Occurrence of allergic bronchopulmonary aspergillosis in Chinese adults with asthma and COPD comorbidity.

INTRODUCTION

Allergic bronchopulmonary aspergillosis (ABPA) is thought to occur frequently in asthma. However, there are no available data about the occurrence of ABPA in patients with simultaneous asthma and COPD.

METHODS

We conducted a multicenter cohort study using medical records from 3382 subjects. The asthma-COPD overlap (ACO) was defined as post-bronchodilator forced expiratory volume in 1 s divided by a forced vital capacity (FEV1/FVC) of <0.7. In addition, patients had either a history of asthma or significant bronchodilator reversibility. The subjects were categorized into nonsmokers and smokers. We reported the occurrence of ABPA in each category and performed a multivariable logistic regression to identify factors associated with ABPA.

RESULTS

We classified 1849 (54.7 %) and 1533 (45.3 %) subjects as smokers and nonsmokers, respectively. The proportion of subjects with elevated serum total IgE (≥500IU/mL) and positive A. fumigatus-specific IgE was significantly higher among nonsmokers (25.5 % and 33.2 %, respectively) than smokers (11.1 % and 13.2 %, respectively; both p < 0.001). We diagnosed ABPA in 418 (9.4 %) subjects with ACO. The occurrence of ABPA was 12.8 % in nonsmokers and 6.6 % in smokers. Smokers with ABPA had worse pulmonary function and a higher exacerbation rate, as well as longer-term corticosteroids prescribed than nonsmokers. The multivariable analysis identified coexisting atopic conditions, rural residence, biomass use, and asthma duration as significant factors associated with ABPA.

CONCLUSIONS

These findings support the revised guidelines provide diagnostic algorithm recommendation for screening all subjects for ABPA, irrespective of asthma or COPD. Biomass use in rural areas is associated with ABPA progression.