Frequency of Aspergillus fumigatus sensitization and its impact on longitudinal asthma control: a 12-week prospective cohort study

The role of fungi as the dominant allergen in asthma pathogenesis has been extensively explored. Most intriguing has been the relationship between asthma and Aspergillus fumigatus, given its ubiquitous presence and tendency to cause a wide spectrum of diseases in humans. Existing literature suggests that Aspergillus sensitization is associated with increased asthma severity, but prospective data comparing treatment outcomes between Aspergillus-sensitized and non-sensitized asthma patients remain limited. This study aimed to (i) determine the prevalence of Aspergillus fumigatus sensitization in an asthma cohort and (ii) prospectively compare longitudinal treatment outcomes, including symptom control, quality of life, and lung function, between sensitized and non-sensitized groups. A total of 124 patients with asthma were recruited. Patients were divided into two groups: Aspergillus-sensitized and non-sensitized, as determined by skin prick tests with Aspergillus fumigatus antigen. A total of 36 patients (29.03%) were found to be sensitive to Aspergillus fumigatus. Aspergillus-sensitized patients were evaluated for allergic bronchopulmonary aspergillosis, and 5 were identified and excluded from the study. The remaining 119 asthma patients, 31 sensitized and 88 non-sensitized, were included in the analysis. Baseline clinical characteristics, spirometry findings, and symptom questionnaire scores (Asthma Control Test and mini Asthma Quality of Life Questionnaire) were obtained. Asthma symptom control was assessed as per the Global Initiative for Asthma guidelines. All patients received standard asthma therapy and were followed up at a three-month interval. At baseline, both groups were similar in clinical characteristics, asthma symptom control, lung function, and symptom questionnaire scores. On follow-up, no differences were found between the two groups in asthma symptom control, symptom questionnaire scores, or exacerbation frequency. Aspergillus fumigatus sensitization was not associated with increased asthma severity or poorer treatment outcomes. Testing for Aspergillus sensitization may be reserved for patients with a poor therapeutic response or a strong clinical suspicion of allergic bronchopulmonary aspergillosis.