Allergic bronchopulmonary aspergillosis as a complication of COPD: A new entity

Author:

Colas Tcherakian

Author address:

France

Full conference title:

European Academy of Allergy and Clinical Immunology Congress 2019

Abstract:

Background
Allergic broncho-pulmonary aspergillosis (ABPA) is associated with two recognized conditions: asthma and cystic fibrosis. Here, we report on patients with ABPA occurring in patients with long-standing chronic obstructive pulmonary disease (COPD)

Method
Adult patients with diagnoses of both COPD (GOLD criteria) and ABPA (Patterson’s criteria) followed in our institution were identified thanks to the medical information system database. Patients’ demographic, clinical and paraclinical (including spirometry values and assessment of Bhalla scoring system on chest CT-scans) findings as well as follow-up outcomes were recorded and compared to 16 ABPA-free COPD patients matched on age, FEV1 and follow-up duration.

Results
16 patients (13 men), median age (IQR) 61 years (ranging from 55 to 79 years), median tobacco consumption 47 PYwere identified. The diagnosis of ABPA followed that of COPD after a median of 6 years (with a range from 1 to 10 years). At diagnosis of ABPA, median FEV1 was 36% (1127mL) . All patients were investigated for specific IgE=19,4 kUI/l, IgE=2684 kUI/l, eosinophilia=1271/mm3. 13/16 had positive IgG, 10 had evidence of Aspergillus sp. in sputum. Immediate prick tests were positive in 6 out of 7 patients. All patients received inhaled and oral steroids, 13 patients received oral fungicides and 7 omalizumab.
During follow-up, annual rate of FEV1 decline (-56 vs -34 mL/year;p= 0.04) and hospitalization rates for flare up (1.69 vs 0.53/year;p=0,0007) were significantly higher in ABPA-BPCO patients than in ABPA-free COPD patients. Bronchiectasis extension (p=0.002) and mucoid impaction extension (p=0.03) but not emphysema (p=0,45) were significantly higher in ABPA-BPCO patients than in ABPA-free COPD patients. Among ABPA-BPCO patients, the use of antifungal drugs prevented the loss of FEV1 (-51mL/year vs +92 mL/year; p=0.02) whereas omalizumab tended to lower the annual exacerbations rate.

Conclusion
ABPA can occur during the course of COPD and is associated with impaired respiratory function and multiple hospitalizations. Treatment with antifungal drugs and/or omalizumab could improve long-term outcomes and should be discussed promptly once the diagnosis is established.

Abstract Number: TP0757

Conference Year: 2019

Link Conference abstract: 

EAACI 2019

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