, 95% CI −16.6, −0.88, p = .03), representing worse respiratory-related quality of life, accounting for demographics, disease characteristics, and the presence of a pulmonary exacerbation. Conclusion: The presence of Aspergillus fumigatus in CF sputum was associated with worse respiratory quality of life in CF in a crosssectional, single center study. Longitudinal analysis examining the clinical implications of Aspergillus fumigatus on respiratory health over time is needed.

Urban Life as Risk Factor for Aspergillosis

“…Aspergillus is among the most common life-threatening airborne opportunistic fungus found indoors (Rocchi et al, 2020). The presence of Af in CF sputum is associated with worse respiratory quality of life in CF (Hong et al, 2020) and chronic Af is associated with more frequent pulmonary exacerbation dependent hospitalizations (Hong et al, 2018). CF patient registry data has already been used for risk factor analysis and macrolides, inhaled antibiotics and inhaled corticosteroids were associated with persistent Af isolation (Hong et al, 2018).…”

“…The life-limiting autosomal recessive disorder Cystic fibrosis (CF) is characterized by abnormal viscous secretions in the lower airways leading to obstruction, inflammation, tissue damage and destruction of the lung (Elborn, 2016).In patients with CF, fungal colonization of the respiratory tract is frequently found (Pihet et al, 2009). Aspergillus fumigatus (Af), the most common filamentous fungus in CF patients with a prevalence of 30 %, is becoming more frequently isolated (Ziesing et al, 2016;Brandt et al, 2018;Schwarz et al, 2018;Hong et al, 2020). The airways are constantly exposed to fungal spores, yet which are only a part of the airway pathogens in the environment.…”

Frequent Pet Contact as Risk Factor for Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis

“…Af colonization is more common in adolescence and adulthood (Pihet et al, 2009;Warris et al, 2019). The respiratory tract of 10.3 to 60 % of CF patients is colonized by Af (Pihet et al, 2009;Ziesing et al, 2016;Warris et al, 2019;Hong et al, 2020). The presence of this environmental filamentous fungus in CF sputum is associated with worse respiratory quality of life (Hong et al, 2020).…”

“…The respiratory tract of 10.3 to 60 % of CF patients is colonized by Af (Pihet et al, 2009;Ziesing et al, 2016;Warris et al, 2019;Hong et al, 2020). The presence of this environmental filamentous fungus in CF sputum is associated with worse respiratory quality of life (Hong et al, 2020). Inhaling Af spores into the lungs may cause multiples diseases including invasive pulmonary aspergillosis, aspergilloma (Mousavi et al, 2016) and growth of Af hyphae within the bronchial lumen triggers an immunoglobulin E (IgE)-mediated hypersensitivity response that results in airway inflammation, bronchospasm, and bronchiectasis (Armstead et al, 2014;Janahi et al, 2017).…”

CFTR Modulators Dampen Aspergillus-Induced Reactive Oxygen Species Production by Cystic Fibrosis Phagocytes

“…Aspergillus fumigatus is the major fungal pathogen isolated from sputum of far more CF patients than those diagnosed with ABPA (Warris et al, 2019 ). Studies indicate that infection with A. fumigatus in the CF airways can result in increased pulmonary exacerbations, bronchiectasis, and worse respiratory quality of life (Amin et al, 2010 ; Breuer et al, 2019 ; Hong et al, 2020 ). Nevertheless, there is a lack of data on how to manage those infections, e.g., eradication of infection or damping the inflammation, and what the associated risks and benefits of such approaches would be.…”