Bronchoscopic phenotypes and anatomical airway involvement in invasive tracheobronchial aspergillosis without classic immunosuppression: association with in-hospital mortality.

BACKGROUND

The prognostic relevance of visual bronchoscopic phenotyping and airway lesion extent in invasive tracheobronchial aspergillosis (ITBA) without classic immunosuppression remains unclear. This study aimed to describe the clinical, radiological and bronchoscopic features of ITBA, and to evaluate the association between visual bronchoscopic assessment and in-hospital mortality.

METHODS

We conducted a retrospective cohort study at National Lung Hospital in Hanoi, Vietnam, from January 2023 to December 2025. Adult patients with histopathologically proven ITBA lacking classic immunosuppressive factors were included. On bronchoscopy, patients were dichotomised by the predominance of pseudomembranes and an airway involvement score was calculated to assess the extent of the lesions.

RESULTS

The study included 31 patients with proven ITBA (mean age 61.4 years; 83.9% male). Diabetes (41.9%), chronic obstructive pulmonary disease (29.0%) were the most common comorbidities, and 16.1% of the cohort were immunocompetent. Bronchoscopy revealed the pseudomembranous phenotype in 61.3% of patients. Overall in-hospital mortality was 29.0%. While the pseudomembranous phenotype was more frequent among deceased patients than survivors (88.9% vs. 50.0%), this difference was not statistically significant (p = 0.101). In contrast, deceased patients had a significantly higher median airway involvement score (3 points vs. 2 points; p = 0.007), indicating more extensive disease. No major procedural complications occurred.

CONCLUSION

ITBA can manifest in patients without classic immunosuppression. Beyond the diagnostic utility, bronchoscopy may provide prognostic relevance for this selected cohort, particularly through evaluation of the anatomical extent of airway involvement, rather than visual bronchoscopic phenotyping.