Impact of Aspergillus fumigatus in allergic airway diseases

For decades, fungi have been recognized as associated with asthma and other reactive airway diseases. In contrast to type I-mediated allergies caused by pollen, fungi cause a large number of allergic diseases such as allergic bronchopulmonary mycoses, rhinitis, allergic sinusitis and hypersensitivity pneumonitis. Amongst the fungi, Aspergillus fumigatus is the most prevalent cause of severe pulmonary allergic disease, including allergic bronchopulmonary aspergillosis (ABPA), known to be associated with chronic lung injury and deterioration in pulmonary function in people with chronic asthma and cystic fibrosis (CF). The goal of this review is to discuss new understandings of host-pathogen interactions in the genesis of allergic airway diseases caused by A. fumigatus. Host and pathogen related factors that participate in triggering the inflammatory cycle leading to pulmonary exacerbations in ABPA are discussed

Invasive pulmonary aspergillosis complicating allergic bronchopulmonary aspergillosis

Invasive pulmonary aspergillosis is a frequent complication in immunocompromised patients. The role of the prolonged use of steroids in predisposing to invasive aspergillosis has been recognized, but exceptionally described in asthmatic patients. We report the case of a 59-year-old woman with bronchial asthma treated with steroid therapy for a long time, who developed an invasive pulmonary aspergillosis with an unusual combination of invasive and allergic disease. It seems reasonable to think that allergic disease due to allergic bronchopulmonary aspergillosis (ABPA) preceded the terminal invasive process. Adjunctive therapy with antifungal agents in patients with ABPA is considered, since there is the risk of an invasive pulmonary aspergillosis

Ability of different flow rates of fractional exaled nitric oxide (FeNO) to discriminate between asthmatic and no asthamatic subject

Background: Nitric oxide (NO) is a gaseous molecule produced by certain cell types in an inflammatory response.The Fraction of exhaled NO (FeNO) is an aspecic, non-invasivebiomarker that can be used for asthma diagnosis, follow-up andtherapy; it correlates with bronchial hyperresponsiveness and withsputum eosinophilia [Kaiser et al. 2008, Taylor et al. 2006].To measure FeNO in exhaled air, subjects are asked to inhale NOfree air deeply to total lung capacity through a lter connected to ananalyzer, and to exhale slowly through the lter for 10s.Different expiratory flow rates are ensured by placing expiratoryresistors in the exhalation circuit, which yield expiratory flow rates of 50, 100, 200 and 250 ml/s.FeNO:1. is usually modied by smoking habits and asthma2. is usually higher in atopic subjects3. is flow-dependent (higher at lower flow rates and viceversa)Measurements are normally set up at 50 ml/s, but the flow rate that better discriminates between asthmatic and non asthmatic subjects is still unknown.Aim: To test the power of different flow rates of FeNO to discriminate between asthmatic subjects and controls.Conclusion:FeNO 100: best performance.FeNO 50 and FeNO 100 have a similar validity in identifying subjects with current asthma.FeNO 100 has a statistically significant greater AUR than FeNO200 and than FeNO 250