Page 44 - Škrgat, Sabina, ed. 2023. Severe Asthma Forum - Monitoring and Treatable Traits in Severe Asthma. Koper: University of Primorska Press. Severe Asthma Forum, 2
P. 44
Mucus impaction ease and as a result almost twice the dura-
tion of asthma. Those with AFAD had over-
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma Mucus impaction in AFAD is most striking- all about a 10% deficit in FEV1 which was not
ly evident in those patients who present with related to atopy and not seen in patients sen-
lobar collapse due to inspissated mucus but is sitised to non- thermotolerant or non-filamen-
also seen in the smaller airways on CT scans7. tous fungi. Significant differences in radio-
The precise pathway by which IgE sensitisa- logical appearances between those sensitised
tion to thermotolerant filamentous fungi may and non-sensitised to fungi included bronchi-
cause production of viscid mucus is not clear ectasis (50% versus 29%), tree-in-bud (17%
but could be related to excess production of vs 4%) and collapse/ consolidation (35% vs
MUC5AC by goblet cells because of vigor- 21%). Authors suggested that IgE sensitisation
ous T2 hyperimmune stimulation7,14. Evolu- to thermotolerant filamentous fungi, in par-
tion of mucin synthesis is complex and include ticular A. fumigatus but not total IgE, is asso-
activated eosinophils as well since there is ev- ciated with fixed airflow obstruction and sev-
idence that they induce mucin synthesis in eral radiological abnormalities in moderate to
human airway epithelial cells via EGFR (epi- severe asthma.
dermal growth factor receptor)15.
The group of Kurukulaaratchy18 re-
Immaging, functional impairment ported that A. fumigatus sensitisation in pa-
and comorbidities tients with difficult asthma identifies a more
severe form of disease associated with older
Aspergillus fumigatus sensitization defined by age, male sex, longer duration of disease, lung
a specific IgE of 0.35 kU/L or greater was as- function impairment, bronchiectasis, higher
sociated with functional and radiological ab- inflammatory parameters, greater treatment
normalities: 83.4% had an abnormal HRCT needs but less psychophysiologic comorbidi-
with bronchial wall thickening (41.3%), bron- ties.
chiectasis (35.3%), air trapping (20.3%) and
bronchial dilatation (16.5%). Radiological Fungal bronchitis
evidence of airway disease was also associat-
ed with more obstructive spirometry. A. fumi- Fungal bronchitis describes chronic purulent
gatus sensitization was associated with a 2.01 sputum production due to non-invasive in-
increased hazard ratio of bronchiectasis and fection with thermotolerant fungi in the con-
more obstructive spirometry. They suggested text of a relatively immunocompetent host. It
that patients with A. fumigatus sensitization is not widely used in the medical literature.
had variable clinical and radiological A positive sputum culture for thermotoler-
characteristics that frequently did not ant fungi is critical for the diagnosis of fun-
conform to the conventional diagnostic gal bronchitis. In a recent report19 the group
criteria for ABPA16. of Wardlaw and co-workers have recognised
a clinical presentations of often chronic exac-
All patients with IgE sensitisation to A. erbations of airway disease which were un-
fumigatus are at risk of lung damage irre- responsive to standard treatment with broad
spective of whether they meet the criteria for spectrum antibiotics or high dose oral corti-
ABPA17. A large cohort (n = 431) of asthmat- costeroids, in which sputum culture was pos-
ics enriched for IgE sensitisation to fungi were itive for either A. fumigatus or Candida spp.
recruited in a cross-sectional study to deter- Usually the sputum was white/creamy or
mine the relationship between immunological brown rather than the green associated with
biomarkers of fungal allergy and evidence of bacterial infection, and was very mucoid or
lung damage in asthma17. The patients with rubbery in consistency19.
AFAD had higher rates of early-onset dis-
tion of asthma. Those with AFAD had over-
severe asthma forum 2: severe asthma - monitoring and treatable traits in severe asthma Mucus impaction in AFAD is most striking- all about a 10% deficit in FEV1 which was not
ly evident in those patients who present with related to atopy and not seen in patients sen-
lobar collapse due to inspissated mucus but is sitised to non- thermotolerant or non-filamen-
also seen in the smaller airways on CT scans7. tous fungi. Significant differences in radio-
The precise pathway by which IgE sensitisa- logical appearances between those sensitised
tion to thermotolerant filamentous fungi may and non-sensitised to fungi included bronchi-
cause production of viscid mucus is not clear ectasis (50% versus 29%), tree-in-bud (17%
but could be related to excess production of vs 4%) and collapse/ consolidation (35% vs
MUC5AC by goblet cells because of vigor- 21%). Authors suggested that IgE sensitisation
ous T2 hyperimmune stimulation7,14. Evolu- to thermotolerant filamentous fungi, in par-
tion of mucin synthesis is complex and include ticular A. fumigatus but not total IgE, is asso-
activated eosinophils as well since there is ev- ciated with fixed airflow obstruction and sev-
idence that they induce mucin synthesis in eral radiological abnormalities in moderate to
human airway epithelial cells via EGFR (epi- severe asthma.
dermal growth factor receptor)15.
The group of Kurukulaaratchy18 re-
Immaging, functional impairment ported that A. fumigatus sensitisation in pa-
and comorbidities tients with difficult asthma identifies a more
severe form of disease associated with older
Aspergillus fumigatus sensitization defined by age, male sex, longer duration of disease, lung
a specific IgE of 0.35 kU/L or greater was as- function impairment, bronchiectasis, higher
sociated with functional and radiological ab- inflammatory parameters, greater treatment
normalities: 83.4% had an abnormal HRCT needs but less psychophysiologic comorbidi-
with bronchial wall thickening (41.3%), bron- ties.
chiectasis (35.3%), air trapping (20.3%) and
bronchial dilatation (16.5%). Radiological Fungal bronchitis
evidence of airway disease was also associat-
ed with more obstructive spirometry. A. fumi- Fungal bronchitis describes chronic purulent
gatus sensitization was associated with a 2.01 sputum production due to non-invasive in-
increased hazard ratio of bronchiectasis and fection with thermotolerant fungi in the con-
more obstructive spirometry. They suggested text of a relatively immunocompetent host. It
that patients with A. fumigatus sensitization is not widely used in the medical literature.
had variable clinical and radiological A positive sputum culture for thermotoler-
characteristics that frequently did not ant fungi is critical for the diagnosis of fun-
conform to the conventional diagnostic gal bronchitis. In a recent report19 the group
criteria for ABPA16. of Wardlaw and co-workers have recognised
a clinical presentations of often chronic exac-
All patients with IgE sensitisation to A. erbations of airway disease which were un-
fumigatus are at risk of lung damage irre- responsive to standard treatment with broad
spective of whether they meet the criteria for spectrum antibiotics or high dose oral corti-
ABPA17. A large cohort (n = 431) of asthmat- costeroids, in which sputum culture was pos-
ics enriched for IgE sensitisation to fungi were itive for either A. fumigatus or Candida spp.
recruited in a cross-sectional study to deter- Usually the sputum was white/creamy or
mine the relationship between immunological brown rather than the green associated with
biomarkers of fungal allergy and evidence of bacterial infection, and was very mucoid or
lung damage in asthma17. The patients with rubbery in consistency19.
AFAD had higher rates of early-onset dis-
