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


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 to individuals with COPD or bronchiectasis without overlap?

Study Design: Prospective, observational and cross-sectional.

Methods: We prospectively recruited n=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 (rAsp f) allergens and the occurrence of ABPA (ABPA) in relation to clinical outcomes.

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

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

Original languageEnglish
Early online date5 Aug 2021
Publication statusE-pub ahead of print - 5 Aug 2021


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


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