Impact of Fungal Sensitization on Long-Term Outcomes in Severe Asthma.

Abstract

Fungal sensitization has been associated with some features of severe asthma, but whether severe asthma with fungal sensitization (SAFS) requires specific management remains unclear. The long-term outcomes of SAFS remain poorly studied. To assess the impact of fungal sensitization on disease severity using the Asthma Severity Scoring System (ASSESS) score and its evolution over time in a severe asthma cohort. This retrospective analysis included adult patients with severe asthma evaluated at Bichat Hospital (Paris, France) between 2017 and 2022. All patients underwent specific IgE testing for Aspergillus, Botrytis, Alternaria, Penicillium, Cladosporium, and Candida. SAFS was defined as the presence of at least 1 positive specific IgE result. Among the 245 patients included, 69 (28.2%) had SAFS. At baseline, the ASSESS score was significantly higher in the SAFS group than in the severe asthma without fungal sensitization (SAwoFS) group (13.7 ± 2.8 vs 12.0 ± 3.0; P < .0001). This greater severity was supported by a lower FEV₁ (65.5% vs 76.5% predicted; P = .0007), higher daily oral corticosteroid use (36.2% vs 18.2%; P = .0026), and higher hospitalization rates over the last 6 months (36.2% vs 19.9%; P = .007). At 12 months, the mean ASSESS score significantly decreased in both groups (SAFS: 12.4 ± 3.4; SAwoFS: 10.2 ± 3.6; P = .00015), but remained significantly higher in the SAFS group, driven by persistently lower FEV₁ (65% vs 80% predicted; P = .0006), higher exacerbation rate (74.6% vs 55.3%; P = .008), and higher daily oral corticosteroid use (30% vs 14.7%; P = .009). Biologics were initiated in 51% of patients with SAFS and 56% of patients with SAwoFS. Among patients treated with biologics, ASSESS scores remained significantly higher in the SAFS group (12.8 vs 10.0; P = .0015). Patients with SAFS represent a particularly severe asthma phenotype, even after treatment with biologics. Nonetheless, they show a significant response to standardized care for severe asthma.