الفهرس | Only 14 pages are availabe for public view |
Abstract Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation. Asthma results from interaction of many genetic and environmental factors which influence on the tone or reactivity of the airways. The World Health Organization recently stated approximately 300 million people have asthma. Moreover if remain uncontrolled, it leads to poor quality of life and increased economic threat to the family and the society It is thought that up to 10% of people with asthma have poorly controlled disease with major life impact despite guideline-based combination high-dose inhaled corticosteroid/long-acting bronchodilator therapy, i.e. severe asthma. One-third to one-half of these severe asthmatics has atopic sensitization to filamentous fungi, most prominently to Aspergillus fumigatus. Allergic bronchopulmonary aspergillosis (ABPA) occurs almost exclusively in people with asthma. It results from atopic sensitization to hypha antigens of filamentous fungi (A. fumigatus in 90% of cases), which provokes a florid innate and adaptive immuneinflammatory. The aim of this study was to evaluate the role of Aspergillus fumigatus infection in patients with uncontrolled asthma. The present study was conducted on 80 patients known to be uncontrolled bronchial asthma according GINA guidelines (GINA2014); they were selected from El- Mahalla Chest Hospital from September 2014 to December 2015.They were 27 males and 53 females, their ages ranged from 23 years to 52 years ( 36.763±7.889). All subjects were subjected to the following: 1. Medical history taking. 2. Physical examination (general and local examination). 3- Radiographic study: a) Plain chest X ray (posterior-anterior and lateral view). b) High resolution computed tomography (HRCT) of the chest. 4- Laboratory investigation: a) Serum total IgE levels. b) Complete blood count (Eosinophilic count). c) Specific IgE for Aspergillus fumigatus. 5- Sputum examination of Aspergillus fumigatus. 6- Pulmonary function tests (before and after bronchodilator). The results of the present study showed that, the prevalence of ABPA was 15% in patients with uncontrolled asthma; higher prevalence of ABPA might be due to improved diagnostic methods and awareness that have led to recent reports of higher prevalence of ABPA. In our study we found that elevated level of specific antibodies to Aspergillus fumigatus is considered the hallmark of ABPA. In the present study, we founfound that 12 patients (15%) of patients had central bronchiectasis on HRCT which is usually the most common finding in ABPA with asthma. In our study, there were significant inverse correlations between FEV1% on one side and serum total IgE, peripheral blood eosinophilia, HRCT, sputum culture for A. fumigatus and A. fumigatus specific IgE test. In our study there were significant positive correlations between A. fumigatus specific IgE test and duration of asthma. In our study there were significant positive correlations between serum total IgE and peripheral blood eosinophilia. |