Allergic bronchopulmonary aspergillosis in cystic fibrosis: Case-control study from the French registry

Allergic bronchopulmonary aspergillosis (ABPA) is a significant complication in people with cystic fibrosis (pwCF), driven by hypersensitivity to Aspergillus fumigatus. This study aimed to identify factors associated with the development of ABPA in pwCF, using data from the French CF Registry (FCFR). We conducted a multicenter case-control study utilizing anonymized data from the FCFR, spanning the period from 2016 to 2021. A total of 312 ABPA cases were matched to 936 controls. Various clinical factors, including CFTR variants, nutritional status, glucose disorders, respiratory function, chronic bacterial colonization, and treatments such as antibiotics, corticosteroids, and antifungals, were analyzed. Multivariate analyses and logistic regression models were used to identify associations with ABPA. PwCF who received more frequent intravenous antibiotics (OR = 2.47, P = .013), long-term inhaled corticosteroids (OR = 1.82, P < .001), or antifungals (OR = 5.83, P < .0001) exhibited a higher likelihood of developing ABPA. Additionally, glucose disorders were significantly associated with ABPA (OR = 1.41, P = .03). In contrast, a higher body mass index (BMI >25 kg/m²) appeared to be a protective factor (OR = 0.47, P = .03). No significant associations were observed with lung function, CFTR variants, or chronic Pseudomonas aeruginosa colonization. These findings suggest that certain clinical factors and treatments, particularly glucose disorders, frequent antibiotic use, and corticosteroid therapy, are associated with the development of ABPA in pwCF. Notably, a higher BMI may have a protective effect. Further research is needed to explore the underlying mechanisms of these associations and optimize treatment strategies for ABPA in CF, especially as CF therapies continue to evolve.