High Frequency of Allergic Bronchopulmonary Aspergillosis in Bronchiectasis-COPD Overlap

Pei Yee Tiew, Albert Yick Hou Lim, Holly R. Keir, Alison J. Dicker, Micheál Mac Aogáin, Sze Lei Pang, Low Teck Boon, Tidi Maharani Hassan, Mau Ern Poh, Huiying Xu, Thun How Ong, Mariko Siyue Koh, John Arputhan Abisheganaden, Augustine Tee, Fook Tim Chew, James D. Chalmers, Sanjay H. Chotirmall (Lead / Corresponding author)

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
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Background: Allergic bronchopulmonary aspergillosis (ABPA) is associated with frequent exacerbations and poor outcomes in chronic respiratory disease, but remains underdiagnosed. The role of fungal sensitization in bronchiectasis-COPD overlap (BCO) is unknown.

Research Question: What is the occurrence and clinical relevance of Aspergillus sensitization and ABPA in BCO when compared with individuals with COPD or bronchiectasis without overlap?

Study Design: Prospective, observational, cross-sectional study.

Methods: We prospectively recruited 280 patients during periods of clinical stability with bronchiectasis (n = 183), COPD (n = 50), and BCO (n = 47) from six hospitals across three countries (Singapore, Malaysia, and Scotland). We assessed sensitization responses (as specific IgE) to a panel of recombinant Aspergillus fumigatus allergens and the occurrence of ABPA in relationship to clinical outcomes.

Results: Individuals with BCO show an increased frequency and clinical severity of ABPA compared with those with COPD and bronchiectasis without overlap. BCO-associated ABPA is associated with more severe disease, higher exacerbation rates, and lower lung function when compared with ABPA occurring in the absence of overlap. BCO with a severe bronchiectasis severity index (BSI; > 9) is associated significantly with the occurrence of ABPA that is unrelated to underlying COPD severity.

Conclusions: BCO demonstrates a high frequency of ABPA that is associated with a severe BSI (> 9) and poor clinical outcomes. Clinicians should maintain a high index of suspicion for the potential development of ABPA in patients with BCO with high BSI.

Original languageEnglish
Pages (from-to)40-53
Number of pages14
Issue number1
Early online date5 Aug 2021
Publication statusPublished - 1 Jan 2022


  • Bronchiectasis-COPD overlap
  • Aspergillus
  • ABPA
  • sensitization
  • BCO


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