S82 Fungal sensitisation in children with severe therapy resistant asthma

Abstract

Introduction: Severe asthma with fungal sensitisation (SAFS) in adults is associated with reduced lung function and increased morbidity [EurRespir J 2006;27:615e26, Am J RespirCare Med 2009; 179:11e18]. We hypothesised that fungal sensitisation in children with severe, therapy-resistant asthma (STRA) is associated with increased symptoms, medication use and airway inflammation, and reduced lung function. Methods: STRA was defined as before [Lancet 2010;376:814e25]. All children had been through a detailed assessment to optimise adherence and other aspects of basic management, as far as possible. We retrospectively evaluated 166 patients (median age at referral 11.7 years [4;17]; 61% males). SAFS (n=76) was defined as specific IgE (spIgE) or skin prick test (SPT) positivity to any of Aspergillus fumigatus, Alternaria alternata or Cladosporium herbarum. Non-sensitised patients (n=90) had negative spIgE and SPT to all fungal allergens tested. Age of onset, atopy, symptoms (asthma control test), medication usage, lung function and airway inflammation were assessed. Results: More boys had SAFS (57/76 (75%) vs 43/90 (48%), p<0.001). Children with SAFS had earlier onset of asthma (median 0.5 years [0;12.5] vs 1.5 [0;12.5], p=0.006), higher total serum IgE (637 IU/ml [12;6737] vs 177 [1;10 881], p=0.002) and higher sum of inhalant allergen SPT and spIgE [Allergy 2007;62:1379;86] (16 mm [0;38] vs 9 mm [0;36], p<0.001, and 78 IU/ml [0;400] vs 19 IU/ml [0;243], p=0.02, respectively). Children with SAFS had a lower FEV1 (1.4 L [0.5;3.8], vs 1.9 [0.7;4.3], p=0.008) and lower FVC (2.3 L [0.6;4] vs 2.6 [0.8;5.5], p=0.045). Bronchodilator reversibility was more frequent in SAFS (n=59/73 (81%) vs 42/81 (52%), p<0.001). Maintenance oral steroids were more frequently prescribed in SAFS (n=18/76(24%) vs 8/88 (9%), p=0.02). Symptoms and airway inflammation (assessed in sputum, bronchoalveolar lavage and endobronchial biopsy) were similar in children with and without fungal sensitisation. Conclusions: Children with STRA and fungal sensitisation had lower lung function, earlier asthma onset, more atopy and more bronchodilator responsiveness. There is a need for a randomised controlled trial of antifungal therapy in paediatric SAFS.