Clinical characteristics of Aspergillus fumigatus sensitised severe asthma patients in severe asthma registry (SHARP)

<bold>Background:</bold> Aspergillus fumigatus sensitisation (AFS) is more common in severe asthma (SA) than in mild asthma. While AFS is linked to poor outcomes in asthma, its clinical relevance within SA remains unclear due to limited large-scale real-world data. <bold>Aims:</bold> To compare clinical, functional, inflammatory, and radiographic characteristics between AFS and non-AFS patients in a large SA cohort. <bold>Methods:</bold> We performed a cross-sectional analysis on data from 1954 SA patients across 11 European countries in SHARP. Data were compared between AFS (skin prick test/specific IgE >0.35 kU/L) and non-AFS patients. <bold>Results:</bold> AFS was found in 441 (22.6%) patients. Clinical characteristics differed between AFS and non-AFS patients (Table 1). There were no differences between groups in number of exacerbations per year (0.72±1.9 vs 0.94±1.9, p=0.55), FEV1 (69.7±21.9% vs 69.9±22.4%, p=0.88) and daily oral corticosteroid (OCS) dose (11.3±9.9 vs 11.1± 9.8 mg, p=0.91). <table-wrap><object-id>erj;66/suppl_69/PA3659/TB1</object-id><object-id>T1</object-id><object-id>TB1</object-id><caption> Table 1 </caption><table><colgroup><col></col><col></col><col></col><col></col></colgroup><tbody><tr><td>Characteristic</td><td>AFS</td><td>Non-AFS</td><td>p</td></tr><tr><td>Age, years</td><td>58.4±13.7*</td><td>55.4±13.8*</td><td><0.0001</td></tr><tr><td>Asthma duration, years</td><td>26.3±18.2*</td><td>19.2±15.4*</td><td><0.0001</td></tr><tr><td>Total IgE, kU/L</td><td>147.0±2.7*</td><td>96.0±3.1*</td><td><0.0001</td></tr><tr><td>Bronchiectasis, %</td><td>30</td><td>16</td><td><0.0001</td></tr><tr><td>Atopic dermatitis, %</td><td>19</td><td>10</td><td><0.0001</td></tr><tr><td>Nasal polyps, %</td><td>26</td><td>33</td><td>0.0035</td></tr><tr><td>Obesity, %</td><td>23</td><td>33</td><td>0.0001</td></tr><tr><td>Osteoporosis, %</td><td>29</td><td>22</td><td>0.0058</td></tr></tbody></table><table-wrap-foot><fn> * Mean±SD </fn></table-wrap-foot></table-wrap> <bold>Conclusion:</bold> Real-world data show that Aspergillus fumigatus sensitisation (AFS) in severe asthma is associated with prolonged asthma duration and suggests increased airway damage (e.g., bronchiectasis). However, AFS does not appear to correlate with higher exacerbation rates and OCS use within severe asthma population. Whether AFS is relevant for biologic treatment response remains to be determined.