Fungal-Driven Airways Dis-Immunity From Asthma to Allergic Bronchopulmonary Aspergillosis: Dissecting Similarities and Differences. An EAACI Task Force Report.

Abstract

Severe asthma and allergic bronchopulmonary aspergillosis (ABPA) do not rarely coexist and share several similarities in terms of pathobiological background, together with overlapping clinical manifestations, misleading the correct diagnosis. Within that scenario, severe asthma with fungal sensitization (SAFS) further complicates the correct pheno-endotyping, which still needs to be recognized in the light of the greater burden and higher risk of irreversible damage related to ABPA and SAFS when compared to asthma alone. The identification of pathobiological drivers underlying different conditions remains challenging; in fact, available biomarkers, although accurate when related to each specific condition, do not always fully support a clear-cut differential diagnosis. The opportunity for innovative targeted treatments, although needing further evidence, should further stimulate a precise endo-phenotyping of severe asthma patients presenting some hallmarks of fungal-related dis-immunity to provide them the best standard of care for preventing disease evolution and achieving complete remission. This review provides a comparative outline of the recent advances in terms of pathophysiology, clinical manifestations, biomarkers, and management of asthma and ABPA, including a focus on SAFS, with the aim of updating the practical approach to those conditions and supporting their correct recognition.