Diagnostic criteria for invasive pulmonary aspergillosis in COPD patients

Abstract Over 400 million people have chronic obstructive pulmonary disease (COPD), with exacerbations representing a major health burden. Although the overall incidence of invasive pulmonary aspergillosis (IPA) in patients with COPD with hospitalised exacerbation is only 1 to 4%, certain factors substantially increase this frequency. Risk factors compromising defences against Aspergillus spp in COPD patients include systemic or high-dose inhaled corticosteroids, comorbidities including bronchiectasis, diabetes, and cardiovascular disease, and prolonged courses of antibiotics. An international group of experts met to develop criteria for diagnosing IPA based on existing literature and consensus in non-ventilated COPD patients. The preliminary diagnostic recommendations were further evaluated by additional experts using the Delphi methodology. A hospitalized exacerbation of COPD with two or more of the above clinical risk factors should prompt 1) a CT scan of the chest, 2) sending a respiratory sample (sputum, induced sputum or bronchoscopy sample) for direct microscopy for fungi, high volume fungal culture and preferably Aspergillus PCR, and if a bronchoscopy sample is obtained then also Aspergillus antigen (galactomannan), 3) a serum sample for galactomannan and Aspergillus IgG. The combination of a high-risk COPD patient, with compatible imaging abnormalities and any two positive tests (two samples or different tests on the same respiratory sample) for Aspergillus is sufficient to establish the diagnosis of IPA with enough confidence to initiate antifungal therapy and/or enroll the patient in a clinical or epidemiological study of IPA in COPD. Additional studies are required to augment performance data for most assays in COPD and validate the proposed diagnostic criteria.

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Publication Details

Journal
American Journal of Respiratory and Critical Care Medicine
Published
2026-06-30
DOI
https://doi.org/10.1093/ajrccm/aamag310
Primary Topic
Antifungal resistance and susceptibility
Type
article
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article

Diagnostic criteria for invasive pulmonary aspergillosis in COPD patients

Nicolás Roche, Sébastien Imbert, Mona Bafadhel, Takahiro Takazono et al.
American Journal of Respiratory and Critical Care Medicine
Antifungal resistance and susceptibility
article

Diagnostic criteria for invasive pulmonary aspergillosis in COPD patients

Nicolás Roche, Sébastien Imbert, Mona Bafadhel, Takahiro Takazono, Wim Janssens, John Robert Hurst, Animesh Ray, Alexander G. Mathioudakis, P Y Tiew, Tom Wilkinson, Darius Armstrong James, Sara Gago, Katrien Lagrou, Thomas R. Rogers, Chris Kosmidis, Jørgen Vestbo, David W. Denning, Pierre Bulpa, Jesús Guinea Ortega, David M G Halpin, S H Chotirmall, Y Sun, Xin Su, MeiLan K Han, Jose Barbaran Lopez, Claus F Vogelmeier, P Lewis White
article en

Abstract

Abstract Over 400 million people have chronic obstructive pulmonary disease (COPD), with exacerbations representing a major health burden. Although the overall incidence of invasive pulmonary aspergillosis (IPA) in patients with COPD with hospitalised exacerbation is only 1 to 4%, certain factors substantially increase this frequency. Risk factors compromising defences against Aspergillus spp in COPD patients include systemic or high-dose inhaled corticosteroids, comorbidities including bronchiectasis, diabetes, and cardiovascular disease, and prolonged courses of antibiotics. An international group of experts met to develop criteria for diagnosing IPA based on existing literature and consensus in non-ventilated COPD patients. The preliminary diagnostic recommendations were further evaluated by additional experts using the Delphi methodology. A hospitalized exacerbation of COPD with two or more of the above clinical risk factors should prompt 1) a CT scan of the chest, 2) sending a respiratory sample (sputum, induced sputum or bronchoscopy sample) for direct microscopy for fungi, high volume fungal culture and preferably Aspergillus PCR, and if a bronchoscopy sample is obtained then also Aspergillus antigen (galactomannan), 3) a serum sample for galactomannan and Aspergillus IgG. The combination of a high-risk COPD patient, with compatible imaging abnormalities and any two positive tests (two samples or different tests on the same respiratory sample) for Aspergillus is sufficient to establish the diagnosis of IPA with enough confidence to initiate antifungal therapy and/or enroll the patient in a clinical or epidemiological study of IPA in COPD. Additional studies are required to augment performance data for most assays in COPD and validate the proposed diagnostic criteria.

American Journal of Respiratory and Critical Care Medicine
Cardiff and Vale University Health Board (GB), University of Nagasaki (JP), Inserm (FR), Philipps University of Marburg (DE), King's College - North Carolina (US), Nanyang Technological University (SG), King's College London (GB), Peking University (CN), Université Paris Cité (FR), Trinity College Dublin (IE), Singapore General Hospital (SG), University of Exeter (GB), University of Michigan (US), Manchester Academic Health Science Centre (GB), Tan Tock Seng Hospital (SG), Hospital General Universitario Gregorio Marañón (ES), Public Health Wales (GB), Hôpital Cochin (FR), Manchester University NHS Foundation Trust (GB), CHU Dinant Godinne UCL Namur (BE), NIHR Imperial Biomedical Research Centre (GB), Nanjing Drum Tower Hospital (CN), Michigan Medicine (US), HM Hospitales (ES), German Center for Lung Research (DE), Peking University Third Hospital (CN), The London College (GB), Wythenshawe Hospital (GB), Centre de Recherche Cardio-Thoracique de Bordeaux (FR), St. James's Hospital (IE), Pulmonary and Critical Care Associates (US), University of Southampton (GB), Nagasaki University (JP), University College London (GB), Imperial College London (GB), All India Institute of Medical Sciences (IN), Cardiff Metropolitan University (GB), KU Leuven (BE)
Partnerships for the goals
Openalex Percentile: Top 7%
Antifungal resistance and susceptibility
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