Abstract
BackgroundAcute exacerbations of COPD (AECOPD) are often associated with infectious agents, some of which may be non-usual, including Aspergillus spp. However, the importance of Aspergillus spp. in the clinical management of AECOPD still remains unclear.ObjectivesThe aims of the study were to analyze the prevalence and risk factors associated with Aspergillus spp. isolation in AECOPD, and to investigate the associated clinical outcomes during a 1-year follow-up period.MethodsPatients presenting with an AECOPD requiring hospitalization were prospectively included from four hospitals across Spain. Clinical, radiological and microbiological data were collected at admission and during the follow-up period (1, 6 and 12 months after discharge), and re-admissions and mortality data collected during the follow-up.ResultsA total of 240 patients with severe AECOPD were included. Valid sputum samples were obtained in 144 (58%) patients, and in this group, the prevalence of Aspergillus spp. isolation was 16.6% on admission and 14.1% at one-year follow-up. Multivariate logistic-regression showed that AECOPD in the previous year (OR 12.35; 95% CI, 1.9-29.1; p < 0.001), concurrent isolation of pathogenic bacteria (OR 3.64; 95% CI 1.65-9.45, p = 0.001) and concomitant isolation of Pseudomonas aeruginosa (OR 2.80; 95% IC, 1.81-11.42; p = 0.001) were the main risk factors for Aspergillus spp. isolation.ConclusionsThe main risk factors for Aspergillus spp. isolation were AECOPD in the previous year and concomitant isolation of Pseudomonas aeruginosa. However, although Aspergillus spp. is often isolated in sputum samples from patients with AECOPD, the pathogenic and clinical significance remains unclear.
Highlights
Exacerbations of chronic obstructive pulmonary disease (COPD) are frequent events in the natural history of the disease, increasing mortality especially when patients require hospitalization [1,2]
Spain Full list of author information is available at the end of the article that some infectious agents, typically respiratory viruses and bacteria, increase bronchial and systemic inflammation, which is commonly seen in Acute exacerbations of COPD (AECOPD) [4,5]. These microbial agents account for the etiology of 75% of AECOPD, in Anthonisen Type I exacerbations [6]
The overall mortality rate at months was 11.3% (27 patients); (10.8%) in the non-Aspergillus spp. group and three (12.5%) in the Aspergillus spp. group (p = 0.373). This is the first study to date to prospectively determine the prevalence of airway Aspergillus spp. and examine the associated risk factors for isolation, in a cohort of severe COPD patients requiring hospitalization for an AECOPD
Summary
Exacerbations of chronic obstructive pulmonary disease (COPD) are frequent events in the natural history of the disease, increasing mortality especially when patients require hospitalization [1,2]. Acute exacerbations of COPD (AECOPD) are characterized clinically by worsening of dyspnoea, increased sputum production and/or changes in sputum purulence [3]. Overall, these microbial agents account for the etiology of 75% of AECOPD, in Anthonisen Type I exacerbations [6]. Aspergillus spp. may be responsible for important clinical events from saprophytic colonization of the airways to rapidly invasive and life-threatening disseminated diseases, depending on the host immune status and the presence of underlying lung disease [9]. Acute exacerbations of COPD (AECOPD) are often associated with infectious agents, some of which may be non-usual, including Aspergillus spp. The importance of Aspergillus spp. in the clinical management of AECOPD still remains unclear
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