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Clinical factors associated with pulmonary aspergillosis in patients with chronic obstructive pulmonary disease
Sonia Molinos-Castro1, Paula M Pesqueira-Fontán1, Sergio Rodríguez-Fernández1
1Servicio de Medicina Interna, Hospital da Barbanza, Ribeira, A Coruña, España.
Objective:
To explore the clinical and epidemiological characteristics of chronic obstructive pulmonary disease (COPD) patients with Aspergillus spp. isolation from respiratory samples, and to identify which factors may help us to distinguish between colonisation and infection.
Methods:
A retrospective cohort study was performed. All patients with COPD and respiratory isolation of Aspergillus spp. over a 12-year period were included. Patients were assigned to 2 categories: colonisation and pulmonary aspergillosis (PA), which includes the different clinical forms of aspergillosis. A binary logistic regression model was performed to identify the predictive factors of PA.
Results:
A total of 123 patients were included in the study: 48 (39.0%) with colonisation and 75 (61.0%) with PA: 68 with probable invasive pulmonary aspergillosis and 7 with chronic pulmonary aspergillosis. Spirometric stages of the GOLD classification were not correlated with a higher risk of PA. Four independent predictive factors of PA in COPD patients were identified: home oxygen therapy (OR: 4.39; 95% CI: 1.60-12.01; P=.004), bronchiectasis (OR: 3.61; 95% CI: 1.40-9.30; P=.008), hospital admission in the previous three months (OR: 3.12; 95% CI: 1.24-7.87; P=.016) and antifungal therapy against Candida spp. in the previous month (OR: 3.18; 95% CI: 1.16-8.73; P=.024).
Conclusions:
Continuous home oxygen therapy, bronchiectasis, hospital admission in the previous three months and administration of antifungal medication against Candida spp. in the previous month were associated with a higher risk of pulmonary aspergillosis in patients with COPD.
Insights
Chronic obstructive pulmonary disease (COPD) patients with Aspergillus isolation face higher pulmonary aspergillosis risks due to home oxygen, bronchiectasis, recent hospital admission, and prior antifungal use.
Area of Science:
- Medical Mycology
- Pulmonology
- Epidemiology
Background:
- Aspergillus spp. isolation in respiratory samples from patients with chronic obstructive pulmonary disease (COPD) can represent either colonization or infection.
- Distinguishing between colonization and pulmonary aspergillosis (PA) is crucial for appropriate patient management.
- Understanding risk factors for PA in COPD patients is essential for early diagnosis and treatment.
Purpose of the Study:
- To investigate the clinical and epidemiological features of COPD patients with Aspergillus spp. isolated from respiratory samples.
- To identify factors predicting the development of pulmonary aspergillosis (PA) versus colonization in COPD patients.
Main Methods:
- Retrospective cohort study including 123 COPD patients with Aspergillus spp. isolation over 12 years.
- Patients categorized into colonization or pulmonary aspergillosis (PA) groups.
- Binary logistic regression analysis to identify predictive factors for PA.
Main Results:
- Pulmonary aspergillosis (PA) was diagnosed in 75 (61.0%) patients, while 48 (39.0%) had colonization.
- Four independent predictors for PA in COPD patients were identified: home oxygen therapy (OR: 4.39), bronchiectasis (OR: 3.61), recent hospital admission (OR: 3.12), and prior antifungal therapy for Candida spp. (OR: 3.18).
- GOLD spirometric stages did not correlate with an increased risk of PA.
Conclusions:
- Continuous home oxygen therapy, bronchiectasis, recent hospital admission, and prior antifungal use against Candida spp. are associated with an increased risk of pulmonary aspergillosis in COPD patients.
- These factors can aid in differentiating between Aspergillus colonization and infection in this vulnerable population.
- Further research may focus on targeted interventions for high-risk COPD patients.
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