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Review
. 2023 Aug;51(4):813-829.
doi: 10.1007/s15010-022-01960-2. Epub 2023 Jan 20.

The clinical spectrum of aspergillosis in chronic obstructive pulmonary disease

Akaninyene Otu  1 , Chris Kosmidis  2 , Alexander G Mathioudakis  3   4 , Chibuike Ibe  5 , David W Denning  6
Affiliations
Review

The clinical spectrum of aspergillosis in chronic obstructive pulmonary disease

Akaninyene Otu et al. Infection. 2023 Aug.

Abstract

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. In this review, we present the clinical spectrum and pathogenesis of syndromes caused by Aspergillus in COPD namely invasive aspergillosis (IA), community-acquired Aspergillus pneumonia, chronic pulmonary Aspergillosis and Aspergillus sensitisation. Some of these entities are clearly linked to COPD, while others may coexist, but are less clearly liked directly to COPD. We discuss current uncertainties as these pertain to IA in COPD cohorts and explore areas for future research in this field.

Keywords: Aspergillosis; Bronchiectasis; Chronic pulmonary disease.

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Conflict of interest statement

Denning and family hold Founder shares in F2G Ltd, a University of Manchester spin-out antifungal discovery company. He acts, or has recently acted, as a consultant to Pulmatrix, Pulmocide, Zambon, iCo Therapeutics, Mayne Pharma, Biosergen, Bright Angel Therapeutics, Cipla and Metis. He sits on the DSMB for a SARS CoV2 vaccine trial. In the last three years, he has been paid for talks on behalf of Dynamiker, Hikma, Gilead, Merck, Mylan and Pfizer. The other co-authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Clinical presentations of aspergillosis and associated airway obstruction
Fig. 2
Fig. 2
The various entities associated with Aspergillus pulmonary disease
Fig. 3
Fig. 3
CT thorax of a female patient with asthma and significant COPD. A right upper lobe mass was found consistent with acute pneumonia. Evolution over the next few weeks and further imaging demonstrated the interval development of a fungal ball with an area of consolidation. This was consistent with a primary community-acquired Aspergillus pneumonia and the secondary development of chronic cavitary pulmonary aspergillosis with a fungal ball
Fig. 4
Fig. 4
A chest radiograph and CT scan of a patient with COPD showing contraction of the right upper lobe with several large cavities and pleural thickening visible. No fungal balls are seen within the cavities. The left upper lobe is almost completely replaced by emphysematous bullae
Fig. 5
Fig. 5
Chest X-ray of an ex-smoker (30 pack-years) patient with COPD and emphysema who developed increasing frequency of respiratory infections. Imaging shows upper lobe fibrosis with traction bronchiectasis and a positive Aspergillus IgG antibody test. A large cavity is visible occupying the whole left upper lobe
Fig. 6
Fig. 6
CT thorax of a long term smoker with COPD presenting with increasing shortness of breath for 20 years. CT scan shows multiple nodules on the left side, two of which had cavitated, in association with a raised Aspergillus IgG titre, all in keeping with chronic cavitary pulmonary aspergillosis
See this image and copyright information in PMC

References

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