D3.109 - Clinical Characteristics of Asthma Patients with Fungal Sensitization: A Retrospective Cross-Sectional Study

Allergic fungal airway diseases encompass a broad spectrum, ranging from fungal-sensitized asthma (FSA) to allergic bronchopulmonary aspergillosis (ABPA). Fungal sensitization is associated with poor asthma control and increased disease severity and affects up to 30-70% of patients with severe asthma. Severe asthma with fungal sensitization (SAFS) has been defined for patients with severe asthma who do not fulfill ABPA criteria but have IgE-mediated fungal sensitization. This study compares the clinical characteristics of FSA, SAFS, and ABPA.

This retrospective cross-sectional study included adult asthma patients followed at a tertiary care outpatient clinic. Demographic, functional, radiological characteristics, current treatments, fungal and other aeroallergen sensitization profiles were analyzed.

Among the 762 asthma patients screened, 75 patients with fungal sensitization were included in the final analysis (Figure 1).The mean age of 75 patients was 50.4 ± 15 years, and 62.7% (n = 47) were female. The mean age of asthma onset and disease duration were 31.4 ± 15 and 18.66 ± 10.75 years, respectively. The prevalence of aspergillus sensitization was 71.4% (n=25) in FSA, 61.1% (n=11) in SAFS, and 100% (n=22) in ABPA patients (p = 0.007). The prevalence of alternaria sensitization was 68.6% (n=24) in FSA, 66.7% (n=12) in SAFS, and 13.6% (n=3) in ABPA patients (p < 0.001). Non-fungal sensitization was present in 62.7% of the patients and the most common were house dust mite (41.4%) and pollen (40.0%). In ABPA patients, FEV₁ values were significantly lower, while eosinophil counts and total IgE levels were significantly higher. Abnormal lung imaging findings were observed in 90.9% of ABPA, 77.8% of SAFS, and 22.9% of FSA patients (p < 0.001) (Table 1). Oral corticosteroid use was more frequent in SAFS and ABPA compared with FSA (p = 0.01). Omalizumab use was significantly higher in ABPA than in SAFS (95.2% vs 27.8%, p < 0.001). Mepolizumab was used more frequently than benralizumab among SAFS patients (61.1% vs. 11.1%).

Given the prominent radiological findings observed in patients with SAFS, close follow-up is recommended due to the risk of progression to ABPA. These findings support the possibility that SAFS may represent a potential “pre-ABPA” stage.