Abstract
The role of Aspergillus fumigatus in the airways of chronic obstructive pulmonary disease (COPD) patients with bronchiectasis is currently unclear. We searched for a sensitive and noninvasive method for A. fumigatus detection in the sputum of COPD patients and addressed potential risk factors for its presence. Induced sputum samples of 18 COPD patients and 17 COPD patients with bronchiectasis were analyzed for the presence of A. fumigatus by culture, galactomannan detection, and PCR. Of the patients with COPD–bronchiectasis overlap, 23.5% had a positive culture for A. fumigatus versus 10.5% of COPD patients without bronchiectasis (p = 0.39). The median sputum galactomannan optical density index was significantly higher in patients with COPD and bronchiectasis compared with patients with COPD alone (p = 0.026) and ranged between the levels of healthy controls and A. fumigatus-colonized cystic fibrosis patients. Both the presence of bronchiectasis and the administration of systemic corticosteroids were associated with sputum galactomannan (p = 0.0028 and p = 0.0044, respectively) and showed significant interaction (p interaction = 0.022). PCR for Aspergillus was found to be a less sensitive method, but was critically dependent on the extraction technique. The higher sputum galactomannan levels suggest a more abundant presence of A. fumigatus in the airways of patients with COPD–bronchiectasis overlap compared with patients with COPD without bronchiectasis, particularly when systemic corticosteroids are administered.
Highlights
Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease, characterized by progressive airflow limitation, which is caused by an abnormal inflammatory response to chronic inhalation of irritants, mainly cigarette smoke [1]
Whereas an irreversible obstructive lung function is obligatory in COPD, bronchiectasis is diagnosed by structural airway abnormalities observed on computed tomography (CT) of the thorax
To investigate the role of A. fumigatus in patients with COPD, we explored the feasibility of galactomannan detection and A. fumigatus polymerase chain reaction (PCR) on sputum samples
Summary
Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease, characterized by progressive airflow limitation, which is caused by an abnormal inflammatory response to chronic inhalation of irritants, mainly cigarette smoke [1]. Both small airways (obstructive bronchiolitis) and parenchyma (emphysema) are affected. The clinical relevance is not clear, several retrospective studies showed that more than 20% of COPD patients with A. fumigatus detected in respiratory samples eventually developed aspergillosis [15,16]. We assumed a more abundant presence of A. fumigatus in the sputum of patients with COPD-bronchiectasis overlap and addressed the role of CS as a potential risk factor
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