Prevalence of fungal sensitization and its association with clinical parameters of asthma—A longitudinal study in a tertiary care center in Tamil Nadu

Studies have shown that asthmatics with sensitization to fungi have worse outcomes, but published data from tropical countries like India are lacking.

We studied the prevalence of sensitization to clinically relevant fungi in asthmatics and investigated the impact of these fungi on asthma.

This prospective observational study was conducted in a tertiary care hospital in India. The skin prick test was used to check the sensitization status to fungal and non-fungal allergens. The association between fungal sensitization and various asthma outcomes, i.e. lung function, treatment phase, level of control, exacerbations in the previous year, was evaluated.

Out of 720 patients, 472 (65.6%) were sensitized to one or more fungal allergens; Aspergillus fumigatus was the predominant fungus in these patients. Patients with fungal sensitization (FS) had a lower lung function than those with no fungal sensitization (NFS; mean [SD] FEV₁ [% predicted, post-BD] 73.6% [19.6] vs. 83.2% [15.0]; p < 0.001), were more likely to be on step 4 or 5 of Global Initiative for Asthma (GINA) treatment (78.1% vs. 63.7; p < 0.001), and were more likely to be on high-dose inhaled corticosteroids (28.2% of FS patients vs. 18.1% of NFS; p < 0.001). Furthermore, 11% of FS had uncontrolled asthma versus 4% of the NFS patients (p = 0.003). Persistent significant bronchodilator reversibility of FEV₁ was seen in 37.9% of FS patients vs. 13.4% of NFS patients (p < 0.001).

Fungal sensitization was associated with poorer asthma outcomes. In patients with FS, the physician needs to anticipate and sensitize the patient about the risk of a severe course of asthma.