Heterogeneity of Aspergillus fumigatus sensitization testing captured by national severe asthma registries in SHARP

Backround: Aspergillus fumigatus sensitization (AFS) is associated with various clinical outcomes in asthma. It remains unclear how AFS is recognized and captured in severe asthma (SA) clinical practice. <bold>Aims:</bold> To assess differences in AFS testing practices among SHARP countries and evaluate clinical profile differences between AFS and non-AFS tested patients. <bold>Methods:</bold> We performed a cross-sectional analysis using data from 3443 patients across 11 countries in SHARP. <bold>Results:</bold> 1954 (57%) were AFS-tested; 441 (23%) were AFS-positive, and 1513 (77%) AFS-negative. Testing was most frequent in southern Europe (82%), with a positivity rate of 17%, followed by western (60%/31%), eastern (41%/7%), and northern Europe (27%/16%). <table-wrap><object-id>erj;66/suppl_69/PA3660/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><caption> Table 1: Clinical characteristics tested vs non-tested </caption><table><colgroup><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td>Characteristic</td><td>Tested</td><td>Non-tested</td><td> p</td></tr><tr><td>Asthma duration, years*</td><td>20.7(16.3)</td><td>19.2(15.5)</td><td> 0.010</td></tr><tr><td>FEV1, %predicted*</td><td>69.9(22.3)</td><td>72.9(22.6)</td><td> 0.002</td></tr><tr><td>Chronic sinusitis with nasal polyps**</td><td>612(31)</td><td>328(22)</td><td><0.001</td></tr><tr><td>Bronchiectasis**</td><td>383(20)</td><td>195(13)</td><td><0.001</td></tr><tr><td>Adrenal insufficiency**</td><td>127(6)</td><td>47(3)</td><td><0.001</td></tr><tr><td>Daily oral corticosteroids (OCS)**</td><td>353(36)</td><td>158(26)</td><td><0.001</td></tr></tbody></table><table-wrap-foot><fn> *mean(SD), **N(%) </fn></table-wrap-foot></table-wrap> <bold>Conclusion:</bold> Aspergillus fumigatus sensitization (AFS) testing and the positive test rate in severe asthma patients varies widely across Europe. AFS testing is more common in those with longer asthma duration, poorer lung function, multiple comorbidities, and higher OCS use. Further research should clarify the clinical relevance of AFS, particularly its impact on biological treatment responses and systematic testing value in severe asthma management.