cohort study evaluating the incidence of chronic pulmonary aspergillosis
infections in a suspected high-risk population of danish patients suspected of
pulmonary malignancy from 2016 to 2019. Patient examination process and
diagnosis is audited according to predetermined criteria and up to date
Study aims to assess:
CPA incidence among patients referred for chest-malignancy examination
Characteristics and subtype of identified CPA patients
A diagnostic algorithm to ensure identification of CPA with a high
Chronic pulmonary aspergillosis
(CPA) is a life-threatening and neglected pulmonary fungal infection. It is
estimated that more than 3 million people are suffering of CPA worldwide .
National and international studies on CPA incidence are still relatively scarce
and in a clinical context CPA is by many considered as being a rare condition.
But some of the currently published studies indicate that the incidence may be
relatively high in selected populations . The estimated 5-year mortality
rate of CPA is estimated to be 40-80% depending on comorbidities and CPA
subtype [3, 4]. Tools for early diagnosis and antifungal treatment are
therefore crucial aspects in order to improve the individual patient's long-term
Early diagnosis of CPA is clinically difficult since the symptoms (e.g.
breathlessness, sputum production, hemoptysis, malaise, weight loss, low grade
fever) and imaging (e.g. opacity, cavitation) is very similar to other common
respiratory diseases (e.g. lung cancer, tuberculosis, chronic obstructive
pulmonary disease, emphysema) [1, 2, 5]. Additionally, these conditions are
known risk factors for developing CPA and the patient might therefore suffer
from several severe respiratory diseases simultaneously [1, 4, 5].
In a Danish context, patients with the above-mentioned
symptoms and imaging findings would often be referred for assessment of
possible malignancy in the chest. This patient population could therefore
potentially have a high incidence of CPA with the possibility of early diagnosis
if the optimal diagnostics are chosen. No studies have however previously
assessed the incidence of CPA or the optimal CPA diagnostic approach in such a
1. Denning DW, Cadranel J, Beigelman-Aubry
C, Ader F, Chakrabarti A, Blot S, Ullmann AJ, Dimopoulos G, Lange C, European
Society for Clinical M, Infectious D, European Respiratory S. Chronic pulmonary
aspergillosis: rationale and clinical guidelines for diagnosis and management. The
European respiratory journal : official journal of the European Society for
Clinical Respiratory Physiology 2016: 47(1): 45-68.
2. Page ID, Byanyima R, Hosmane S, Onyachi
N, Opira C, Richardson M, Sawyer R, Sharman A, Denning DW. Chronic pulmonary
aspergillosis commonly complicates treated pulmonary tuberculosis with residual
cavitation. The European respiratory journal : official journal of the
European Society for Clinical Respiratory Physiology 2019: 53(3).
3. The Lancet Respiratory M. Chronic
pulmonary aspergillosis: help is on the way. The Lancet Respiratory medicine
2016: 4(2): 83.
4. Lowes D, Al-Shair K, Newton PJ, Morris
J, Harris C, Rautemaa-Richardson R, Denning DW. Predictors of mortality in
chronic pulmonary aspergillosis. The European respiratory journal : official
journal of the European Society for Clinical Respiratory Physiology 2017:
5. Bongomin F, Harris
C, Hayes G, Kosmidis C, Denning DW. Twelve-month clinical outcomes of 206
patients with chronic pulmonary aspergillosis. PloS one 2018: 13(4):
Description of the cohort
Any patient referred and accepted for
examination according to the Lung Cancer package at the Center of
Thoracic Oncology at the
department of respiratory medicine (J), Odense University Hospital (OUH)
between 2016 to 2019, using intention-to-treat analysis.
The candidate population has been collected by
export of patients with the diagnosis code DZ031B and DZ031BR.
There is some limitation to the chronology of
diagnosis code assignment, but we aim to include 1000 patients from "newest" to
"oldest", meaning patients coded in 2019 first, then 2018 etc.
examination in the lung cancer package
Data and biological material
Baseline characteristics such as
comorbidity, medication, selected exposures and lung-status
Referral information and symptoms
at time of referral
Examination procedures and
results, such as biochemistry, invasive procedures, pathology, microbiology and
Diagnosis and events until