Describing the burden and characteristics of Aspergillus-related chronic lung disease at Imperial College Healthcare Trust: a 10-year retrospective study.

BACKGROUND

The epidemiology of Aspergillus-related chronic lung disease remains poorly defined. We aimed to characterise the local burden at Imperial College Healthcare National Health Service Trust, London, across a 10-year period (2014-2024).

METHODS

Electronic health records were reviewed to identify individuals tested for serological markers of Aspergillus species infection after which thoracic CT scans were reviewed for features of Aspergillus-related chronic lung disease. Patients were classified into diagnostic categories based on definitions provided in the recent British Thoracic Society Clinical Statement.

RESULTS

In total, 334 individuals met criteria for serologic allergic bronchopulmonary aspergillosis (sABPA), 145 for ABPA, 74 for chronic pulmonary aspergillosis (CPA), 38 for simple aspergilloma and 11 with CPA-ABPA overlap. Serological responses varied: ABPA patients had higher median Aspergillus fumigatus-specific immunoglobulin (Ig)E titres (7.52 kUA/L, vs 1.94 kUA/L, p<0.05) and a greater proportion were positive for Aspergillus antibody (IgG) or precipitins (62.5% vs 32.9%, p<0.05) compared with sABPA. CPA patients had lower median total IgE (94 vs 1494 IU/mL, p<0.05) and A. fumigatus-specific IgE (2.24 vs 7.52 kUA/L, p<0.05) than ABPA patients. There was a wide spectrum of radiological presentations across diagnostic categories.

CONCLUSIONS

While case numbers are likely underestimated, our findings highlight a substantial and heterogeneous local burden. This improved understanding of local epidemiology will inform our local service development.