A STUDY TO DETERMINE THE CLINICAL

SIGNIFICANCE OF ASPERGILLUS
SENSITIZATION IN PATIENTS WITH
BRONCHIAL ASTHMA

Presented by:
T.V.Rajagopal,Resident,Dept of
Respiratory Medicine
 Review of literature
1. In the previous study by Ritesh Agarwal et al*
to deduce the clinical significance of
aspergillus sensitisation in asthma it was
concluded that there was only weak
association between aspergillus sensitisation
and asthma severity.

*Agarwal R, Noel V, Aggarwal A, Gupta D, Chakrabarti A. Clinical significance of

Aspergillus sensitisation in bronchial asthma. Mycoses. 2011;54(5):e531-e538.
2. D.menzies et al* concluded that even in the
absence of criteria fulfilling ABPA,patients with
aspergillus sensitisation more often have
radiological abnormalities and poorer lung
function

* Menzies D, Holmes L, McCumesky G, Prys-Picard C, Niven R. Aspergillus

sensitization is associated with airflow limitation and bronchiectasis in severe
asthma. Allergy. 2011;66(5):679-685.
 Aims & Objectives
Identification of Aspergillus sensitisation
in patients with bronchial asthma and its
clinical significance.

To study the prevalence of Aspergillus

sensitisation in patients with bronchial
asthma.
To evaluate the impact of Aspergillus
sensitization on disease severity.
Inclusion criteria:
 Patients will be included in the study if they are aged 18 years or more
and meet either or both of the following criteria for the diagnosis of
bronchial asthma:
 History of recurrent or episodic attacks of chest tightness, wheezing,
breathlessness and cough (especially nocturnal)
 An obstructive pattern on spirometry with or without the presence of
bronchodilator reversibility. (FEV1/FVC< 0.75 with reversibility increase in
FEV1 of >12% and >200 mL from baseline, 10–15 minutes after 200 -400
mcg albuterol or equivalent)
Exclusion criteria:
 Age more than 65 years
 Diagnosis of ABPA or chronic obstructive pulmonary disease
 Pregnancy
 Other immunosuppressive states such as chronic liver disease, chronic
renal failure, uncontrolled diabetes mellitus, chronic heart failure,
immunosuppressive drugs other than glucocorticoids for controlling
asthma
 Failure to give informed consent.
Methodology
Aspergillus sensitisation tests
• Aspergillus sensitisation was tested initially with skin prick test (SPT) using
commercially available allergen. It was graded using the following grading
1+,2+,3+,4+,5+ respectively for 0 -3 mm,3 – 5 mm,6-8 mm,9 -11 mm,> 11
mm wheal diameter.
• Aspergillus specific IgE was done using commercial ImmunoCAP system
with 0.35kUA/L as reference for positive result

Assessment of severity:

Asthma control test-ACT is a validated, self-administered questionnaire with

five items that has been developed as an easy method for patients and
clinicians to assess symptoms (daytime and nocturnal), use of rescue
medications and the effect of asthma on daily functioning

GINA (Global initiative for asthma) symptom control:

• Symptom control was assessed using GINA symptom control questionnaire
after adhering to treatment for atleast 1 month and was graded well-
controlled,partly or uncontrolled.
Flow of patients
 Table 1: Distribution of Study Population
according to Aspergillus sensitivity
Group Description No. of patients Percentage

Group I Aspergillus sensitive 20 35.09

Group II Aspergillus negative 37 64.91

Total 57 100.00

Group I
35.09%

Group II
64.91%

Chart 1: Distribution of Study Population according to Aspergillus sensitivity

 Table 2: Comparison of High Resolution Computed
Tomography (HRCT) Findings

Total (N=57) Aspergillus sensitive Aspergillus non- Statistical significance

group(n=20) sensitive group(n=37)

No. % No. % ² P

10 7 35.00 3 8.11 6.490 0.011

Bronchiectasis
Mucus Plugging 2 1 5.00 1 2.70 0.202 0.653

Emphysema 10 4 20.00 6 16.22 0.128 0.720

Bronchial wall thickening 4 2 10.00 2 5.41 0.420 0.517

9 6 3 8.11 4.679 0.031

Others* 30.00

*Cyst, Fibrosis, Focal ground glass opacity, Nodules & Ground glass
opacity, Patchy ground glass opacity
 Table 3: Comparison of
Symptom control
Symptoms Aspergillus sensitive Aspergillus non-sensitive Total (N=57)
group(n=20) group(n=37)

No. % No. % No. %

9 7 18.92 16 28.07
Uncontrolled 45.00

Partly Controlled 1 5.00 7 18.92 8 14.04

Well Controlled 10 50.00 23 62.16 33 57.89

²=5.270(df=2); p=0.072
 Conclusions
1. The severity of asthma is associated atleast partially to fungal
sensitisation with sentisation to aspergillus at a prime point of
pathogenesis.
2. Aspergillus sensitisation is significantly associated with
bronchiectasis even in the absence of clinical features.
3. Other findings like centrilobular nodules,mosaic perfusion and
ground glassing were more common in sensitised individuals.
4. Sensitised individuals had uncontrolled symptoms in a higher
proportion than non-sensitised individuals but was not
statistically significant.
Future implications to be researched
I. Is fungal colonisation adequate for making asthma
severe?
II. It is body’s immune responses or the fungal
allergens/proteases lead to lung damage causing
severe asthma?
III. Are there different sensitisation patterns based on
regional differences in environment, leading to
varying prevalence of SAFS and ABPA.
THANK YOU