Published ahead of print on September 7, 2006, doi:10.1164/rccm.200603-423OC
© 2006 American Thoracic Society doi: 10.1164/rccm.200603-423OC
Effect of Allergic Bronchopulmonary Aspergillosis on Lung Function in Children with Cystic FibrosisDepartments of Paediatrics and Psychiatry, and Division of Human Genetics, University of Bern, Bern; and Swiss Institute of Allergy and Asthma Research, Davos, Switzerland Correspondence and requests for reprints should be addressed to Richard Kraemer, M.D., Professor and Chairman, Department of Paediatrics, University of Bern, Inselspital, CH-3010 Bern, Switzerland. E-mail: richard.kraemer{at}insel.ch Rationale: The relationship between sensitization to Aspergillus fumigatus and progression of pulmonary function is not yet established in cystic fibrosis (CF). Objectives: We aimed to evaluate onset of A. fumigatus sensitization and development of allergic bronchopulmonary aspergillosis (ABPA), as well as to determine the physiologic factors of lung function influencing these mechanisms in CF. Methods: Serial annual lung function tests performed in 122 children with CF (62 males; 60 females; age: 6–18 yr) provided data pertaining to FRC measured by plethysmography, lung clearance index, volume of trapped gas, effective specific airway resistance, and forced expiratory indices (FEV1, FEF at 50% VC). Specific IgE to recombinant A. fumigatus allergens, rAspf1 and rAspf3, served as marker for sensitization, and to rAspf4 and rAspf6 as indications for a serologic ABPA, were clinically diagnosed (Nelson criteria). By linear mixed-effect model analysis, five patient groups, (1) not sensitized and free from Pseudomonas aeruginosa, (2) intermittently P. aeruginosa colonized, (3) chronically P. aeruginosa infected, (4) sensitized, and (5) with ABPA, were retrospectively evaluated. Measurements and Main Results: A. fumigatus sensitization was best reflected by increased rAspf1+3-specific IgE levels, whereas, in most patients, sensitization was preceded by P. aeruginosa infection. Patients with ABPA demonstrated the most severe progression in all lung function parameters, and FEF at 50% VC, volume of trapped gas, and effective specific airway resistance were the best predictors (p < 0.0001). However, regarding distinction between sensitization to A. fumigatus and development of ABPA in the course of CF, chronic P. aeruginosa infection has to be taken into account. Conclusions: Airway narrowing, gas trapping, and small airway disease are the major targets for functional derangement in ABPA.
Key Words: allergic bronchopulmonary aspergillosis • Aspergillus fumigatus sensitization • cystic fibrosis • lung function • Pseudomonas aeruginosa infection
This article has been cited by other articles:
|
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
