Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Mycoses. 2023 Nov;66(11):953-959. doi: 10.1111/myc.13640. Epub 2023 Aug 9.
The long-term outcomes of allergic bronchopulmonary aspergillosis (ABPA) are poorly characterised.
We retrospectively included treatment-naïve subjects of acute stage ABPA-complicating asthma from three randomised trials. All the subjects received oral prednisolone for 4 months and were monitored every 6 weeks for 6 months and then every 6 months. Our primary objective was to estimate the incidence rate and the frequency of subjects experiencing ABPA exacerbation. The key secondary objectives were to evaluate the factors predicting ABPA exacerbation and the changes in serum total IgE seen during treatment.
We included 182 subjects. Eighty-one (44.5%) patients experienced 120 exacerbations during 512 patient-years of follow-up. The incidence rate of ABPA exacerbations was 234/1000 patient-years. Most (73/81, 90.1%) subjects experienced ABPA exacerbation within three years of stopping therapy. On multivariate logistic regression analysis, peripheral blood eosinophil count ≥1000 cells/μL (adjusted odds ratio [aOR] 2.43; 95% confidence interval (CI), 1.26-4.67), the extent of bronchiectasis (aOR 1.10; 95% CI, 1.03-1.18), age (aOR 0.97; 95% CI, 0.94-0.99), and female sex (aOR 2.16; 95% CI, 1.10-4.24) independently predicted ABPA exacerbation after adjusting for serum total IgE and high-attenuation mucus. The best cut-off for serum total IgE after 6 weeks for identifying treatment response and ABPA exacerbations was a 20% decline and a 50% increase, respectively.
ABPA exacerbations were common within 3 years of stopping treatment. Age, female sex, peripheral blood eosinophilia and the extent of bronchiectasis predicted ABPA exacerbations. The optimal serum total IgE cut-off for defining ABPA response and exacerbations is a 20% decline and a 50% increase, respectively.
变应性支气管肺曲霉病（ABPA）的长期预后较差。
我们回顾性纳入了来自三项随机试验的急性 ABPA 合并哮喘的初治患者。所有患者均接受口服泼尼松龙治疗 4 个月，并在 6 周时每 6 周监测一次，然后每 6 个月监测一次。我们的主要目的是估计发生 ABPA 加重的发生率和频率。主要次要目标是评估预测 ABPA 加重的因素和治疗期间血清总 IgE 的变化。
我们纳入了 182 名患者。81 名（44.5%）患者在 512 患者年的随访中经历了 120 次加重。ABPA 加重的发生率为 234/1000 患者年。大多数（73/81，90.1%）患者在停止治疗后三年内发生 ABPA 加重。多变量逻辑回归分析显示，外周血嗜酸性粒细胞计数≥1000 细胞/μL（调整优势比[aOR]2.43；95%置信区间[CI]1.26-4.67）、支气管扩张程度（aOR 1.10；95%CI 1.03-1.18）、年龄（aOR 0.97；95%CI 0.94-0.99）和女性（aOR 2.16；95%CI 1.10-4.24）在调整血清总 IgE 和高衰减黏液后，独立预测 ABPA 加重。在 6 周时，血清总 IgE 下降 20%和增加 50%分别是预测治疗反应和 ABPA 加重的最佳截断值。
在停止治疗后 3 年内，ABPA 加重很常见。年龄、女性、外周血嗜酸性粒细胞增多和支气管扩张程度预测 ABPA 加重。用于定义 ABPA 反应和加重的最佳血清总 IgE 截断值分别为下降 20%和增加 50%。
