Though its role is established in other pulmonary diseases, Aspergillus remains an underrecognized yet significant contributor to clinical decline in bronchiectasis. It can both initiate and worsen disease through direct infection or immune-mediated mechanisms. Emerging tools such as next-generation sequencing (NGS) have identified distinct fungal endophenotypes—particularly those characterized by Aspergillus fumigatus colonization, heightened Th2 inflammation, and increased exacerbation burden. These fungal-driven subtypes are associated with accelerated lung function decline and more severe symptoms, highlighting the potential value of targeted antifungal or immunomodulatory therapies in selected patients.
A recent study published in the journal CHEST® adds critical insight into the immunologic landscape of bronchiectasis.1 Among patients with noncystic fibrosis bronchiectasis, elevated Aspergillus-specific IgG was independently associated with worse lung function, higher exacerbation rates, and impaired quality of life. These findings reinforce the clinical relevance of Aspergillus serologies as both diagnostic and prognostic biomarkers in this population.
Despite its clinical importance, diagnosis of Aspergillus-related disease in bronchiectasis remains challenging. Conventional sputum cultures have limited sensitivity, serum galactomannan lacks validation in hosts who are immunocompetent, and radiographic findings often mirror baseline bronchiectasis. While molecular diagnostics such as NGS offer promise, they remain largely investigational.
Environmental exposures, regional climate, and host immune status further shape the expression of Aspergillus-related disease. Given these variables, routine screening for allergic bronchopulmonary aspergillosis and increased vigilance for Aspergillus-related disease in at-risk patients are increasingly advocated. The findings by Pollock and colleagues underscore a broader clinical imperative: to integrate Aspergillus serologies into routine bronchiectasis care and to adopt a phenotype-driven, personalized approach to fungal surveillance and treatment.
As our understanding evolves, Aspergillus is not merely a colonizer but a key determinant of outcomes in bronchiectasis—one that warrants greater diagnostic attention and therapeutic nuance.
References
1. Pollock J, Goeminne PC, Aliberti S, et al. Aspergillus serologic findings and clinical outcomes in patients with bronchiectasis: data from the European Bronchiectasis Registry. Chest. 2025;167(4):975-992.
