The global impact of Aspergillus infection on COPD
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(2020) 20:241
RESEARCH ARTICLE
Open Access
The global impact of Aspergillus infection on COPD Emily E. Hammond1†, Charles S. McDonald1†, Jørgen Vestbo2,3 and David W. Denning2,4*
Abstract Background: Advanced chronic obstructive pulmonary disease (COPD) often leads to hospitalisation and invasive aspergillosis (IA) is a serious complication. Aspergillus sensitisation may worsen symptoms in COPD. Methods: We identified published papers between January 2000 and May 2019 with > 50 subjects and GOLD criteria for grade II, III or IV (FEV1/FVC < 70% and FEV1 < 80%) using standardised criteria in multiple countries, to reestimate the prevalence of COPD. Hospitalised COPD patients develop IA in 1.3–3.9%, based on positive cultures of Aspergillus spp. and radiological findings. Given limited data on per-patient annual hospitalisation rates, we assumed a conservative 10.5% estimate. Annual IA mortality in COPD was estimated using the literature rates of 43–72%. A separate literature search assessed the impact of Aspergillus sensitisation on severity of COPD (by FEV1). Results: We re-estimated the global prevalence of COPD GOLD stages II-IV at 552,300,599 people (7.39% of the population) with 339,206,893 (8.58%) in Asia, 85,278,783 (8.52%) in the Americas, 64,298,051 (5.37%) in Africa, 59,484,329 (7.77%) in Europe and 4,032,543 (10.86%) in Oceania. An estimated 57,991,563 (10.5%) people with COPD are admitted to hospital annually and of these 753,073 (1.3%) – 2,272,322 (3.9%) develop IA and 540,451–977,082 deaths are predicted annually. Aspergillus sensitisation prevalence in COPD was 13.6% (7.0–18.3%) and not related to lower predicted FEV1% (P > 0.05). Conclusions: The prevalence of COPD is much higher than previously estimated. Overall COPD mortality may be higher than estimated and IA probably contributes to many deaths. Improved rapid diagnosis of IA using culture and non-culture based techniques is required in COPD hospital admissions to reduce mortality. Keywords: Fungal infection, Aspergillus, Emphysema, Survival, Incidence
Background Chronic obstructive pulmonary disease (COPD) is the most prevalent non-communicable disease of the lungs. It is both preventable and treatable but usually progressive and irreversible [1] with the majority of deaths from COPD occurring in less-developed countries [2]. An * Correspondence: [email protected] † Emily E. Hammond and Charles S. McDonald are Joint first authors. 2 Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Science Centre, Manchester, UK 4 National Aspergillosis Centre, Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK Full list of author information is available at the end of the article
ageing population has led to a relative increase in the burden of COPD morbidity and mortality across the world over recent years which has focused the spotlight on COPD as a significa
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