Indeterminate role of Aspergillus in CF, Australasian study finds

Cystic fibrosis

By Mardi Chapman

16 Oct 2018

About 18% of young children with cystic fibrosis are returning BAL cultures positive for Aspergillus species although there seems to be no association with FEV1% predicted or with lung function decline into adolescence.

Data from 156 patients in the Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACF BAL) study found Aspergillus at age 5 years was associated with HRCT scores for air trapping but not bronchiectasis.

In contrast, children with positive P. aeruginosa BAL cultures at age 5 years had an increased probability of airway wall thickening and bronchiectasis.

The study authors said the findings might reflect the relatively mild nature of bronchiectasis and the underlying lung disease in this age group.

“Nevertheless, positive Aspergillus BAL cultures at age 5 years were associated with an increased probability of air trapping, which in young children with CF correlates with small airways structural lung disease,” they wrote in Thorax.

And given the increasing incidence of potential pathogens, particularly Aspergillus fumigatus, chest HRCT scans over time were warranted to ascertain any long-term impact of the organism on structural lung injury, they suggested.

The clinical benefit of treating Aspergillus in early life also remains to be established.

“In this study, we noted that 13 children received the antifungal agent, itraconazole, in the first 5 years of life, although no evidence of allergic bronchopulmonary aspergillosis was seen in this cohort.”

“The effects of this treatment cannot be determined in this study as the numbers are small, and therapeutic drug monitoring was not undertaken systematically, which is essential for the drug in this population.”

A study of itraconazole in adults with positive respiratory cultures had failed to show a beneficial effect, the researchers noted.

The study found nutritional status and hospitalisation secondary to pulmonary exacerbations were the major factors adversely affecting lung function in young patients with CF rather than the presence of Aspergillus.

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