Abstract
BackgroundAdvanced chronic obstructive pulmonary disease (COPD) often leads to hospitalisation and invasive aspergillosis (IA) is a serious complication. Aspergillus sensitisation may worsen symptoms in COPD.MethodsWe identified published papers between January 2000 and May 2019 with > 50 subjects and GOLD criteria for grade II, III or IV (FEV1/FVC < 70% and FEV1 < 80%) using standardised criteria in multiple countries, to re-estimate the prevalence of COPD. Hospitalised COPD patients develop IA in 1.3–3.9%, based on positive cultures of Aspergillus spp. and radiological findings. Given limited data on per-patient annual hospitalisation rates, we assumed a conservative 10.5% estimate. Annual IA mortality in COPD was estimated using the literature rates of 43–72%. A separate literature search assessed the impact of Aspergillus sensitisation on severity of COPD (by FEV1).ResultsWe re-estimated the global prevalence of COPD GOLD stages II-IV at 552,300,599 people (7.39% of the population) with 339,206,893 (8.58%) in Asia, 85,278,783 (8.52%) in the Americas, 64,298,051 (5.37%) in Africa, 59,484,329 (7.77%) in Europe and 4,032,543 (10.86%) in Oceania. An estimated 57,991,563 (10.5%) people with COPD are admitted to hospital annually and of these 753,073 (1.3%) – 2,272,322 (3.9%) develop IA and 540,451–977,082 deaths are predicted annually. Aspergillus sensitisation prevalence in COPD was 13.6% (7.0–18.3%) and not related to lower predicted FEV1% (P > 0.05).ConclusionsThe prevalence of COPD is much higher than previously estimated. Overall COPD mortality may be higher than estimated and IA probably contributes to many deaths. Improved rapid diagnosis of IA using culture and non-culture based techniques is required in COPD hospital admissions to reduce mortality.
Highlights
Advanced chronic obstructive pulmonary disease (COPD) often leads to hospitalisation and invasive aspergillosis (IA) is a serious complication
Aspergilli are Hammond et al BMC Pulmonary Medicine (2020) 20:241 ubiquitous soil-dwelling fungi that have the ability to cause a range of pulmonary conditions including invasive aspergillosis (IA), chronic pulmonary aspergillosis (CPA) including aspergilloma, hypersensitivity pneumonitis, and allergic bronchopulmonary aspergillosis (ABPA) [8]
COPD prevalence data collation Data were initially collected from three large studies: Burden of Obstructive Lung Disease (BOLD), Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) and BREATHE to provide estimates on COPD prevalence, [3, 17, 18]
Summary
Advanced chronic obstructive pulmonary disease (COPD) often leads to hospitalisation and invasive aspergillosis (IA) is a serious complication. Chronic obstructive pulmonary disease (COPD) is the most prevalent non-communicable disease of the lungs. It is both preventable and treatable but usually progressive and irreversible [1] with the majority of deaths from COPD occurring in less-developed countries [2]. An. Bacteria and viruses are a major cause of COPD exacerbations [6] whereas the role of fungi is less well understood. Aspergilli are Hammond et al BMC Pulmonary Medicine (2020) 20:241 ubiquitous soil-dwelling fungi that have the ability to cause a range of pulmonary conditions including invasive aspergillosis (IA), chronic pulmonary aspergillosis (CPA) including aspergilloma, hypersensitivity pneumonitis, and allergic bronchopulmonary aspergillosis (ABPA) [8]. Prior estimates of the annual global incidence of IA range upwards from 200,000 [9], but difficulties in the precise diagnosis of IA in COPD patients has restrained efforts to include this group in the estimates [10]
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