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

Autor:	Nomura N; Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Matsumoto H; Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka, Japan., Asano K; Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan., Hayashi Y; Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Yokoyama A; Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan., Nishimura Y; Division of Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan., Hashimoto N; Department of Respiratory Medicine, Nagoya University, Nagoya, Japan.; Department of Respiratory Medicine, Fujita Health University, Toyoake, Aichi, Japan., Sakagami T; Department of Respiratory Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan., Fukunaga K; Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan., Hizawa N; Department of Pulmonary Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan., Yamasaki A; Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Tottori, Japan., Nagase H; Department of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan., Hattori N; Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan., Kondo M; Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan., Harada N; Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan., Sugiura H; Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan., Miki M; Department of Respiratory Medicine, NHO Toneyama Medical Center, Osaka, Japan.; Department of Internal Medicine, Tokushima Prefecture Naruto Hospital, Tokushima, Japan., Kimura T; Department of Respiratory Medicine and Allergy, Tosei General Hospital, Aichi, Japan., Toyoshima M; Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan., Matsuno O; Department of Respiratory Medicine, Osaka Habikino Medical Center, Osaka, Japan., Koh H; Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, Tokyo, Japan., Kita T; Department of Respiratory Medicine, NHO Kanazawa Medical Center, Kanazawa, Japan., Tomioka H; Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Kobe, Japan., Tomii K; Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan., Ohnishi H; Department of Respiratory Medicine, Akashi Medical Center, Hyogo, Japan., Takata S; Department of Respiratory Medicine, NHO Fukuokahigashi Medical Center, Fukuoka, Japan., Tobino K; Department of Respiratory Medicine, Iizuka Hospital, Fukuoka, Japan., Imokawa S; Department of Respiratory Medicine, Iwata City Hospital, Shizuoka, Japan., Sunadome H; Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Nagasaki T; Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.; Department of Respiratory Medicine and Allergology, Kindai University Nara Hospital, Ikoma, Japan., Oguma T; Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Tanabe N; Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan., Hirai T; Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Jazyk:	angličtina
Zdroj:	The journal of allergy and clinical immunology. Global [J Allergy Clin Immunol Glob] 2024 Nov 01; Vol. 4 (1), pp. 100364. Date of Electronic Publication: 2024 Nov 01 (Print Publication: 2025).
DOI:	10.1016/j.jacig.2024.100364
Abstrakt:	Background: Sensitization to Aspergillus, 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 Aspergillus -sensitized refractory asthma with bronchiectasis and determine the refractory phenotype in this population and ABPA. Methods: This study included cases of the oldest available Aspergillus fumigatus -specific IgE data and chest computed tomography images from a nationwide survey of refractory asthma with bronchiectasis. The characteristics of the A fumigatus -IgE positive ( Af sIgE + ) group were investigated and compared with its nonsensitized counterpart ( Af sIgE - ) and ABPA group. Cluster analysis was conducted to determine the refractory phenotype. Results: The Af sIgE + group (n = 35) demonstrated type 2 inflammation levels intermediate between the ABPA (n = 42) and Af sIgE - (n = 38) groups while exhibiting higher blood monocyte counts than the Af sIgE - group. Cluster analysis conducted in patients with ABPA and Af 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 Pseudomonas aeruginosa in the sputum <5 years later. Conclusion: The refractory phenotype with persistent mucus plugs was identified in Aspergillus -sensitized refractory asthma with bronchiectasis and ABPA. Mucus plug prevention is warranted. Competing Interests: Supported by the Scientific Assembly of Allergy, Immunology & Inflammation, 10.13039/501100009098Japanese Respiratory Society, 10.13039/100030831Novartis Japan, and the 10.13039/100009619Japan Agency for Medical Research and Development (research grant 24ek0410097 for Allergic Disease and Immunology). Disclosure of potential conflict of interest: K. Asano received lecturer fees from Sanofi, AstraZeneca, and Boehringer Ingelheim outside this work; and received a research grant on Allergic Disease and Immunology from the Japan Agency for Medical Research and Development. K. Fukunaga received lecturer fees from Sanofi, AstraZeneca, GlaxoSmithKline, Kyorin Pharmaceutical, Boehringer Ingelheim, and Novartis Pharma outside this work; and received grants from Boehringer Ingelheim and Chugai Pharmaceutical outside this work. N. Harada received lecturer fees from Sanofi, AstraZeneca, GlaxoSmithKline, Kyorin Pharmaceutical, and Novartis Pharma outside this work; and royalties from Sanofi, AstraZeneca, Daikin Investment, and TOSOH. T. Hirai received lecturer fees from AstraZeneca, Kyorin Pharmaceutical, and Boehringer Ingelheim outside this work. N. Hattori received lecturer fees from Sanofi, AstraZeneca, GlaxoSmithKline, Kyorin Pharmaceutical, Ono Pharmaceutical, MSD, and Pfizer Japan outside this work. T. Kimura received lecture fees from Sanofi, AstraZeneca, GlaxoSmithKline, Eli Lilly Japan, Chugai Phamaceutical, Novartis Pharma, Brsitol Myers Squibb, Meiji Seika Pharma, DAIICHI SANKYO, and MSD outside this work. H. Matsumoto received lecturer fees from Sanofi, AstraZeneca, GlaxoSmithKline, Kyorin Pharmaceutical, and Boehringer Ingelheim; received grants from Kyorin Pharmaceutical, Boehringer Ingelheim, and Teijin Pharma outside this work; and received support from the Japanese Respiratory Society and a research grant from Novartis Japan. O. Matsuno received lecturer fees from Sanofi, AstraZeneca, and GlaxoSmithKline. T. Sakagami received lecturer fees from AstraZeneca, GlaxoSmithKline, Novartis Pharma, and Boehringer Ingelheim outside this work. H. Sugiura received lecturer fees from Sanofi, AstraZeneca, GlaxoSmithKline, Novartis Pharma, and Boehringer Ingelheim outside this work. H. Sunadome reports grants from Philips Japan, ResMed, Fukuda Denshi, and Fukuda Lifetec Keiji outside this work. N. Tanabe received research grants from Daiichi Sankyo and FUJIFILM outside this work. K. Tomii received lecturer fees from Sanofi, AstraZeneca, GlaxoSmithKline, and Novartis Pharma outside this work. A. Yokoyama received lecturer fees from Sanofi, AstraZeneca, GlaxoSmithKline, and Boehringer Ingelheim outside this work. The rest of the authors declare that they have no relevant conflicts of interest. (© 2024 The Author(s).)
Databáze:	MEDLINE
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