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Bronchodilator responsiveness in children with cystic fibrosis and allergic bronchopulmonary aspergillosis

Mordechai Pollak, Michelle Shaw, David Wilson, Hartmut Grasemann, Felix Ratjen
European Respiratory Journal 2020 56: 2000175; DOI: 10.1183/13993003.00175-2020
Mordechai Pollak
1Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
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  • ORCID record for Mordechai Pollak
  • For correspondence: morduchp@gmail.com
Michelle Shaw
2Translational Medicine, Sickkids Research Institute, Toronto, ON, Canada
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David Wilson
1Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
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Hartmut Grasemann
1Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
2Translational Medicine, Sickkids Research Institute, Toronto, ON, Canada
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Felix Ratjen
1Division of Respiratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
2Translational Medicine, Sickkids Research Institute, Toronto, ON, Canada
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Extract

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity lung disease that occurs in approximately 9% of children with cystic fibrosis (CF) [1]. While ABPA is commonly associated with worsening lung function, differentiating ABPA from other causes of pulmonary function decline often poses a clinical challenge. This is reflected by major differences among the various diagnostic criteria for ABPA that have been suggested to date [2–5]. A positive bronchodilator response (BDR) is characteristic for asthma which is a common co-morbidity in CF patients, but whether this is helpful in differentiating ABPA from other causes of deterioration in lung function is currently unclear. A recent observational study of paediatric CF patients found a significant higher BDR in ABPA compared to patients not sensitised to Aspergillus fumigatus [6]; this stands in contrast to the CF Foundation consensus that did not identify airway obstruction reversibility as a characteristic of CF-related ABPA [5]. We therefore aimed to evaluate the clinical utility of BDR for diagnosis of ABPA in CF by comparing rates of positive BDR prior to a diagnosis of ABPA to CF patients experiencing acute lung function deteriorations for other causes.

Abstract

CF patients with a new diagnosis of ABPA had a similar BD response, compared to CF patients with acute lung function deterioration from other causes. BD response testing did not help differentiating ABPA from other causes of lung function deterioration. https://bit.ly/39Oegnh

Footnotes

  • Conflict of interest: M. Pollak has nothing to disclose.

  • Conflict of interest: M. Shaw has nothing to disclose.

  • Conflict of interest: D. Wilson has nothing to disclose.

  • Conflict of interest: H. Grasemann has nothing to disclose.

  • Conflict of interest: F. Ratjen reports grants and personal fees for consultancy from Vertex, personal fees for consultancy from Novartis, Bayer, Roche and Genetech, outside the submitted work.

  • Received January 28, 2020.
  • Accepted March 31, 2020.
  • Copyright ©ERS 2020
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Bronchodilator responsiveness in children with cystic fibrosis and allergic bronchopulmonary aspergillosis
Mordechai Pollak, Michelle Shaw, David Wilson, Hartmut Grasemann, Felix Ratjen
European Respiratory Journal Aug 2020, 56 (2) 2000175; DOI: 10.1183/13993003.00175-2020

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Bronchodilator responsiveness in children with cystic fibrosis and allergic bronchopulmonary aspergillosis
Mordechai Pollak, Michelle Shaw, David Wilson, Hartmut Grasemann, Felix Ratjen
European Respiratory Journal Aug 2020, 56 (2) 2000175; DOI: 10.1183/13993003.00175-2020
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