Abstract
The clinical features by declining lung function remain uncharacterized in chronic pulmonary aspergillosis (CPA) patients. We investigated the clinical characteristics of CPA patients based on spirometric impairments (restrictive spirometric pattern [RSP] and obstructive spirometric pattern [OSP]) and their severity. We retrospectively analyzed medical records of CPA patients who underwent pulmonary function tests from March 2017 to February 2020. We used Global Lung Initiative 2012 equations with lower limit of normal. The clinical characteristics of patients with RSP were compared to those with OSP. Additionally, RSP patients’ characteristics were analyzed according to forced vital capacity (FVC) tertile, and OSP patients’ characteristics were analyzed according to forced expiratory volume in 1 second (FEV1) tertile. Among the 112 patients with CPA (52 [46%] with RSP and 60 [54%] with OSP), body mass index (BMI) was significantly lower in patients with RSP than in those with OSP (17.6 kg/m2 versus 20.3 kg/m2; P = 0.003), and non-tuberculous mycobacterial disease was more frequently observed in patients with RSP than in those with OSP (28.8% versus 11.7%; P = 0.004). Additionally, for patients with RSP, younger age and bilateral pulmonary lesions were more frequently observed in the first tertile group than in the other groups (P for trend: 0.025 and 0.001, respectively). For patients with OSP, low BMI, paracavitary infiltrates, and elevated WBC count were more frequently observed in the first tertile group than in the other groups (P for trend: < 0.001, 0.011, and 0.041, respectively). Differences in the clinical features of CPA patients were identified according to heterogeneous spirometric patterns and their severity. Further studies are needed to investigate the clinical significance of these findings.
Highlights
Pulmonary diseases with obstructive spirometric pattern (OSP) are subdivided based on the forced expiratory volume in 1 second (FEV1), and those with restrictive spirometric pattern (RSP) are subdivided based on the forced vital capacity (FVC) for the objective evaluation of clinical features and prognosis [7, 8]
The data are presented as median or number (%). § Spirometric pattern was defined as follows: (1) restrictive spirometry pattern was defined as a post-bronchodilator FEV1/FVC lower limit of normal (LLN) and a FVC < LLN; (2) obstructive spirometry pattern was defined as a post-bronchodilator FEV1/FVC < LLN
The data are presented as median or number (%). § Restrictive spirometry pattern was defined as a post-bronchodilator FEV1/FVC LLN and a FVC < LLN
Summary
Chronic pulmonary aspergillosis (CPA) is a progressively destructive disease caused by Aspergillus infection that results in inflammation and damage to the lung parenchyma and pleura. Chronic pulmonary aspergillosis and heterogeneous spirometric patterns forced expiratory volume in 1 second; ILD, interstitial lung disease; LLN, lower limit of normal; NSP, normal spirometric pattern; OSP, obstructive spirometric pattern; PFT, pulmonary function test; NTM, non-tuberculous mycobacterial disease; RSP, restrictive spirometric pattern. CPA usually occurs in non-immunocompromised patients with pre-existing pulmonary diseases such as tuberculous destroyed lung, non-tuberculous mycobacterial disease (NTM), emphysema, bronchiectasis, and sarcoidosis [2, 3]. Abnormal spirometric results obtained from chronic lung disease may manifest in one of two forms, an obstructive spirometric pattern (OSP) or a restrictive spirometric pattern (RSP) [6]. Previous studies have demonstrated that spirometry was a useful method for measuring and monitoring chronic lung disease, which is divided into obstructive lung disease (e.g., chronic obstructive pulmonary disease [COPD] and bronchiectasis) and restrictive lung disease (e.g., interstitial lung disease [ILD] and sarcoidosis) [6]
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