Introduction: Growing evidence suggests that patients with severe COPD are at a higher risk of pulmonary aspergillosis (PA), especially during an exacerbation. The levels of GM in exhaled breath condensate (EBC) might allow earlier diagnosis and extend the diagnostic yield of noninvasive mycological tests. Objective: Evaluate the role of GM in EBC for early diagnosis of PA in severe COPD patients at exacerbation. Methods: Serum and EBC were collected from 15 severe or very severe COPD patients at exacerbation and tested for GM using a Platelia® Aspergillus Ag test. Sera/EBC fluids with an index >0.5 were considered positive. Double diffusion in agarose gel (DD) for antibody response to Aspergillus was also determined. Results: Two patients had probable, 7 possible and 6 had no evidence of PA according to the criteria proposed by Bulpa. Serum positive GM assay was observed in two samples of the patients with probable PA and in one sample of two patients with possible PA. In patients with probable PA also serum precipitins was positive (A. fumigatus). EBC analysis yielded GM positive results (range, 0.87.5) in one patient with probable PA, in 2 patients with possible PA and in 2 patients without PA. In a patient with probable PA, positivity of the GM in EBC, preceded that of the serum of 4 days. GM in EBC was negative in 5 out of 7 cases with possible PA and in 5 out of 6 without PA. The sensitivity of GM in EBC was lower for the diagnosis of probable and possible PA compared to serum GM. However, considering the discordant results in serum and in EBC of four patients with possible PA we suggest that EBC GM levels can expand the diagnostic yield of PA.
Full conference title:
European Respiratory Society Annual Congress
- ERS 22nd (2012)