Allergy and Airway: Allergy - Asthma Slide |

Characteristics of Fungal Sensitization in Thai Severe Asthma FREE TO VIEW

Theerasuk Kawamatawong, MD; Pirun Pukapong, MD; Ticha Rerkpattanapipat, MD; Thitiporn Suwatanapongched, MD
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Ramathibodi Hospital, Bangkok, Thailand

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):10A. doi:10.1016/j.chest.2016.08.013
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SESSION TITLE: Allergy - Asthma Slide

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 07:30 AM - 08:30 AM

PURPOSE: Aim of this study is to identify prevalence and clinical characteristic of fungal sensitization and Allergic Bronchopulmonary Aspergillosis (ABPA) in Thai severe asthma patients.

METHODS: Cross sectional study was conducted from August 2014 to December 2015 in severe asthma patients. Severe asthma was defined by having clinical significant exacerbation in past year and/or fixed airflow obstruction. Blood for eosinophils count, serum total IgE, and specific IgE (sIgE) for Aspergillus fumigatus skin prick test (SPT) for aeroallergen, exhaled nitric oxide (FENO) were done. High-resolution computed tomography (HRCT) of chest was performed.

RESULTS: Total 82 consecutive patients with severe asthma were recruited. Their mean postbronchodilator FEV1 was 69.2% predicted and FEV1/FVC was 67%. Twenty-one patients (28%) had serum total IgE ≥ 1,000 IU/L. A fumigatus sensitization was noted in 11 (52.3%) from 21 patients in high total IgE group (11 with positive sIgE for A fumigatus, 2 with positive SPT for aspergillus). Hence they were diagnosed ABPA. Six from 59 (10%) patients in low total IgE group had aspergillus sensitization (5 with positive SPT for aspergillus, 2 with positive sIgE for A fumigatus). Not only positive sIgE for A fumigatus but also positive sIgE for Dp1 or Dp2 was associated with having serum IgE level ≥ 1,000 IU/L (both with p = 0.005). However, positive SPT for different allergens were not different between low and high IgE group. Regarding patients in high total IgE group, age at onset of disease, lung function parameters, blood eosinophils and FENO were not different between patients with and without aspergillus sensitization. In patients with A fumigatus sensitization and high serum total IgE, HRCT detected central bronchiectasis was noted in 2 patients (ABPA-CB). Remaining 9 ABPA patients were labelled serologic ABPA (ABPA-S).

CONCLUSIONS: Prevalence of A. fumigatus sensitization and ABPA in Thai severe asthma patients are 20.7% and 13.4%, respectively. There is no clinical and laboratory findings differentiating severe asthma with and without ABPA. The discordance between sIgE and SPT result for diagnosis aspergillus sensitization is noted.

CLINICAL IMPLICATIONS: Prevalence of ABPA in Thai severe asthma patients is not uncommon. Identification of aspergillus sensitization in severe asthma should be performed for targeting specific treatment.

DISCLOSURE: The following authors have nothing to disclose: Theerasuk Kawamatawong, Pirun Pukapong, Ticha Rerkpattanapipat, Thitiporn Suwatanapongched

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