PT - JOURNAL ARTICLE 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 TI - Environmental fungal sensitisation associates with poorer clinical outcomes in COPD AID - 10.1183/13993003.00418-2020 DP - 2020 Aug 01 TA - European Respiratory Journal PG - 2000418 VI - 56 IP - 2 4099 - http://erj.ersjournals.com/content/56/2/2000418.short 4100 - http://erj.ersjournals.com/content/56/2/2000418.full SO - Eur Respir J2020 Aug 01; 56 AB - 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 nondiseased 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 assessed outdoor and indoor environmental allergen exposure in COPD. We identified key fungi in outdoor air and developed 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 11 COPD patients and linked to clinical outcome.Results High frequencies of sensitisation to a broad range of allergens occur in COPD. Fungal sensitisation associates with frequent exacerbations, and unsupervised clustering reveals a “highly sensitised fungal predominant” subgroup 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.Fungal sensitisation associates with frequent exacerbations in COPD, and represents a treatable trait. Outdoor and indoor environments represent a key source of fungal allergen exposure, amenable to intervention, in “sensitised” COPD patients. https://bit.ly/2Vw3kHi