Emphysema increases susceptibility to chronic pulmonary aspergillosis

Among patients with Mycobacterium avium complex pulmonary disease (MAC-PD), the risk of chronic pulmonary aspergillosis (CPA) development and mortality is high in the presence of emphysema, according to a study.

Researchers looked at 203 patients (mean age 73 years) with MAC-PD at the Jikei Daisan Hospital in Japan. They analysed the mortality and CPA development rates after MAC-PD diagnosis in patients with vs without emphysema.

Majority of the patients with MAC-PD had bronchiectasis (99.4 percent). None of the patients tested positive for HIV antibody. Those with vs without emphysema were mostly men (88.24 percent vs 12.14 percent; p<0.0001) and had a history of smoking (91.18 percent vs 14.29 percent; p<0.0001). The average Goddard score of patients with emphysema was 5.94.

Multivariate Cox proportional hazards regression analysis revealed several negative prognostic factors in patients with MAC-PD, including emphysema (hazard ratio [HR], 11.46, 95 percent confidence interval [CI], 1.30–100.90; p=0.028), cavities (HR, 3.12, 95 percent CI, 1.22–7.94; p=0.017), and low body mass index (<18.5 kg/m²; HR, 4.62, 95 percent CI, 1.63–13.11; p=0.004).

The incidences of CPA and related mortality were higher in MAC-PD patients with than without emphysema (p<0.0001 for both).

The present data suggest that detecting emphysema may play a role in establishing early diagnosis and treatment of MAC-PD and CPA to improve prognosis.