title: Evaluation of clinical characteristics and prognosis of chronic pulmonary aspergillosis depending on the underlying lung diseases: Emphysema vs prior tuberculosis.
abstract: OBJECTIVE
  There have been scarce data evaluating the differences of clinical characteristics and prognosis of chronic pulmonary aspergillosis (CPA) depending on underlying pulmonary diseases. We tried to clarify them in CPA patients who had pulmonary emphysema or previous pulmonary tuberculosis.
  
  
  METHODS
  We reviewed and evaluated CPA patients diagnosed between 2007 and 2013 with pulmonary emphysema (PE group; n = 29), with previous pulmonary tuberculosis (PT group; n = 47) and with combination of these 2 underlying conditions (CTE group; n = 24).
  
  
  RESULTS
  In CT findings, fungus balls were rare in PE group (7% in PE group and 36% in PT group; p = 0.006). Compared with PT group, PE group patients exhibited more frequent preceding antibiotics administration (45% vs 11%; p = 0.002) and fever (52% vs 17%; p = 0.002), less frequent hemosputum (24% vs 57%; p = 0.008), and more frequent consolidations in imaging (79% vs 38%; p = 0.001) and respiratory failure (34% vs 13%; p = 0.020), possibly suggesting more acute clinical manifestations of CPA in emphysematous patients. Trend of the differences between PT and PE group was not changed when patients with fungal balls were excluded. Multivariate Cox regression analysis of risks for all-cause mortality revealed age (HR, 1.079; p = 0.002) and emphysema (HR, 2.45; p = 0.040) as risk factors.
  
  
  CONCLUSIONS
  Assessment of underlying lung diseases is needed when we estimate prognosis and consider treatment of CPA patients. Particularly, emphysematous patients can be presented as refractory pneumonia and show poor prognosis.
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan. Electronic address: koyamak@tokyo-hosp.jp.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Koyama
authors.affiliation: Asthma and Allergy Center, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Nobuharu
authors.initials: N
authors.lastname: Ohshima
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Suzuki
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kawashima
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Okuda
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Sato
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Maho
authors.initials: M
authors.lastname: Suzukawa
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nagai
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Matsui
authors.affiliation: Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Japan; Asthma and Allergy Center, National Hospital Organization Tokyo National Hospital, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ohta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004646:Emphysema / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055732:Pulmonary Aspergillosis / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications*
keywords: Chronic pulmonary aspergillosis; Pneumonia; Previous pulmonary tuberculosis; Prognosis; Pulmonary emphysema