Aspergillus spp. Isolation in people with bronchiectasis: data from EMBARC

Although Aspergillus spp. are increasingly recognized in bronchiectasis patients, their clinical significance remains unclear. A secondary analysis of the EMBARC registry (a prospective observational study enrolling adults with clinically and HRCT-confirmed bronchiectasis) was performed. Patients were categorized into Group A (with a respiratory sample positive for Aspergillus) and Group B (with a respiratory sample negative for Aspergillus). Among 9,891 patients with respiratory samples available at the baseline visit, 403 (4.1%) were Aspergillus-positive. The most common isolated species were A. fumigatus (83.4%), A. niger (12.7%), A. flavus (3.5%), and A. terreus (2.2%). Compared to Group B, Group A patients were younger (64[53-72] vs 66[55-73] years, P<0.001), more often never-smokers (65.3% vs 57.8%, P=0.01), and had higher rates of asthma (36.7% vs 30.5%, P=0.008), osteoporosis (16.6% vs 12.3%, P=0.011), and oncological diseases (13.6% vs 9.9%, P=0.016), while COPD was more prevalent in Group B (18.6% vs 23.4%, P=0.027). Group A exhibited higher BSI (8[5-12] vs 7[4-10], P=0.001), more frequent exacerbators (48.6% vs 41.9%, P=0.007), and increased hospitalization in the previous year (39.7% vs 26.8%, P<0.001) in comparison to Group B. They were also more frequently treated with inhaled corticosteroids (62.8% vs 53.6%, P<0.001), bronchodilators (LABA 67.5% vs 53.5%, P<0.001; LAMA 38.0% vs 28.5%, P<0.001), oral corticosteroids (12.7% vs 4.6%, P<0.001), long-term macrolides (29.8% vs 19.7%, P<0.001), and inhaled antibiotics (21.6% vs 10.1%, P<0.001). Our data suggest that Aspergillus spp. isolation is associated with increased disease severity in bronchiectasis.