Refractory phenotype of -sensitized asthma with bronchiectasis and allergic bronchopulmonary aspergillosis.

BACKGROUND

Sensitization to mucus plugs, and bacterial colonization may coexist and relate to a refractory phenotype during follow-up in asthma with bronchiectasis and allergic bronchopulmonary aspergillosis (ABPA).

OBJECTIVE

This study aimed to clarify the features of -sensitized refractory asthma with bronchiectasis and determine the refractory phenotype in this population and ABPA.

METHODS

This study included cases of the oldest available -specific IgE data and chest computed tomography images from a nationwide survey of refractory asthma with bronchiectasis. The characteristics of the -IgE positive ( sIgE) group were investigated and compared with its nonsensitized counterpart ( sIgE) and ABPA group. Cluster analysis was conducted to determine the refractory phenotype.

RESULTS

The sIgE group (n = 35) demonstrated type 2 inflammation levels intermediate between the ABPA (n = 42) and sIgE (n = 38) groups while exhibiting higher blood monocyte counts than the sIgE group. Cluster analysis conducted in patients with ABPA and sIgE newly determined 2 clusters: one was characterized by a younger age of asthma onset with fungal detection in sputum, and the other was characterized by mucus plugs and inflammation with eosinophils and monocytes, which was significantly related to mucus plugs, airflow limitation, and trend to show exacerbation. In the latter cluster, mucus plugs persisted, and 30% yielded in the sputum <5 years later.

CONCLUSION

The refractory phenotype with persistent mucus plugs was identified in -sensitized refractory asthma with bronchiectasis and ABPA. Mucus plug prevention is warranted.