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. 2014 Dec 5;9(12):e114745.
doi: 10.1371/journal.pone.0114745. eCollection 2014.

Estimation of the burden of chronic and allergic pulmonary aspergillosis in India

Ritesh Agarwal  1 , David W Denning  2 , Arunaloke Chakrabarti  3
Affiliations

Estimation of the burden of chronic and allergic pulmonary aspergillosis in India

Ritesh Agarwal et al. PLoS One. .

Abstract

Background and objectives: It would be of considerable interest to clinicians if the burden of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) in India were known. Herein, we estimate the burden of CPA following pulmonary tuberculosis (PTB), and ABPA (and severe asthma with fungal sensitization [SAFS]) complicating asthma.

Methods: We used the population estimates for India from the 2011 census data. The burden of asthma was estimated using three different methods (Global Initiative against Asthma [GINA] report statement, World Health Survey [WHS] estimates, Indian study on the epidemiology of asthma and chronic bronchitis [INSEARCH]). Global and India-specific figures were used for calculating the prevalence of ABPA and SAFS. The World Health Organization estimates were used for calculating PTB rates while the frequency of CPA was assessed from a previously published scoping review. Sensitivity analysis was performed to determine the burden in various scenarios.

Results: The total Indian population in 2011 was 1.2 billion. The asthma prevalence in adults was estimated at about 27.6 (range, 17-30) million. The burden of ABPA ranged from 0.12-6.09 million with different assumptions (best estimate, 1.38 [range, 0.86-1.52] million). The prevalence of SAFS was approximated at about 0.52-1.21 million (best estimate, 0.96 [range, 0.6-1.06] million). The incident TB cases were about 2.1 million while the annual incidence of CPA varied 27,000-0.17 million cases, with different estimates. If the mortality of CPA is estimated as 15% annually, the 5-year prevalence of CPA was placed at 290,147 cases with 5-year prevalence rate being 24 per 100,000.

Conclusion: There is a significant burden of ABPA, SAFS and CPA in India. Prospective community-based studies are required to accurately determine the prevalence of these disorders.

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Conflict of interest statement

Competing Interests: Dr. Denning holds founder shares in F2G Ltd a University of Manchester spin-out company and has current grant support from the National Institute of Allergy and Infectious Diseases, National Institute of Health Research, the European Union and AstraZeneca. He acts as a consultant to Trinity group, T2 Biosystems, GSK, as well as other companies over the last 5 years including Pfizer, Schering Plough (now Merck), Astellas and Gilead. In the last 3 years, he has been paid for talks on behalf of Astellas, GSK, Gilead and Pfizer. The other authors have no competing interests to report. The competing interests do not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. Factors used for assessing the annual incidence and 5-year period prevalence of chronic pulmonary aspergillosis (CPA) as a sequel to pulmonary tuberculosis.
See this image and copyright information in PMC

References

    1. Hogan C, Denning DW (2011) Allergic bronchopulmonary aspergillosis and related allergic syndromes. Semin Respir Crit Care Med 32:682–692. - PubMed
    1. Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, et al. (2013) Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy 43:850–873. - PubMed
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    1. Smith NL, Denning DW (2011) Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J 37:865–872. - PubMed
    1. Agarwal R, Chakrabarti A (2010) Clinical manifestations and natural history of allergic bronchopulmonary aspergillosis. In: Pasqualotto ACeditor. Aspergillosis: From Diagnosis to Prevention. New York: Springer. pp.707–724.

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