Diagnostic criteria for invasive pulmonary aspergillosis in chronic obstructive pulmonary disease patients

作者：David W. Denning, Thomas Richard Rogers, Takahiro Takazono, Xin Su, Katrien Lagrou, Philip Lewis White, Darius Armstrong James, Mona Bafadhel, Jose Barbaran Lopez, Pierre A. Bulpa, Sanjay Haresh Chotirmall, Sara Gago, Jesús Guinea Ortega, David M G Halpin, MeiLan K Han, John Robert Hurst, Sébastien Imbert, Wim Janssens, Chris Kosmidis, Alexander G. Mathioudakis, Animesh Ray, Nicolás Roche, Y Sun, Pei Yee Tiew, Claus Franz Vogelmeier, Tom M. A. Wilkinson, Jørgen Vestbo · 发表于：American Journal of Respiratory and Critical Care Medicine · 年份：2026 · DOI：10.1093/ajrccm/aamag310 · 被引用次数：3 · 研究领域：Antifungal resistance and susceptibility、Chronic Obstructive Pulmonary Disease (COPD) Research、Fungal Infections and Studies

Over 400 million people have chronic obstructive pulmonary disease (COPD), with exacerbations representing a major health burden. Although the overall incidence of invasive pulmonary aspergillosis (IPA) in patients with COPD with hospitalised exacerbation is only 1 to 4%, certain factors substantially increase this frequency. Risk factors compromising defences against Aspergillus spp in COPD patients include systemic or high-dose inhaled corticosteroids, comorbidities including bronchiectasis, diabetes, and cardiovascular disease, and prolonged courses of antibiotics. An international group of experts met to develop criteria for diagnosing IPA based on existing literature and consensus in non-ventilated COPD patients. The preliminary diagnostic recommendations were further evaluated by additional experts using the Delphi methodology. A hospitalized exacerbation of COPD with two or more of the above clinical risk factors should prompt 1) a CT scan of the chest, 2) sending a respiratory sample (sputum, induced sputum or bronchoscopy sample) for direct microscopy for fungi, high volume fungal culture and preferably Aspergillus PCR, and if a bronchoscopy sample is obtained then also Aspergillus antigen (galactomannan), 3) a serum sample for galactomannan and Aspergillus IgG. The combination of a high-risk COPD patient, with compatible imaging abnormalities and any two positive tests (two samples or different tests on the same respiratory sample) for Aspergillus is sufficient to e...