Bronchiectasis and Aspergillus: a complex relationship single centre analysis

Bronchiectasis is a chronic respiratory disease resulting in permanent and irreversible structural airway damage that predispose to infections. Aspergillus possesses diverse immunopathological capabilities and may promote a range of pathologies. How such clinical states influence “endophenotypes” in bronchiectasis is therefore of importance. In order to investigate that complex relationship, we performed an analysis in our study centre (IRCCS Policlinico San Matteo Respiratory Unit) involving 120 patients affected by non-CF bronchiectasis. Among them we have detected 25 isolations of Aspergillus spp. (2 on sputum and the remnant on bronchoalveolar lavage): 15 A.fumigatus, 4 A.terreus, 7 A.niger. 19 out 25 patients were yet categorised as frequent exacerbator. Mean BSI and FACED score were respectively 2.28 and 1.3. Antifungal treatment was started in 15 cases after multidisciplinary discussion with infectious disease physicians; 2 patients were treated with systemic corticosteroid for ABPA diagnosis. Most frequent symptoms were cough, sputum production, haemoptysis and dyspnea. Almost all patients continued to have frequent exacerbation episodes despite treatment, thus their phenotype did not vary significantly. Our analysis points out the possible impact of Aspergillus in bronchietasic patients’ phenotype. Furthermore, it has been recently demonstrated that microbial interactions in conjunction with host immunity may have important clinical roles in bronchiectasis. Aspergillus infection complicates the clinical course and exacerbations in bronchiectasis and therefore dedicated research to better understand the Aspergillus-host interaction in the bronchiectasis airway should now be better investigated.