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Guo L, Wu X, Wu X. Aspergillus infection in chronic obstructive pulmonary diseases. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:129-138. [PMID: 36710403 PMCID: PMC9978918 DOI: 10.1111/crj.13585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 10/07/2022] [Accepted: 12/31/2022] [Indexed: 01/31/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic airway non-specific inflammatory disease characterised by airway obstruction and alveolar destruction. In recent years, due to the extensive use of antibiotics, glucocorticoids, immunosuppressants and other drugs, pulmonary fungal infection in patients with AECOPD, especially aspergillus infection, has gradually increased. The forms of aspergillus infection present in COPD patients include sensitisation, chronic pulmonary aspergillosis (CPA) and invasive pulmonary aspergillosis (IPA). This review will summarise diagnostic and treatment of aspergillus in COPD patients.
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Affiliation(s)
- Liang Guo
- Institute of Respiratory DiseaseThe Second Affiliated Hospital (Xinqiao Hospital), Army Medical UniversityChongqingChina
| | - Xiulin Wu
- Department of Geriatrics and Special Service medicineThe First Affiliated Hospital (Xinan Hospital), Army Medical UniversityChongqingChina
| | - Xueling Wu
- Department of Respiratory MedicineRenji Hospital, Shanghai Jiaotong University School of MedicineShanghaiChina
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Dhooria S, Sehgal IS, Muthu V, Agarwal R. Treatment of allergic bronchopulmonary aspergillosis: from evidence to practice. Future Microbiol 2021; 15:365-376. [PMID: 32286102 DOI: 10.2217/fmb-2019-0276] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder caused by dysregulated immune responses against Aspergillus fumigatus. The disorder usually complicates the course of patients with asthma and cystic fibrosis. Patients with ABPA most often present with asthma that is poorly controlled despite inhaled corticosteroids and long-acting β2 agonists. The treatment of ABPA is complicated due to the occurrence of recurrent exacerbations and spontaneous remissions. The drugs used for treating ABPA include systemic glucocorticoids, antifungal agents and biologics, each with its own benefits and drawbacks. In this review, we illustrate the treatment pathway for ABPA in different situations, using a case-based approach. In each case, we present the options for treatment based on the available evidence from recent clinical trials.
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Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Agarwal R, Sehgal IS, Dhooria S, Muthu V, Prasad KT, Bal A, Aggarwal AN, Chakrabarti A. Allergic bronchopulmonary aspergillosis. Indian J Med Res 2021; 151:529-549. [PMID: 32719226 PMCID: PMC7602921 DOI: 10.4103/ijmr.ijmr_1187_19] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is an inflammatory disease caused by immunologic reactions initiated against Aspergillus fumigatus colonizing the airways of patients with asthma and cystic fibrosis. The common manifestations include treatment-resistant asthma, transient and fleeting pulmonary opacities and bronchiectasis. It is believed that globally there are about five million cases of ABPA, with India alone accounting for about 1.4 million cases. The occurrence of ABPA among asthmatic patients in special clinics may be as high as 13 per cent. Thus, a high degree of suspicion for ABPA should be entertained while treating a patient with bronchial asthma, particularly in specialized clinics. Early diagnosis and appropriate treatment can delay (or even prevent) the onset of bronchiectasis, which suggests that all patients of bronchial asthma should be screened for ABPA, especially in chest clinics. The current review summarizes the recent advances in the pathogenesis, diagnosis and management of ABPA.
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Affiliation(s)
- Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Kuruswamy T Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Abstract
PURPOSE OF REVIEW Allergic bronchopulmonary aspergillosis (ABPA) is a disease frequently complicating asthma and cystic fibrosis. ABPA is increasingly recognized in other obstructive lung diseases (OLDs), including chronic obstructive pulmonary disease (COPD) and noncystic fibrosis bronchiectasis. Herein, we summarize the recent developments in ABPA complicating OLDs. RECENT FINDINGS Recent research has described the clinical features and natural history of ABPA complicating asthma in children and the elderly. We have gained insights into the pathophysiology of ABPA, especially the role of eosinophil extracellular trap cell death and mucus plugs. The utility of recombinant fungal antigens in the diagnosis of ABPA has been established. Newer, more sensitive criteria for the diagnosis of ABPA have been proposed. Although ABPA is uncommon in COPD and noncystic fibrosis bronchiectasis, aspergillus sensitization is more common and is associated with a higher exacerbation rate. SUMMARY Several advances have occurred in the diagnosis and treatment of ABPA in recent years. However, there is an unmet need for research into the genetic predisposition, pathophysiology, and treatment of ABPA. Apart from asthma and cystic fibrosis, patients with other OLDs also require evaluation for Aspergillus sensitization and ABPA.
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Connell D, Shah A. The contribution of Aspergillus fumigatus to COPD exacerbations: a "sensitive" topic. Eur Respir J 2020; 56:56/2/2002223. [PMID: 32855304 DOI: 10.1183/13993003.02223-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 11/05/2022]
Affiliation(s)
- David Connell
- Dept of Respiratory Medicine, NHS Tayside, Dundee, UK.,Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Anand Shah
- Dept of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK .,Dept of Infectious Diseases Epidemiology, School of Public Health, Imperial College London, London, UK
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Oladipupo OA, Dutta D, Chong NS. Analysis of chemical constituents in mainstream bidi smoke. BMC Chem 2019; 13:93. [PMID: 31384840 PMCID: PMC6661734 DOI: 10.1186/s13065-019-0614-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/15/2019] [Indexed: 11/30/2022] Open
Abstract
Bidi, an indigenous form of cigarette in South Asian countries, is popular because of its low cost and multi-flavored variants. Although recent studies have shown that bidi smokers suffer from various adverse health effects including cancer, research on bidi smoke composition and exposure levels is still very limited. In this research, the vapor and particulate phases of bidi were characterized using gas chromatography coupled with mass spectrometry (GC–MS) and Fourier-transform infrared spectrometry (FTIR). The amounts of nicotine, cotinine, indole, substituted phenols, substituted pyridines, and phytol found in different size fractions of the particulate matter collected using a cascade impactor were reported. Due to the low combustibility of the tendu leaf in bidi, a six-second puff interval was used to sample the smoke constituents for analysis. Significant levels of carbon monoxide, hydrogen cyanide, and hydrocarbons like ethylene, methane and 1, 3-butadiene were detected in the mainstream bidi smoke. In addition, 3-methylpyridine, cotinine, α-amyrin, and β-amyrin were also present at high levels in bidi smoke. Despite having less tobacco compared to conventional cigarette, bidi smokers are potentially exposed to significantly higher concentrations of nicotine due to the greater puffing frequency. The non-porous nature and higher moisture content of tendu leaf in bidis compared to cigarette wrapping paper led to higher levels of carbon monoxide and tar in bidi smoke compared to regular cigarette smoke. Results of this study indicate the presence of harmful and carcinogenic chemicals in the mainstream bidi smoke that could be harmful to human health.
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Affiliation(s)
- Omobola Ajoke Oladipupo
- 1Department of Chemistry, Middle Tennessee State University, P.O. Box 68, Murfreesboro, TN 37132 USA.,2Present Address: Eli Lilly and Company, Lilly Technology Center North, 1220 West Morris Street, Indianapolis, IN 46221 USA
| | - Dibyendu Dutta
- 3Department of Professional Science, Middle Tennessee State University, P.O. Box 83, Murfreesboro, TN 37132 USA
| | - Ngee Sing Chong
- 1Department of Chemistry, Middle Tennessee State University, P.O. Box 68, Murfreesboro, TN 37132 USA
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Everaerts S, Lagrou K, Dubbeldam A, Lorent N, Vermeersch K, Van Hoeyveld E, Bossuyt X, Dupont LJ, Vanaudenaerde BM, Janssens W. Sensitization to Aspergillus fumigatus as a risk factor for bronchiectasis in COPD. Int J Chron Obstruct Pulmon Dis 2017; 12:2629-2638. [PMID: 28919731 PMCID: PMC5587018 DOI: 10.2147/copd.s141695] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bronchiectasis-chronic obstructive pulmonary disease (COPD) overlap presents a possible clinical phenotype of COPD, but it is unclear why it develops in a subset of patients. We hypothesized that sensitization to Aspergillus fumigatus (A fum) is associated with bronchiectasis in COPD and occurs more frequently in vitamin D-deficient patients. METHODS This observational study investigated sensitization to A fum in an outpatient clinical cohort of 300 COPD patients and 50 (ex-) smoking controls. Total IgE, A fum-specific IgE against the crude extract and against the recombinant antigens and A fum IgG were measured using ImmunoCAP fluoroenzyme immunoassay. Vitamin D was measured by radioimmunoassay, and computed tomography images of the lungs were scored using the modified Reiff score. RESULTS Sensitization to A fum occurred in 18% of COPD patients compared to 4% of controls (P=0.0110). In all, 31 COPD patients (10%) were sensitized to the crude extract and 24 patients (8%) had only IgE against recombinant antigens. A fum IgG levels were significantly higher in the COPD group (P=0.0473). Within COPD, A fum-sensitized patients were more often male (P=0.0293) and more often had bronchiectasis (P=0.0297). Pseudomonas aeruginosa and Serratia marcescens were more prevalent in historical sputum samples of A fum-sensitized COPD patients compared to A fum-non-sensitized COPD patients (P=0.0436). Vitamin D levels were comparable (P=0.2057). Multivariate analysis demonstrated that sensitization to recombinant f1 or f3 had a 2.8-fold increased risk for bronchiectasis (P=0.0030). CONCLUSION These results highlight a potential role for sensitization to A fum in COPD-related bronchiectasis.
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Affiliation(s)
- Stephanie Everaerts
- Department of Respiratory Diseases, University Hospitals Leuven
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, KU Leuven
| | - Katrien Lagrou
- Department of Laboratory Medicine, University Hospitals Leuven
- Department of Microbiology and Immunology, KU Leuven
| | - Adriana Dubbeldam
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven
| | - Kristina Vermeersch
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, KU Leuven
| | | | - Xavier Bossuyt
- Department of Laboratory Medicine, University Hospitals Leuven
- Department of Microbiology and Immunology, KU Leuven
| | - Lieven J Dupont
- Department of Respiratory Diseases, University Hospitals Leuven
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, KU Leuven
| | - Bart M Vanaudenaerde
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, KU Leuven
| | - Wim Janssens
- Department of Respiratory Diseases, University Hospitals Leuven
- Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, KU Leuven
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