The Effect of Chronic Infection With Aspergillus Fumigatus on Lung Function and Hospitalization in Patients With Cystic Fibrosis

Chest. 2010 Jan;137(1):171-6. doi: 10.1378/chest.09-1103. Epub 2009 Jun 30.

Abstract

Background: The relevance of Aspergillus fumigatus in patients with cystic fibrosis (CF) not affected by allergic bronchopulmonary aspergillosis is unclear. Our aim was to determine the effect of persistent infection with A fumigatus on pulmonary exacerbations and lung function in children with CF.

Methods: This was a retrospective cohort study of patients with CF followed at The Hospital for Sick Children from 1999 to 2006. Persistent A fumigatus infection was defined as the presence of two or more positive sputum or bronchoalveolar cultures for A fumigatus in a given year. The primary outcome measure was the annual number of hospitalizations for pulmonary exacerbations.

Results: Two hundred thirty patients with CF were included in the analysis. The FEV(1) of patients persistently infected with A fumigatus was 3.61% (P< or =.0001) lower during the study period compared with uninfected patients. There was a significant interaction between A fumigatus and Pseudomonas aeruginosa on lung function (P=.0006). Patients not infected with either organism had the highest pulmonary function. Persistent A fumigatus infection (relative risk [RR]=1.94, P=.0002) and CF-related diabetes (RR=1.64, P=.028) were associated with an increased risk of pulmonary exacerbations requiring hospitalization, whereas there was no increased risk of pulmonary exacerbations among patients with allergic bronchopulmonary aspergillosis (RR=1.02, P=.94). When adjusted for baseline pulmonary function, none of these variables were associated with a significantly increased risk of pulmonary exacerbations, with only chronic A fumigatus infection trending toward significance (RR=1.40, P=.065).

Conclusions: Persistent A fumigatus infection is an independent risk factor for hospital admissions in patients with CF.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aspergillosis, Allergic Bronchopulmonary / complications*
  • Aspergillosis, Allergic Bronchopulmonary / microbiology
  • Aspergillosis, Allergic Bronchopulmonary / physiopathology
  • Aspergillus fumigatus / isolation & purification*
  • Bronchoalveolar Lavage Fluid / microbiology
  • Chronic Disease
  • Cystic Fibrosis / physiopathology*
  • Cystic Fibrosis / therapy
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume / physiology*
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Respiratory Function Tests
  • Retrospective Studies
  • Sputum / microbiology
  • Young Adult