Bronchiectasis and aspergillus-associated diseases in severe asthma
Aspergillus (ASP) sensitization is frequent in severe asthma (SA). Aspergillus-associated disease, such as allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA) can be associated with bronchiectasis (B). B is a comorbidity in patients with SA. We investigated the prevalence and the characteristics of Aspergillus-associated bronchiectasis in 73 consecutive immunocompetent patients with SA.Methods: All the patients underwent assessment of history, spirometry, FENO, circulating eosinophils (EOS), serum total IgE, IgE-ASP (increased if> 0.10 kUA/L), and IgG-ASP (increased if>40 U/ml), chest X-rays, paranasal sinus CT and chest HRCT. ABPA and CPA were diagnosed according to Agarwal and Denning (Clin Exp Allergy 2013) and ERS/ESCMID consensus (Eur Respir J 2016).Results: Bronchiectasis was found in 30 (41%) patients and was significantly associated with higher IgG-ASP (64+-75 vs 22+-35 U/ml,p=0.002), increased annual exacerbations (3.33+-1.7 vs 2.1+-1, p
Conclusion: ABPA patients have higher levels of sIgG and sIgE of A.fumigatus than SAFS patients. Combination of sIgG and sIgE of A.fumigatus to diagnosis ABPA and SAFS patients is important.
Conclusions: The severe asthmatic patients examined had a high prevalence of Aspergillus sensitization and of Aspergillus-associated diseases as ABPA (26%) and CPA (26%). It has to be demonstrated the benefit of an early recognition and treatment of these diseases on the course of asthma.
Three years ago we started treating patients diagnosed with ABPA, an allergic lung disease provoked by Aspergillus fumigatus (Af), with a combined therapy of voriconazole and prednisolone. We used voriconazole at a dose of 200 mg twice a day for 4 months, while the initial prednisolone dose was 0.75 mg/kg/day for 1 month, then 0.25 mg/kg/day for 1 month, then progressive tapering (5 mg each fortnight) until the minimum dose of 5 mg/day, maintained until the fourth month. We evaluated patients at 6 months from the end of therapy. We enrolled 25 patients in the disease acute phase, who had never used azol therapy before, wit...
We describe a case of a 32-month-old male with CGD who presented acutely with decreased energy and non-specific abdominal discomfort. Upon further work up he was found to have invasive Aspergillus fumigatus.
Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for IL-4/IL-13, key drivers of type 2 inflammation in multiple diseases. In the phase 3 LIBERTY ASTHMA QUEST study (NCT02414854), add-on dupilumab 200mg/300mg every 2 weeks vs placebo reduced severe exacerbations and improved pre-bronchodilator FEV1 in patients with uncontrolled, moderate-to-severe asthma. Treatment effects were greater in patients with elevated baseline type 2 biomarkers. Allergic bronchopulmonary aspergillosis (ABPA) is characterized by Aspergillus fumigatus (Af) hypersensitivity and robust type 2 inflammatory responses.
ConclusionsIgE against rAsp f1 and f2 (using receiver-operating characteristic–derived cutoffs) were found to be the most useful in differentiating ABPA from ASA. Because this study was conducted at a single center, our results require further validation.
ConclusionIgE against rAsp f1 and f2 (using ROC derived cut-offs) were found to be the most useful in differentiating ABPA from ASA. Due to conduct at single-center, our results require further validation.
Conclusions In conclusion, articles in this Research Topic made a very significant contribution to our understanding of the role played by environmental factors, dysbiotic conditions, and infections in triggering diseases. Since this is a rapidly expanding area of research, many other factors contributing to the onset of these diseases are not covered here. We are confident, however, that further studies will expand the list as well as bring a better understanding of mechanisms involved in the onset of autoimmune and autoinflammatory diseases. Author Contributions All authors listed have made a substantial, direct and i...
Conclusions: RoutineA. fumigatus-sIgE screening for asthma patients can significantly improve the diagnostic rate of ABPA.Int Arch Allergy Immunol
Conclusion: Our study demonstrates the difficulty in applying the ISHAM criteria to historic cohorts and our results are similar to the study by Page et al(2). The ISHAM criteria are a huge step in standardising the diagnosis of ABPA for future clinical and research studies. Obligatory Criterian=111Total IgE>1000 IU/ml79(71%)+ve Af IgE108(97%)Both obligatory criteria fulfilled79(71%)Full diagnostic criteria fulfilled73(66%)‘Other’ CriteriaRaised Af IgG/+ve precipitins94(85%)Eosinophil>500/uL97(87%)Radiological features of ABPA101(91%)‘Other’ criteria combinations1 ‘other’ criterion...