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Allergic bronchopulmonary aspergillosis complicating COPD is associated with a higher exacerbation rate and a distinct pattern on chest CT scan compared to COPD

Annefleur Maignant, François Mellot, Luc Haudebourg, Helene Neveu, Elisabeth Rivaud, Emilie Catherinot, Camille Bron, Helene Salvator, Alexandre Chabrol, Oana Anitei, Gregoire Trebbia, Jerome Devaquet, Charles Cerf, Louis-Jean Couderc, Colas Tcherakian
European Respiratory Journal 2016 48: PA4195; DOI: 10.1183/13993003.congress-2016.PA4195
Annefleur Maignant
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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François Mellot
2Department of Radiology, Hopital Foch, Suresnes, Hauts de SeineFrance
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Luc Haudebourg
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Helene Neveu
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Elisabeth Rivaud
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Emilie Catherinot
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Camille Bron
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Helene Salvator
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Alexandre Chabrol
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Oana Anitei
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Gregoire Trebbia
3Department of Intensive Care Medicine, Hopital Foch, Suresnes, France
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Jerome Devaquet
3Department of Intensive Care Medicine, Hopital Foch, Suresnes, France
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Charles Cerf
3Department of Intensive Care Medicine, Hopital Foch, Suresnes, France
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Louis-Jean Couderc
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Colas Tcherakian
1Service de Pneumologie, Hopital Foch, Suresnes, Hauts de SeinesFrance
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Abstract

Recent data support that patients with COPD can experienced associated asthma in an overlap syndrome. This raise hypothesis of specific complications in these patients as allergic broncho-pulmonary aspergillosis (ABPA), usually seen in asthma patients, exhibiting potential specific features when associated to COPD. We compiled 16 cases of ABPA (Patterson criteria) diagnosed in COPD patients (GOLD criteria,Tabaco > 10 PY) in a monocentrique retrospective study, then compared to 16 COPD matched patients on age and FEV1, with similar overall follow up (7.8 years). ABPA-COPD group age was 61.1 years, FEV1 was 36% (1127mL), tobacco consumption was 46.6 PY and 8 out of 16 had known asthma in childhood. ABPA diagnosis was done 6 years after COPD diagnosis. All patients were investigated for specific IgE=19,4 kUI/l, IgE=2684 kUI/l, eosinophilia=1271/mm3. 13/16 had positive IgG, 10 had Aspergillus in sputum. Immediate prick test was positive in 6 out of 7 patients. All received inhaled and oral steroids, 13 patients received oral fungicide and 7 omalizumab. When compared to COPD group, ABPA-BPCO group exhibits higher loss of FEV1 (-83,16 vs -31,14mL/year;p= 0.04). A higher hospitalization rate for exacerbation (1.69 vs 0.53/year;p=0,0007). Using Bhalla scoring, chest CT scan exhibits higher severity in bronchiectasis, mucoid impaction extension but not emphysema (p=0,002; p=0,03; p=0,45) as well as overall extent (10,12 vs 6.8;p= 0,003) ABPA-COPD exhibits a specific pattern and must be considered in COPD patients with recurring exacerbations. CT is distinguishing for diagnosis, in association with biological tools.

  • COPD - exacerbations
  • Allergy
  • Bronchiectasis
  • Copyright ©the authors 2016
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Allergic bronchopulmonary aspergillosis complicating COPD is associated with a higher exacerbation rate and a distinct pattern on chest CT scan compared to COPD
Annefleur Maignant, François Mellot, Luc Haudebourg, Helene Neveu, Elisabeth Rivaud, Emilie Catherinot, Camille Bron, Helene Salvator, Alexandre Chabrol, Oana Anitei, Gregoire Trebbia, Jerome Devaquet, Charles Cerf, Louis-Jean Couderc, Colas Tcherakian
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4195; DOI: 10.1183/13993003.congress-2016.PA4195

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Allergic bronchopulmonary aspergillosis complicating COPD is associated with a higher exacerbation rate and a distinct pattern on chest CT scan compared to COPD
Annefleur Maignant, François Mellot, Luc Haudebourg, Helene Neveu, Elisabeth Rivaud, Emilie Catherinot, Camille Bron, Helene Salvator, Alexandre Chabrol, Oana Anitei, Gregoire Trebbia, Jerome Devaquet, Charles Cerf, Louis-Jean Couderc, Colas Tcherakian
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4195; DOI: 10.1183/13993003.congress-2016.PA4195
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