Patients With Aspergillus Fumigatus-Associated Asthma Show Clinical Improvement At High Altitude

L. H. Rijssenbeek-Nouwens , K. B. Fieten , A. O. Bron , S. Hashimoto , E. Bel

Author address: 

Nederlands Asthmacentre Davos, Davos, Switzerland, Dutch Asthmacentre Davos, Davos, Switzerland, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands, Academic Medical Centre Amsterdam, Amsterdam, Netherlands

Abstract: 

Background Sensitization to fungal allergens, especially Aspergillus fumigatus, is a recognized risk factor for severe asthma (Denning ERJ 2006), and is associated with reduced lung function (Fairs AJRCCM 2010). It is unknown whether patients with A.fumigatus-associated asthma (AFAA) constitute a separate phenotype of severe asthma and whether reduced exposure to A.fumigatus has beneficial effects in these patients. The dry climate at high altitude offers an environment that is almost free of A.fumigatus spores and might therefore be of benefit for patients with AFAA. Hypothesis Patients with AFAA constitute a separate asthma phenotype. High altitude treatment improves clinical, functional and inflammatory parameters, and this improvement is accompanied by a reduction in total IgE. Aim To compare patients with severe asthma with or without sensitization to A.fumigatus, to investigate the effect of high altitude treatment (HAT) on clinical, functional, and inflammatory parameters, and to relate those effects to changes in total IgE. Methods 170 patients (13-81 years, 113 female, 85 oral steroid-dependent) with severe asthma were consecutively included in a multidisciplinary 12 weeks treatment program at the Dutch Asthma Centre Davos. Changes from baseline in Asthma Control (Juniper ACQ), Asthma related Quality of Life (Juniper AQOLQ), blood eosinophils, postbronchodilator (pb)FEV %pred., pbRV/TLC %pred., exhaled Nitric Oxide (FeNO), 1 and daily dose of oral corticosteroids were measured and related to changes in total IgE. Parametric and non-parametric tests were used where appropriate. Results In Both groups there were significant improvement in all parameters, except for total Eosinophils, with a more important improvement in FeNO, Total IgE and total Eosinophils in the the AFAA group. In the AFAA group changes from baseline in total IgE are correlated with changes in ACQ (r=0.31, p=0.35), AQLQ (r=-0.734, p=0.01) and FeNO (r=0.298, p=0.04) Conclusions Patients with AFAA differ from patients without A.fumigatus sensitization with respect to age at asthma onset, asthma duration, FeNO, blood eosinophils and total IgE,. These patients show improvements in clinical, functional, and inflammatory parameters after high altitude treatment, which is associated with a marked reduction in total IgE. Implications This suggests that the dry high altitude climate might offer an effective therapeutic option for patients with the A.fumigatus associated asthma phenotype, probably by reduced exposure to Aspergillus spores.
2011

abstract No: 

A31

Full conference title: 

American Thoracic Society
    • ATS 2011