• Pei Yee Tiew, Albert Yick Hou Lim, Holly R Keir, Alison J Dicker, Micheál Mac Aogáin, Sze Lei Pang, Teck Boon Low, Tidi Maharani Hassan, Mau Ern Poh, Huiying Xu, Thun How Ong, Mariko Siyue Koh, John Arputhan Abisheganaden, Augustine Tee, Fook Tim Chew, James D Chalmers, and Sanjay H Chotirmall.
• Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Republic of Singapore; Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Republic of Singapore.
• Chest. 2022 Jan 1; 161 (1): 40-53.

BackgroundAllergic bronchopulmonary aspergillosis (ABPA) is associated with frequent exacerbations and poor outcomes in chronic respiratory disease, but remains underdiagnosed. The role of fungal sensitization in bronchiectasis-COPD overlap (BCO) is unknown.Research QuestionWhat is the occurrence and clinical relevance of Aspergillus sensitization and ABPA in BCO when compared with individuals with COPD or bronchiectasis without overlap?Study DesignProspective, observational, cross-sectional study.MethodsWe prospectively recruited 280 patients during periods of clinical stability with bronchiectasis (n = 183), COPD (n = 50), and BCO (n = 47) from six hospitals across three countries (Singapore, Malaysia, and Scotland). We assessed sensitization responses (as specific IgE) to a panel of recombinant Aspergillus fumigatus allergens and the occurrence of ABPA in relationship to clinical outcomes.ResultsIndividuals with BCO show an increased frequency and clinical severity of ABPA compared with those with COPD and bronchiectasis without overlap. BCO-associated ABPA is associated with more severe disease, higher exacerbation rates, and lower lung function when compared with ABPA occurring in the absence of overlap. BCO with a severe bronchiectasis severity index (BSI; > 9) is associated significantly with the occurrence of ABPA that is unrelated to underlying COPD severity.ConclusionsBCO demonstrates a high frequency of ABPA that is associated with a severe BSI (> 9) and poor clinical outcomes. Clinicians should maintain a high index of suspicion for the potential development of ABPA in patients with BCO with high BSI.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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