Related Experiment Video
Updated: Dec 17, 2025
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations
Pierre Bulpa1, Fabrice Duplaquet2, George Dimopoulos3
1Department of Intensive Care Unit, Mont-Godinne University Hospital, CHU UCL Namur, Namur, Belgium.
Abstract:
Nowadays, reports in the literature support that patients with severe chronic obstructive pulmonary disease (COPD) are at higher risk to develop invasive pulmonary aspergillosis (IPA). However, the interpretation of Aspergillus-positive cultures from the airways in critically ill COPD is still a challenge. Indeed, as the patient could be merely colonized, tissue samples are required to ascertain IPA diagnosis but they are rarely obtained before death. Consequently, diagnosis is often only suspected on the basis of a combination of three elements: clinical characteristics, radiological images (mostly thoracic CT scan), and microbiological, and occasionally serological, results. To facilitate the analysis of these data, several algorithms have been developed, and the best effectiveness has been demonstrated by the Clinical algorithm. This is of importance as IPA prognosis in these patients remains presently very poor and using such an algorithm could promote prompter diagnosis, early initiation of treatment, and subsequently improved outcome.While the most classical presentation of IPA in critically ill COPD patients features a combination of obstructive respiratory failure, antibiotic-resistant pneumonia, recent or chronic corticosteroid therapy, and positive Aspergillus cultures from the lower respiratory tract, the present article will also address less typical presentations and discuss the most appropriate treatments which could alter prognosis.
Insights
Diagnosing invasive pulmonary aspergillosis (IPA) in severe chronic obstructive pulmonary disease (COPD) patients is challenging. A clinical algorithm aids early diagnosis and treatment, potentially improving the poor prognosis for these patients.
Area of Science:
- Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Patients with severe chronic obstructive pulmonary disease (COPD) face an increased risk of invasive pulmonary aspergillosis (IPA).
- Distinguishing IPA from colonization in critically ill COPD patients with positive airway cultures is difficult, as tissue samples are rarely obtained before death.
- Current diagnostic approaches rely on clinical, radiological (CT scans), and microbiological/serological data.
Purpose of the Study:
- To highlight the diagnostic challenges of IPA in critically ill COPD patients.
- To emphasize the utility of diagnostic algorithms, particularly the Clinical algorithm, for improving IPA diagnosis.
- To discuss both typical and atypical presentations of IPA and appropriate treatments to improve patient outcomes.
Main Methods:
- Review of literature on IPA in severe COPD patients.
- Analysis of diagnostic criteria, including clinical, radiological, and microbiological findings.
- Evaluation of the effectiveness of diagnostic algorithms, specifically the Clinical algorithm.
Main Results:
- The Clinical algorithm demonstrates the highest effectiveness in analyzing diagnostic data for IPA in COPD patients.
- Early diagnosis facilitated by algorithms can lead to prompt treatment initiation.
- IPA in critically ill COPD patients is associated with a very poor prognosis.
Conclusions:
- The Clinical algorithm is crucial for timely IPA diagnosis in severe COPD patients, potentially improving outcomes.
- Recognizing both typical and atypical presentations of IPA is essential for effective management.
- Prompt diagnosis and treatment are vital for altering the poor prognosis of IPA in this patient population.
Related Concept Videos
01:20Chronic Obstructive Pulmonary Disease-II: Pathophysiology
Chronic Inflammation
01:25Chronic Obstructive Pulmonary Disease-III: Symptoms and Complications.
Symptoms of COPD can be classified as primary or systemic. Primary symptoms relate to reduced airflow, while systemic or extrapulmonary symptoms relate to COPD's broader impact on the body.
Primary Symptoms of COPD:
01:22Chronic Obstructive Pulmonary Disease
Smoking is a primary risk factor for COPD, with over 80% of patients having a history of it. Patients typically experience progressive dyspnea or labored breathing, frequent coughing, and recurrent pulmonary infections. Many eventually succumb to respiratory failure, characterized by...
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:20Chronic Obstructive Pulmonary Disease-I: Introduction
01:20COPD: Pathogenesis and Clinical Features
The primary cause for the onset of COPD is cigarette smoking and exposure to air pollution. These hazardous factors initiate a chain reaction within the lungs, resulting in chronic inflammation, damage to the airways, and a...