Allergic Bronchopulmonary Aspergillosis Associated Bronchiectasis:clinical Characteristics And Optimization For Its Screening Algorithm

ObjectiveDetermining the aetiology of bronchiectasis is of importance in the evaluation of patients with bronchiectasis.Currently,all national and international bronchiectasis guidelines advocated to actively sought if patients have concomitant with allergic bronchopulmonary aspergillosis at initial assessment,including serum total lgE and aspergillosis specific lgE.ABPA is clinically crucial because bronchiectasis can be prevented if the disorder is diagnosed and treated(such as prescription of corticosteroid and anti-fungi therapy)early.Conversely,delayed diagnosis and treatment will result in irreversible bronchiectasis and impaired quality of life.Although guidelines advocate to screen ABPA in all patients with bronchiectasis,the status of implementation in real-life clinical practice was totally unclear.Meanwhile,this screening strategy is not consistent with precise evaluation and treatment recommended by modern medicine.Therefore,data remain lacking regarding implementation of ABPA screening,clinical characteristics of ABPA in bronchiectasis and the optimization for its screening algorithm based on these clinical data.MethodsWe collected data of consecutive patients with bronchiectasis who have attended to the Department of Respiratory and Critical Care Medicine at the First Affiliated Hospital of Zhengzhou University from January 2016 to April 2021.The rate of patients who have undergone ABPA screening was calculated.Patients were divided into patients with ABPA group and patients without ABPA based on clinical diagnosis.The clinical characteristics and laboratory data between the two groups were compared.All the data collected in this study would be initially included in univariate logistic regression analysis and then in multivariate logistic regression analysis to screen out appropriate variables,establish decision tree and optimize the screening process of ABPA in patients with bronchiectasis.ResultA total of 4907 patients with bronchiectasis were included in this study.Among them,779 patients were screened for ABPA,the ABPA screening rate was 15.9%,and 49 cases were diagnosed as ABPA,with a incidence rate of 6.3%(49/779,6.3%),of which 276 cases were male(35.4%).From 2016 to 2021,the proportion of patients with bronchiectasis receiving ABPA screening was 2.1%,8.7%,13.3%,17.0%,16.8%and 17.2%respectively.Compared with non ABPA bronchiectasis group,the age of symptoms in the ABPA combined group was younger than that in the non ABPA Group[44.0(32.0,55.0)vs 57,0(48.0,66.0),P<0.001].In addition,the ABPA combined group was more likely to be accompanied by short of breath and repeated acute exacerbation of bronchitis,which were(46.9%vs 21.5%,P<0.001),(67.3%vs 37.7%,P<0.001)respectively There was no significant difference in body mass index(BMI)(P>0.05).In terms of laboratory tests,compared with non ABPA bronchiectasis group,the ABPA combined with bronchiectasis group had a higher eosinophil count(EON)and eosinophil percentage,which were[0.75(0.32,1,34)vs.0.12(0.06,0.22),P<0.001]and[13%(5.7%,19.2%)vs.1.8%(0.9%,3.2%),P<0.001]respectively.The difference was statistically significant(P<0.05).The level of s-IgE in ABPA combined bronchiectasis group was higher than that in non ABPA group,[2500(1273,4143)vs 43.3(16.7,117),P<0.001],[8.89(4.84,23.2)vs 0.01(0.00,0.03),P<0.001],and the difference was statistically significant(P<0.05).Between the two groups,the levels of hemagglutinin IgE[3.19(0.63,6.11)vs.0.01(0.00,0.03),P<0.001]and IgE of other molds[5.00(2.16,8.24)vs.0.05(0.03,0.08),P<0.001]in ABPA combined bronchiectasis group were higher than those in non ABPA bronchiectasis group.The sputum culture of Aspergillus fumigatus(20.4%vs.3.7%,P<0.001)and Aspergillus fumigatus(6.12%vs.0.68%,P=0.01)in ABPA combined bronchiectasis group was significantly higher than those in non ABPA bronchiectasis group(P<0.05).There was no significant difference in FEV1%and FVC%between the two groups(P>0.05).In terms of imaging,the incidence of central bronchiectasis and mucus thrombus in ABPA combined bronchiectasis group was higher than that in non ABPA bronchiectasis group(63.3%vs 8.08%,P<0.001)and(55.1%vs 0.95%,P<0.001),respectively.The difference was statistically significant(P<0.05),but there was no significant difference between the two groups in combined with cystic bronchiectasis(P>0.05).The data collected in this study were included in univariate logistic regression analysis,There were 8 variables with,P<0.05 in univariate logistic regression analysis.Eight variables were included in multivariate logistic regression analysis.Finally,TIgE,s-IgE,central bronchiectasis and mucus thrombus were selected as the independent risk factors of ABPA related bronchiectasis.Patients with bronchiectasis were complicated with frequent acute exacerbation of bronchiectasis and EON>0.5 ×109cells/L screening ABPA can be as high as 65.7%;There was no frequent acute exacerbation and EON>0.5×109cells/L screening ABPA was 20.4%.Screening for these specific clinical symptoms was higher than screening for ABPA in patients with bronchiectasis(6.3%)Conclusion1.The clinical symptoms of patients with bronchiectasis combined with ABPA are serious,and patients are prone to short of breath and frequent acute exacerbation of bronchiectasis.2.In recent years,the proportion of patients with bronchiectasis receiving ABPA etiological screening is still not optimistic.3.Screening ABPA for patients with frequent exacerbations of branching and EON>0.5× 109 cells/L can improve the positive rate of screening.