title: Isolation of filamentous fungi from sputum in asthma is associated with reduced post-bronchodilator FEV1.
abstract: BACKGROUND
  Fungal sensitization is common in severe asthma, but the clinical relevance of this and the relationship with airway colonization by fungi remain unclear. The range of fungi that may colonize the airways in asthma is unknown.
  
  
  OBJECTIVE
  To provide a comprehensive analysis on the range of filamentous fungi isolated in sputum from people with asthma and report the relationship with their clinico-immunological features of their disease.
  
  
  METHODS
  We recruited 126 subjects with a diagnosis of asthma, 94% with moderate-severe disease, and 18 healthy volunteers. At a single stable visit, subjects underwent spirometry; sputum fungal culture and a sputum cell differential count; skin prick testing to both common aeroallergens and an extended fungal panel; specific IgE to Aspergillus fumigatus. Fungi were identified by morphology and species identity was confirmed by sequencing. Four patients had allergic bronchopulmonary aspergillosis.
  
  
  RESULTS
  Forty-eight percent of asthma subjects were IgE-sensitized to one fungal allergen and 22% to ≥ 2. Twenty-seven different taxa of filamentous fungi were isolated from 54% of their sputa, more than one species being detected in 17%. This compared with 3 (17%) healthy controls culturing any fungus (P < 0.01). Aspergillus species were most frequently cultured in isolation followed by Penicillium species. Post-bronchodilator FEV (1) (% predicted) in the subjects with asthma was 71(± 25) in those with a positive fungal culture vs. 83 (± 25) in those culture-negative, (P < 0.01).
  
  
  CONCLUSIONS
  Numerous thermotolerant fungi other than A. fumigatus can be cultured from sputum of people with moderate-to-severe asthma; a positive culture is associated with an impaired post-bronchodilator FEV (1) , which might be partly responsible for the development of fixed airflow obstruction in asthma. Sensitization to these fungi is also common.
authors.affiliation: Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Agbetile
authors.forename: A
authors.initials: A
authors.lastname: Fairs
authors.forename: D
authors.initials: D
authors.lastname: Desai
authors.forename: B
authors.initials: B
authors.lastname: Hargadon
authors.forename: M
authors.initials: M
authors.lastname: Bourne
authors.forename: K
authors.initials: K
authors.lastname: Mutalithas
authors.forename: R
authors.initials: R
authors.lastname: Edwards
authors.forename: J P
authors.initials: JP
authors.lastname: Morley
authors.forename: W R
authors.initials: WR
authors.lastname: Monteiro
authors.forename: N S
authors.initials: NS
authors.lastname: Kulkarni
authors.forename: R H
authors.initials: RH
authors.lastname: Green
authors.forename: I D
authors.initials: ID
authors.lastname: Pavord
authors.forename: P
authors.initials: P
authors.lastname: Bradding
authors.forename: C E
authors.initials: CE
authors.lastname: Brightling
authors.forename: A J
authors.initials: AJ
authors.lastname: Wardlaw
authors.forename: C H
authors.initials: CH
authors.lastname: Pashley
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D005260:Female; D005541:Forced Expiratory Volume; D005658:Fungi / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008264:Macrophages / Q000276:immunology; D008297:Male; D008875:Middle Aged; D010587:Phagocytosis / Q000187:drug effects / Q000276:immunology; D013183:Sputum / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D007073:Immunoglobulin E