Around 32% of people who have had prior damage from lung diseases will die after five years if they also get a common fungal infection, a major global review has found.
The review also finds that 15% of people with chronic pulmonary aspergillosis (CPA) die in the first year following other lung diseases.
The international study of CPA – which kills 340,000 people a year around the world – is led by Professor David Denning from The University of Manchester and published today in the leading journal Lancet Infectious Diseases.
Though still high, CPA patients with prior tuberculosis (TB) had a lower overall 5 year mortality of 25%, according to the study.
Though patients with TB tend to be younger, a multivariable analysis showed prior TB was 24% less lethal than other lung conditions, even accounting for age, though the reason for the difference in outcome was not identified.
Being older than 60, having interstitial lung disease, current cancer and smoking-related lung disease carried worse outcomes.
Co-authors Dr Abinhav Sengupta and Dr Animesh Ray from All India Institute of Medical Sciences in Delhi examined the death rates in 8,778 patients described in the literature from all continents except Antarctica.
CPA, in which lungs gradually scar over months and years, is a debilitating condition which causes severe tiredness, weight loss, breathlessness and coughing up blood.
Caused by exposure to airborne spores of the mould Aspergillus, it is harmless to most people, but not to those with lung damage.
A small group of patients with disease in only one lung have it removed surgically have a much lower mortality.
In contrast, very ill patients tend to be treated with the antifungal drug voriconazole and had a significantly higher mortality.
David Denning, Professor of Infectious Diseases in Global Health at The University of Manchester who led the study said: “This truly international collaboration highlights the poor outcome of diagnosed and treated patients with CPA.
“Many are not diagnosed or misdiagnosed as having TB, and then not treated with antifungal agents.
“Treatment with antifungal drugs or surgery improves symptoms and probably reduces deaths from this truly disabling disorder, although as this study shows new strategies to reduce deaths are required, especially straight after diagnosis.”
Earlier in 2024, Professor Denning estimated that CPA developed in 1.8 million people each year, leading to 340,000 deaths (18%), taking into account diagnosed and undiagnosed patients.
Of the deaths, an estimated 204,000 were directly attributable to CPA. This new research takes the CPA mortality down and consequently the number of patients living with CPA up. The last figure (prevalence) was estimated by Denning at over 6 million.
The paper Mortality in chronic pulmonary aspergillosis: a systematic review and individual patient data meta-analysis is available here
