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Updated: Sep 13, 2025

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Fungal-Driven Airways Dis-Immunity From Asthma to Allergic Bronchopulmonary Aspergillosis: Dissecting Similarities

Marco Caminati1,2, Isabella Annesi-Maesano3,4,5, Wojciech Feleszko6

  • 1Allergy Unit and Asthma Center, Verona Integrated University Hospital, Verona, Italy.

Allergy
|August 2, 2025
PubMed

Insights

Severe asthma and allergic bronchopulmonary aspergillosis (ABPA) share similarities, complicating diagnosis. Recognizing severe asthma with fungal sensitization (SAFS) is crucial for better management and preventing irreversible damage.

Area of Science:

  • Pulmonology
  • Allergy and Immunology
  • Mycology

Background:

  • Severe asthma and allergic bronchopulmonary aspergillosis (ABPA) frequently coexist, presenting overlapping symptoms and pathobiological drivers.
  • Severe asthma with fungal sensitization (SAFS) further complicates accurate phenotyping, increasing disease burden and risk of irreversible lung damage.

Purpose of the Study:

  • To provide a comparative overview of recent advances in understanding asthma, ABPA, and SAFS.
  • To update the practical approach to diagnosing and managing these complex respiratory conditions.
  • To highlight the need for precise endotyping for targeted treatments and improved patient outcomes.

Main Methods:

  • Comparative review of pathophysiology, clinical manifestations, and biomarkers.
  • Analysis of current diagnostic challenges and management strategies.
  • Focus on differentiating fungal-related dis-immunity in severe asthma.

Main Results:

  • Shared pathobiological backgrounds and clinical similarities between severe asthma and ABPA can mislead diagnosis.
  • Biomarkers, while specific, may not always provide clear differential diagnoses.
  • SAFS represents a significant challenge in phenotyping severe asthma patients.

Conclusions:

  • Accurate recognition and pheno-endotyping of severe asthma, ABPA, and SAFS are essential for effective management.
  • Further research into pathobiological drivers and innovative targeted treatments is warranted.
  • Improved diagnostic strategies are needed to prevent disease progression and achieve remission.
Keywords:
Aspergillusallergic bronchopulmonary aspergillosisbiologicsfungal sensitizationsevere asthma

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