Clinical significance of fungal sensitization in bronchial asthma: A prospective cross-sectional study at a tertiary care center

INTRODUCTION: The link between fungi and asthma has been extensively investigated. However, the role of fungal allergens as the primary extrinsic factor leading to asthma severity has been incompletely explored. An all-new variant of asthma has been described recently which has been named severe asthma with fungal sensitisation (SAFS). It is characterised by the presence of severe asthma and are sensitized to one or more fungi but have normal or slightly elevated IgE concentration. In this study ALQ test and spirometry was done to assess the severity of asthma. ALQ test is a simple self administered questionnaire, designed to help individuals with breathing problems to determine if they have asthma or for those already diagnosed with asthma if their asthma is under control. METHODS: A prospective observational study was done over a period of 6 months. Name, age, and demographic details collected from all bronchial asthma patients. Using SPT, the sensitization status to fungus was identified in clinically diagnosed bronchial asthma cases and asthma Severity with fungal sensitisation was analysed on the basis of asthma life quality test questionnaire and spirometry. RESULTS: Out of hundred patients studied 60 of the patients were male. Mean duration of asthma was 5years. 40 patients were positive for fungal sensitization by SPT. The most common fungus was Curvularia Lulata followed by aspergillus. 30 patients were positive for aspergillus fungus (ALQ score > 16.5 and mean FEV1 was 28±2) as compared to the 10 patients who were positive for other than aspergillus fungus( ALQ score <16.5 and mean was FEV1 65 ±2 ) severe asthma. Fungal sensitization was found to be significantly associated with uncontrolled asthma. 75% of fungal sensitized patients had uncontrolled asthma as compared to 5% of the non fungal sensitized patients. CONCLUSION: There was high prevalence of sensitization to all fungal allergens. Among all the fungal allergens, aspergillus sensitization is most commonly associated with severe asthma.