title: Aspergillus fumigatus during stable state and exacerbations of COPD.
abstract: Bacteria are often isolated in stable chronic obstructive pulmonary disease (COPD). Whether fungi are also commonly present and associated with clinical and pathological features of disease is uncertain. We investigated the frequency of filamentous fungal culture and IgE sensitisation to Aspergillus fumigatus and the relationship to clinical outcomes in COPD subjects. COPD subjects were recruited to enter a 1-year observational study. Assessments of lung function, allergen testing and sputum analysis for inflammation, bacteria and fungus were undertaken in COPD subjects and healthy smoking and nonsmoking controls. Filamentous fungi were cultured at baseline in 49% (63 out of 128) of COPD subjects, of which 75% (47 out of 63) were A. fumigatus. Fungus was cultured in three out of 22 controls (two were A. fumigatus). The total sputum cell count and inhaled corticosteroid dosage were significantly increased in COPD patients with a positive filamentous fungal culture at baseline (p<0.05). Sensitisation to A. fumigatus was present in 13% of COPD subjects and was associated with worse lung function (forced expiratory volume in 1 s 39% predicted versus 51% predicted; p=0.01), but not related to filamentous fungal culture. A. fumigatus sensitisation is related to poor lung function. Positive filamentous fungal culture is a common feature of COPD. The clinical significance of this remains uncertain.
authors.affiliation: Nuffield Department of Medicine, University of Oxford, Oxford.
authors.forename: Mona
authors.initials: M
authors.lastname: Bafadhel
authors.forename: Susan
authors.initials: S
authors.lastname: McKenna
authors.forename: Joshua
authors.initials: J
authors.lastname: Agbetile
authors.forename: Abbie
authors.initials: A
authors.lastname: Fairs
authors.forename: Dhananjay
authors.initials: D
authors.lastname: Desai
authors.forename: Vijay
authors.initials: V
authors.lastname: Mistry
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Morley
authors.forename: Mitesh
authors.initials: M
authors.lastname: Pancholi
authors.forename: Ian D
authors.initials: ID
authors.lastname: Pavord
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Wardlaw
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Pashley
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Brightling
mesh_terms: D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000150:complications / Q000276:immunology / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000276:immunology / Q000302:isolation & purification*; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000382:microbiology* / Q000503:physiopathology; D013183:Sputum / Q000166:cytology / Q000382:microbiology*
chemical_list: D007073:Immunoglobulin E