Abstract
Aspergillus fumigatus (Af) frequently colonizes the airways of patients with cystic fibrosis (CF) and can cause severe diseases, such as allergic bronchopulmonary aspergillosis, Af bronchitis or even Af pneumonia. However, risk factors, including environmental factors, for acquiring Af in the respiratory tract of patients with CF are rarely studied and described. The aim of this study was to investigate whether urban or rural life could affect colonization with Af in the respiratory tract of patients with CF. Due to privacy policy, registry data are usually not linked to patients´ home addresses. It is therefore very difficult to analyze the influence of the patient´s residential environment. This prospective questionnaire survey was carried out in 31 German CF centers in 2018. Only completed surveys, including a clearly assigned type of residential area were included. Statistical analysis was performed by chi-squared test and logistic regression models. A total of 1016 questionnaires were analyzed (Patients` age: 23 ± 13; 0–88 years; female gender: n=492; 48%). The majority of patients with CF live in large cities (n =314; 30.9%) or urban districts (n=461; 45.4%). Prevalence of 30.2% was found for Af, within the 12 months of investigation period. Af colonization was significantly associated with urban life (p=0.004). Urban live should be considered as possible new risk factor for colonization with Af in the respiratory tract of patients with CF. These new results may raise the awareness of the influence of environmental factors on patient outcomes and should be included in patient guidance and preventive measures.
Highlights
The life-limiting autosomal recessive disorder Cystic fibrosis (CF) is characterized by abnormal viscous secretions in the lower airways leading to obstruction, inflammation, tissue damage and destruction of the lung (Elborn, 2016).In patients with cystic fibrosis (CF), fungal colonization of the respiratory tract is frequently found (Pihet et al, 2009)
Aspergillus species are associated with negative patient outcome and can cause severe diseases, like allergic bronchopulmonary aspergillosis (ABPA) (Singh et al, 2018)
The ABPA diagnosis was determined in every single CF center and was based on the minimal 2003 Cystic Fibrosis Foundation (CFF) consensus criteria (Stevens et al, 2003)
Summary
The life-limiting autosomal recessive disorder Cystic fibrosis (CF) is characterized by abnormal viscous secretions in the lower airways leading to obstruction, inflammation, tissue damage and destruction of the lung (Elborn, 2016).In patients with CF, fungal colonization of the respiratory tract is frequently found (Pihet et al, 2009). Urban Life Associated With Aspergillosis the environment. Aspergillus species are associated with negative patient outcome and can cause severe diseases, like allergic bronchopulmonary aspergillosis (ABPA) (Singh et al, 2018). ABPA is caused by hypersensitivity to allergens of Af (Janahi et al, 2017), is characterized by a variety of clinical and immunological responses (Stevens et al, 2003) and is associated with a negative effect on lung function (Kraemer et al, 2006). As registry data of the patient are not linked with their home address, this questionnaire survey was conducted to gain evidence of an association between aspergillosis and urban or rural life
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