Related Experiment Video

Updated: Jun 5, 2025

Confocal Laser Scanning Microscopy-Based Quantitative Analysis of Aspergillus fumigatus Conidia Distribution in Whole-Mount Optically Cleared Mouse Lung
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Refractory phenotype of Aspergillus-sensitized asthma with bronchiectasis and allergic bronchopulmonary aspergillosis

Natsuko Nomura1, Hisako Matsumoto1,2, Koichiro Asano3

  • 1Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

The Journal of Allergy and Clinical Immunology. Global
|December 11, 2024
PubMed
Abstract

Insights

Aspergillus sensitization, mucus plugs, and bacterial colonization are linked to refractory asthma with bronchiectasis. Persistent mucus plugs characterize a refractory phenotype in these patients, highlighting the need for prevention.

Area of Science:

  • Pulmonology
  • Allergy and Immunology
  • Infectious Disease

Background:

  • Refractory asthma with bronchiectasis can involve Aspergillus sensitization, mucus plugs, and bacterial colonization.
  • These factors may contribute to a persistent, difficult-to-treat asthma phenotype.

Purpose of the Study:

  • To investigate features of Aspergillus-sensitized refractory asthma with bronchiectasis.
  • To define the refractory phenotype in this population and compare it with allergic bronchopulmonary aspergillosis (ABPA).

Main Methods:

  • Analysis of Aspergillus fumigatus-specific IgE data and CT images from a nationwide refractory asthma with bronchiectasis survey.
  • Comparison of Aspergillus-sensitized (Af sIgE+) and non-sensitized (Af sIgE-) groups with an ABPA group.
  • Cluster analysis to identify distinct refractory phenotypes.

Main Results:

  • The Af sIgE+ group showed intermediate type 2 inflammation and higher monocyte counts compared to the Af sIgE- group.
  • Cluster analysis identified two phenotypes: one with early asthma onset and fungal detection, and another with mucus plugs, inflammation (eosinophils, monocytes), airflow limitation, and exacerbations.
  • The latter cluster showed persistent mucus plugs and frequent Pseudomonas aeruginosa detection.

Conclusions:

  • A refractory phenotype characterized by persistent mucus plugs was identified in Aspergillus-sensitized refractory asthma with bronchiectasis and ABPA.
  • Interventions targeting mucus plug prevention are crucial for managing this patient group.
Keywords:
ABPAAspergillus sensitizationbronchiectasismonocytemucus plugrefractory asthma

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