title: Assessment of Aspergillus sensitization or persistent carriage as a factor in lung function impairment in cystic fibrosis patients.
abstract: BACKGROUND
  Cystic fibrosis (CF) patients presenting with persistent carriage of, or sensitization to, Aspergillus fumigatus are often treated with antifungal therapies because the presence of the fungus is commonly thought to impede lung function, even in the absence of allergic bronchopulmonary aspergillosis (ABPA). The aim of this study was to assess Aspergillus-related status modulating the forced expiratory volume in 1 s (FEV₁) of CF patients.
  
  
  METHODS
  From 1995 to 2007, 251 patients were evaluated. Demographic data, cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations, body mass index, and FEV(1) were recorded. The presence of A. fumigatus and Pseudomonas aeruginosa in sputum and the levels of A. fumigatus precipitin, total IgE (t-IgE), and specific anti-A. fumigatus IgE (Af-IgE) were determined. Patients were divided into 3 groups: (1) ABPA: A. fumigatus precipitin ≥3 lines, Af-IgE > 0.35 IU/ml, and t-IgE ≥500 IU/ml; (2) sensitization: Af-IgE > 0.35 IU/ml but t-IgE < 500 IU/ml; and (3) persistent carriage: Af-IgE ≤ 0.35 IU/ml with either an A. fumigatus persistent positive culture or an A. fumigatus precipitin ≥3 lines, provided this serological finding had been found associated with at least 1 A. fumigatus-positive culture. The remaining patients represented the control group. A multivariate analysis was carried out with FEV(1) as the outcome variable.
  
  
  RESULTS
  ABPA, sensitization, and persistent carriage were significantly associated with a larger decline in FEV₁ compared with the control group, with odds ratios of 15.9, 14.9, and 10.7, respectively. This association was independent of other associated factors (P. aeruginosa transient detection, age, being underweight, and low FEV₁ at baseline).
  
  
  CONCLUSIONS
  In addition to ABPA, sensitization and persistent carriage appear to have an impact on pulmonary function in CF patients.
authors: Service de Parasitologie-Mycologie, CHU Rangueil, Toulouse, France. fillaux.j@chu-toulouse.fr
authors: Judith
authors: J
authors: Fillaux
authors: François
authors: F
authors: Brémont
authors: Marléne
authors: M
authors: Murris
authors: Sophie
authors: S
authors: Cassaing
authors: Jean-Luc
authors: JL
authors: Rittié
authors: Laurent
authors: L
authors: Tétu
authors: Christine
authors: C
authors: Segonds
authors: Michel
authors: M
authors: Abbal
authors: Eric
authors: E
authors: Bieth
authors: Antoine
authors: A
authors: Berry
authors: Bernard
authors: B
authors: Pipy
authors: Jean-François
authors: JF
authors: Magnaval
mesh_terms: D000293:Adolescent; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications* / Q000453:epidemiology / Q000276:immunology / Q000503:physiopathology; D001232:Aspergillus fumigatus / Q000276:immunology*; D015992:Body Mass Index; D002353:Carrier State / Q000276:immunology / Q000382:microbiology*; D002648:Child; D003550:Cystic Fibrosis / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D055815:Young Adult