Impact of fungal sensitization on long-term outcomes in a French severe asthma cohort

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Introduction: There is a lack of data on response of Severe Asthma with Fungal Sensitization (SAFS) to standardized care for severe asthma. We aimed to evaluate the effect of fungal sensitization in a severe asthma cohort using the ASSESS (Asthma Severity Scoring System) score and its change over time. Methods: Between 2017 and 2022, adult severe asthma patients evaluated at the Asthma Clinic of Bichat Hospital (Paris, France), were included. In all patients, specific IgE testing for Aspergillus, Botrytis, Alternaria, Penicillium, Cladosporium, Candida was performed. SAFS was defined as the presence of at least 1 specific IgE. Results: Among the 245 patients included, 69 (28.2%) had SAFS. At inclusion, ASSESS was higher in the SAFS group compared to the SAwoFS group (13.7±2.8 vs 12.0±3.0;p<0.01). This increased severity was further evidenced by a lower FEV₁ (66% [48–80] vs 76.5% [61–93];p<0.01), higher daily OCS use (36.2% vs 18.2%;p<0.01), higher hospitalization rate (36.2% vs 19.9%;p<0.05). Biologics were initiated in 54% of SAFS and 56% of SAwoFS. At 12 months, mean ASSESS significantly decreased in both groups (SAFS 12.4±3.4, SAwoFS 10.2±3.6;p<0.01) but remained significantly higher in the SAFS group, due to persistent lower FEV₁ (65% [53–80] vs 80% [64–91];p<0.01), higher exacerbation rate (74.6% vs 55.3%;p<0.05), higher OCS use (30% vs 14.7%;p<0.05). In the subgroup where biologics were introduced, the ASSESS remained significantly higher in the SAFS group (12.8 vs 9.8;p<0.01). Conclusion: In severe asthma patients, those with fungal sensitization represent a particularly severe subgroup, even after the use of biologics. However, SAFS significantly responded to standard care for severe asthma.

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