TY - JOUR T1 - Environmental fungal sensitisation associates with poorer clinical outcomes in COPD JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00418-2020 SP - 2000418 AU - Pei Yee Tiew AU - Fanny Wai San Ko AU - Sze Lei Pang AU - Sri Anusha Matta AU - Yang Yie Sio AU - Mau Ern Poh AU - Kenny J.X. Lau AU - Micheál Mac Aogáin AU - Tavleen Kaur Jaggi AU - Fransiskus Xaverius Ivan AU - Nicolas E. Gaultier AU - Akira Uchida AU - Daniela I. Drautz-Moses AU - Huiying Xu AU - Mariko Siyue Koh AU - David Shu Cheong Hui AU - Augustine Tee AU - John Arputhan Abisheganaden AU - Stephan C. Schuster AU - Fook Tim Chew AU - Sanjay H. Chotirmall Y1 - 2020/01/01 UR - http://erj.ersjournals.com/content/early/2020/04/20/13993003.00418-2020.abstract N2 - Introduction Allergic sensitisation to fungi such as Aspergillus are associated to poor clinical outcomes in asthma, bronchiectasis and cystic fibrosis, however, clinical relevance in COPD remains unclear.Methods Patients with stable COPD (n=446) and non-diseased controls (n=51) were prospectively recruited across three countries (Singapore, Malaysia and Hong Kong) and screened against a comprehensive allergen panel including house dust mites, pollens, cockroach and fungi. For the first time, using a metagenomics approach, we assess outdoor and indoor environmental allergen exposure in COPD. We identify key fungi in outdoor air and develop specific-IgE assays against the top culturable fungi, linking sensitisation responses to COPD outcomes. Indoor air and surface allergens were prospectively evaluated by metagenomics in the homes of n=11 COPD patients and linked to clinical outcome.Results High frequencies of sensitisation to a broad range of allergens occurs in COPD. Fungal sensitisation associates with frequent exacerbations, and, unsupervised clustering reveals a “highly sensitised fungal predominant” sub-group demonstrating significant symptomatology, frequent exacerbations and poor lung function. Outdoor and indoor environments serve as important reservoirs of fungal allergen exposure in COPD, and, promote a sensitisation response to outdoor air fungi. Indoor (home) environments with high fungal allergens associate with greater COPD symptoms and poorer lung function illustrating the importance of environmental exposures on clinical outcomes in COPD.Conclusion Fungal sensitisation is prevalent in COPD and associates with frequent exacerbations representing a potential treatable trait. Outdoor and indoor (home) environments represent a key source of fungal allergen exposure, amenable to intervention, in “sensitised” COPD.FootnotesThis manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.Conflict of interest: Dr. Tiew has nothing to disclose.Conflict of interest: Dr. Ko has nothing to disclose.Conflict of interest: Dr. Pang has nothing to disclose.Conflict of interest: Dr. Matta has nothing to disclose.Conflict of interest: Dr. Sio has nothing to disclose.Conflict of interest: Dr. Poh has nothing to disclose.Conflict of interest: Dr. Lau has nothing to disclose.Conflict of interest: Dr. Mac Aogain has nothing to disclose.Conflict of interest: Dr. Jaggi has nothing to disclose.Conflict of interest: Dr. Ivan has nothing to disclose.Conflict of interest: Dr. Gaultier has nothing to disclose.Conflict of interest: Dr. Uchida has nothing to disclose.Conflict of interest: Dr. Drautz-Moses has nothing to disclose.Conflict of interest: Dr. Xu has nothing to disclose.Conflict of interest: Dr. Koh has nothing to disclose.Conflict of interest: Dr. Shu has nothing to disclose.Conflict of interest: Dr. Tee has nothing to disclose.Conflict of interest: Dr. Abisheganaden has nothing to disclose.Conflict of interest: Dr. Schuster has nothing to disclose.Conflict of interest: Dr. Chew has nothing to disclose.Conflict of interest: Dr. H Chotirmall has nothing to disclose. ER -