A comprehensive global review identified that individuals with pre-existing lung impairment had a 32% mortality rate over five years if they encountered a common fungi infection. Furthermore, the study found that 15% of people with chronic pulmonary aspergillosis (CPA) may pass away within the first year after contracting another lung condition. Professor David Denning from The University of Manchester carried out an international study on CPA, which claims 340,000 lives each year worldwide. The study was published on November 28 in The Lancet Infectious Diseases.
The five-year mortality rate among individuals with tuberculosis (TB) remained high at a rate of 25% whereas it was reduced in those with chronic pulmonary aspergillosis (CPA). While TB patients are often younger, a multivariable study found that past TB was associated with a 24% reduced risk of death than other lung diseases, regardless of controlling for age. However, the reasons behind this divergence remained unknown. In contrast, conditions like interstitial lung disease, being over 60 years old, experiencing cancer, and smoking-related lung diseases were connected to less favorable results.
Dr. Abhinav Sengupta & Dr. Animesh Ray from the All-India Institute of Medical Sciences in Delhi investigated mortality data from 8,778 individuals reported in research spanning all continents except Antarctica. CPA is a severe disorder that causes progressive scarring of the lungs over months or years, resulting in symptoms such as intense exhaustion, weight loss, dyspnea, and coughing up blood.
Airborne spores from the mold Aspergillus are often safe for most people, but they can be dangerous for those who already have lung disease. Professor Denning, a specialist in Infectious Diseases of Global Health at The University of Manchester, emphasized that this multinational study underlines the poor prognosis in individuals with chronic pulmonary aspergillosis (CPA), even when the condition has been identified and treated. He observed that a subset of patients with illness restricted to one lung who had the afflicted lung surgically removed had lower mortality rates.
“Many cases go undiagnosed or are misdiagnosed as tuberculosis, which leads to the absence of proper antifungal treatment,” Denning remarked. “Antifungal medications or surgery can help to manage the symptoms and potentially reduce deaths from this debilitating condition. However, as the study reveals, there is a pressing need for new strategies to reduce mortality rates, particularly in the early stages after diagnosis.”
A comprehensive literature review identified 1,452 citations, of which 72 studies were included for screening, along with an additional 7 references identified from screened papers. The sample sizes from these studies ranged from 10 to 1,705 encompassing a total of 8,778 CPA patients. In 47 of these studies, follow-up data were available for 4,136 patients covering a total of 10,972 patient-years.
The sample sizes of the studies varied from 10 to 1,705 participants encompassing a total of 8,778 patients diagnosed with CPA. Follow-up data were available for 47 studies, accounting for 10,972 patient-years (4,136 patients). In the WHO African and Southeast Asian regions, the reported mean age of patients ranged from 30 to 79.1 years. Younger patients were observed in the African region (30 years in one study) and the Southeast Asian region (mean age of 41.1 years across five studies) compared to older patients in the Western Pacific region (mean age of 64.2 years across 35 studies).
In studies from the Southeast Asian region, 87.5% (IQR 75.0–92.6) of patients had post-tuberculosis lung disease, compared to 21.0% (IQR 18.0–38.0) in European studies. Among the 1,859 patients in the IPD cohort, the largest proportion was from the UK (649 patients, 34.9%), followed by Japan (595 patients, 32.0%), France (192 patients, 10.3%), and four other countries contributing the remaining 500 patients (26.8%). The mean age in this cohort was 61.4 years (SD 14.6), with males comprising 57.1% (1,059 of 1,856 patients with available data).
Based on the overall data including both diagnosed and undiagnosed cases, Professor Denning previously estimated that CPA developed in 1.8 million people annually as of 2024, with approximately 340,000 (18%) deaths attributed to the condition. It is further estimated that CPA directly causes 204,000 deaths annually. Papuga noted that reducing CPA-related mortality increases the number of patients living with this condition. The most recent estimates from Professor Denning suggest a global CPA prevalence exceeding six million cases.
Reference: Sengupta A, Ray A, Upadhyay AD, et al. Mortality in chronic pulmonary aspergillosis: a systematic review and individual patient data meta-analysis. Lancet Infect Dis. 2024:S1473-3099(24)00567-X. doi:10.1016/S1473-3099(24)00567-X
