Impact of bronchiectasis severity on clinical outcomes in patients with allergic bronchopulmonary aspergillosis: a retrospective cohort study

Published online March 13, 2025

Allergic bronchopulmonary aspergillosis (ABPA) is a chronic lung condition caused by hypersensitivity to Aspergillus species typically affecting individuals with asthma or cystic fibrosis. While previous research suggests that bronchiectasis (permanent and irreversible airway dilatation) correlates with more severe ABPA, the impact of its extent on clinical outcomes has remained unclear. In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Sehgal et al. aimed to address this gap by assessing whether the number of bronchiectatic segments on chest CT scans could be a marker for disease severity and predict future exacerbations in ABPA.

In a large retrospective cohort of 705 patients with ABPA and bronchiectasis from a tertiary care center in India, patients were categorized by bronchiectasis severity based on CT-defined segmental involvement as mild (1-5 segments), moderate (6-9), and extensive (≥10). Clinical features, spirometry, and immunological markers were compared across groups. A multivariable Poisson regression model, adjusted for age, body mass index (BMI), lung function, and immunological parameters, was used to evaluate predictors of ABPA exacerbations over a median follow-up of more than five years.

The study found that patients with moderate or extensive bronchiectasis had significantly poorer lung function and elevated immunological markers, including serum total IgE and A. fumigatus-IgE and -IgG. Importantly, these patients were 50% more likely to experience ABPA exacerbations than those with mild disease. High-attenuation mucus, previously considered a marker of severity, was only predictive in patients with less extensive disease. Increasing age and higher BMI were independently associated with reduced exacerbation risk. The authors suggest that bronchiectasis severity should be considered a key indicator of disease burden and be incorporated into future management strategies for ABPA.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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