Asthma and Aspergillosis: Which one causes the other?

Document Type : Mini Review


1 Department of Microbiology, College of Medicine, University of Karbala, Karbala, Iraq

2 Deptartment of Microbiology, College of Medicine, University of Karbala, Karbala, Iraq


The respiratory system of the human body is always exposed to a great number of fungal spores. Asexual spores of Aspergillus are the most frequent type of spores that can be found in various environments. The inhalation of these spores can lead to various undesirable effects in the human body. Aspergillosis is a common type of these harmful effects of inhaled spores, while sensitization, which is resulted from a long-term exposure to Aspergillus spores, is a second type. In some cases, sensitization can develop into various types of allergic diseases such as asthma, which may play a role as a predisposing factor for aspergillosis in other cases. In conclusions, Asthma and Aspergillosis have shared responsibility to form each other in a reversible relationship.


1. Denning DW, Pashley C, Hartl D, Wardlaw A, Godet C, Del Giacco S, Delhaes L, Sergejeva S. Fungal allergy in asthma-state of the art and research needs. Clinical and Translational Allergy. 2014, 4:14.
2. Agarwal R, Chakrabarti A. Fungal asthma. Asia Fungal Working Group, ISHAM. 2019.
3. Denning DW, O̓Driscoll BR, Hogaboam CM, Bowyer P, Niven RM. The link between fungi and severe asthma: a summary of the evidence. Eur Respir J. 2006; 27: 615-626. doi:10.1183/09031936.06.00074705
4. Braman SS. The global burden of asthma. Chest J. 2006; 130: 4S-12S. doi:10.1378/chest.130.1_suppl.4S
5. Kwizera R, Musaazi J, Meya DB, Worodria W, Bwanga F, Kajumbula H, Fowler SJ, Kirenga BJ, Gore R, Denning DW. Burden of fungal asthma in Africa: A systematic review and meta-analysis. PLoS ONE. 2019; 14: e0216568. doi:10.1371/journal.pone.0216568.
6. Agarwal R, Gupta D. Severe asthma and fungi: current evidence. Medical Mycology. 2011;49:S150-S157. doi: 10.3109/13693786.2010.504752
7. Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011; 20:156-174. doi: 10.1183/09059180.00001011.
8. ATS Patient information Series. Aspergillosis, fungal disease series # 4. Crit Care Med. 2012; 186:P1-P2.
9. Bazaz R, Denning DW. Aspergillosis: causes, types and treatment. The Pharmaceutical J.2019;303. doi: 10.1211/PJ.2019.20206738.
10. Shah A. Asthma and Aspergillus. The Indian J Chest Diseases & Allied Sciences. 2004; 46:167-170.
11. Knutsen AP, Slavin RG. Allergic bronchopulmonary aspergillosis in asthma and cystic fibrosis. Clinical and Developmental Immunology. 2011. doi:10.1155/2011/843763.
12. Pasqualotto AC. Aspergillosis: From diagnosis to prevention. Springer, New York. 2010. doi:10.1007/978-90-481-2408-4.
13. Latgé J. Aspergillus fumigatus and aspergillosis. Clinical Microbiology Reviews. 1999; 12:310-350.
14. Benatar SR, Keen GA, Naude WD. Aspergillus hypersensitivity in asthmatic in Cape Town. Clinical & Experimental Allergy. 1980; 10:285-291. doi:10.1111/j.1365-2222.1980.tb02109.x
15. Nath A, Khan A, Hashim Z, Patra JK. Prevalence of Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma at a tertiary care center in North India. Lung India. 2017; 34:150-154. doi:10.4103/0970-2113.201300
16. Fairs A, Agbetile J, Hargadon B, Bourne M, Monteiro WR, Brightling CE, et al. IgE sensitization to Aspergillus fumigatus is associated with reduced lung function in asthma. Am J Respir Crit Care Med. 2010; 182: 1362-1368. doi:10.1164/rccm.201001-0087OC.
17. Urquiza-Ramírez CI, Eliosa-Alvarado GA, González-Flores S, de Córdova-Aguirre F, Velasco-Medina AA, Velázquez-Sámano G. Allergic bronchopulmonary aspergillosis in teenager with bronchial asthma. Rev Med Hosp Gen Méx. 2018; 81:134-138. doi:10.1016/j.hgmx.2017.05.001
18. Greenberger PA, Patterson R. Allergic bronchopulmonary aspergillosis and evaluation in the patient with asthma. J Allergy Clin Immunol. 1988;81:646-650.
19. Mims JW. Asthma: definitions and pathophysiology. Int Forum Allergy Rhinol. 2015; 5: S2-S6. doi: 10.1002/alr.21609.
20. Awadh N, Muller N, Park C, Abboud R, FitzGerald J. Airway wall thickness in patients with near fatal asthma and control groups: assessment with high resolution computed tomographic scanning. Thorax. 1998; 53:248-253. doi: 10.1136/thx.53.4.248
21. Laitinen LA, Heino M, Laitinen A, Kava T, Haahtela T. Damage of the airway epithelium and bronchial reactivity in patients with asthma. Am Rev Respir Dis. 1985; 131:599-606. doi:10.1164/arrd.1985.131.4.599
22. Forte GC, Hennemann ML, Dalcin PT. Asthma control, lung function, nutritional status, and health-related quality of life: differences between adult males and females with asthma. J Bras Pneumol. 2018; 44:273-278. doi: 10.1590/S1806-37562017000000216.
23. Baldaçara RP, Silva I. Association between asthma and female sex hormones. Sao Paulo Med J. 2017; 135:4-14. doi: 10.1590/1516-3180.2016.011827016.
24. Janevic MR, Sanders GM. Asthma self-management in women. JCOM. 2015; 22: 313-320.
25. Akinbami LJ, Moorman JE, Bailey C, Zahran HS, King M, Johnson CA, Liu X. Trends in asthma prevalence, health care use, and mortality in the United States, 2001-2010. NCHS Data Brief. 2012; 94:1-8.
26. Black PN, Sharpe S. Dietary fat and asthma: is there a connection. European Respiratory Journal. 1997; 10:6-12. doi:10.1183/09031936.97.10010006
27. Leynaert B, Neukirch C, Kony S, Guénégou A, Bousquet J, Aubier M, Neukirch F. Association between asthma and rhinitis according to atopic sensitization in a population-based study. J Allergy Clin Immunol. 2004; 113: 86-93. doi:10.1016/j.jaci.2003.10.010
28. Beasley R, Crane J, Lai CK, Pearce N. Prevalence and etiology of asthma. J Allergy and Clinical Immunology. 2000; 105:S466-S472.
doi: 10.1016/S0091-6749(00)90044-7
29. Liu AH, Gilsenan AW, Stanford RH, Lincourt W, Ziemiecki R, Ortega H. Status of asthma control in pediatric primary care: results from the pediatric asthma control characteristics and prevalence survey study (ACCESS). J Pediatr. 2010; 157:276-281. doi: 10.1016/j.jpeds.2010.02.017
30. Vollmer WM, Markson LE, O̓Connor E, Sanocki LL, Fitterman L, Berger M, Buist AS. Association of asthma control with health care utilization and quality of life. Am J Respir Crit Care Med. 1999; 160:1647-1652. doi:10.1164/ajrccm.160.5.9902098
31. Clatworthy J, Price D, Ryan D, Haughney J, Horne R. The value of self-report assessment of adherence, rhinitis and smoking in relation to asthma control. Prim Care Respir J. 2009;18: 300-305. doi: 10.4104/pcrj.2009.00037.
32. Baxi SN, Phipatanakul W. The role of allergen exposure and avoidance in asthma. Adolesc Med State Art Rev. 2010; 21: 57-71.
33. Bush RK, Portnoy JM, Saxon A, Terr AI, Wood RA. The medical effects of mold exposure. J Allergy Clin Immunol. 2006; 117: 326-332. doi:10.1016/j.jaci.2005.12.001
34. Quansah R, Jaakkola MS, Hugg TT, Heikkinen SA, Jaakkola JJ. Residential dampness and molds and the risk of developing asthma: A systematic review and meta-analysis. PLoS ONE. 2012;7: e47526. doi:10.1371/journal.pone.0047526.
35. Targonski PV, Persky VW, Ramekrishnan V. Effect of environmental molds on risk of death from asthma during the pollen season. J Allergy Clin Immunol. 1995; 95:955-961. doi: 10.1016/s0091-6749(95)70095-1
36. O̓Driscoll BR, Hopkinson LC, Denning DW. Mold sensitization is common amongst patients with severe asthma requiring multiple hospital admissions. BMC Pulmonary Medicine. 2005; 5:4. doi:10.1186/1471-2466-5-4.
37. O̓Driscoll BR, Powell G, Chew F, Niven RM, Miles JF, Vyas A, Denning DW. Comparison of skin prick tests with specific serum immunoglobulin E in the diagnosis of fungal sensitization in patients with severe asthma. Clinical & Experimental Allergy. 2009;39:1677-1683. doi: 10.1111/j.1365-2222.2009.03339.x.
38. EL-Hefny A, Mohamed HA. Mould sensitivity in asthmatic children and adult in Cairo. J Egyptian Medical Association. 1967; 50:354-359.
39. Moss RB. Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis. Eur Respir J. 2014; 43:1487-1500. doi: 10.1183/09031936.00139513.
40. Gent JF, Ren P, Belanger K, Triche E, Bracken MB, Holford TR, Leaderer BP. Levels of household mold associated with respiratory symptoms in the first year of life in a cohort at risk for asthma. Environ Health Perspect. 2002; 110:A781-A786. doi:10.1289/ehp.021100781
41. Bush RK, Prochnau JJ. Alternaria-induced asthma. J Allergy Clin Immunol. 2004; 113:227-234. doi:10.1016/j.jaci.2003.11.023
42. Barnes PD, Marr KA. Aspergillosis: Spectrum of disease, diagnosis and treatment. Infect Dis Clin N Am. 2006; 20:545-561. doi:10.1016/j.idc.2006.06.001
43. Geiser DM. Sexual structures in Aspergillus: morphology, importance and genomics. Med Mycol. 2009; 47:S21-S26. doi: 10.1080/13693780802139859.
44. Sherif R, Segal BH. Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications. Curr Opin Pulm Med. 2010;16:242-250.
45. Jenks JD, Hoenigl M. Treatment of aspergillosis. J Fungi. 2018;4, 98; doi:10.3390/jof4030098.
46. Hope WW, Walsh TJ, Denning DW. The invasive and saprophytic syndromes due to Aspergillus spp. Med Mycol. 2005; 43:S207-S238. doi:10.1080/13693780400025179
47. Desai SR, Hedayati V, Patel K, Hansell DM. Chronic aspergillosis of the lungs: Unraveling the terminology and radiology. Eur Radiol. 2015; 25:3100-3107. doi: 10.1007/s00330-015-3690-7.
48. Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002; 121:1988-1999. doi:10.1378/chest.121.6.1988
49. Agarwal R. Severe asthma with fungal sensitization. Current Allergy and Asthma Reports. 2011; 11:403-413. doi: 10.1007/s11882-011-0217-4.
50. Oda N, Miyahara N, Senoo S, Itano J, Taniguchi A, Morichika D, et al. Severe asthma concomitant with allergic bronchopulmonary aspergillosis successfully treated with mepolizumab. Allergology International. 2018;67:521-523. doi:10.1016/j.alit.2018.03.004
51. Sarrafzadeh S, Pourpak Z, Mansoori SD, Fattahi F, Moin M. Allergic bronchopulmonary aspergillosis (ABPA) in asthmatic and cystic fibrosis patients. 13th International J Infectious Diseases. 2008; 12: e77. doi:10.1016/j.ijid.2008.05.192.
52. Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis. Int J Tuberc Lung Dis. 2009; 13:936-944.
53. Menzies D, Holmes L, McCumesky G, Prys-Picard C, Niven R. Aspergillus sensitization is associated with airflow limitation and bronchiectasis in severe asthma. Allergy. 2011; 66:679-685. doi: 10.1111/j.1398-9995.2010.02542.x.
54. Agbetile J, Bourne M, Fairs A, Hargadon B, Desai D, Broad C, et al. Effectiveness of voriconazole in the treatment of Aspergillus fumigatus-associated asthma (EVITA3 study). J Allergy Clin Immunol. 2014; 134:33-39. doi: 10.1016/j.jaci.2013.09.050.
55. Bernton HS. Asthma due to a mold-Aspergillus fumigatus. JAMA. 1930; 95:189-191. doi:10.1001/jama.1930.02720030019004
56. Savio J, Ramachandran P, Jairaj V, Devaraj U, D̕Souza G. A cross-sectional study of skin prick test to Aspergillus fumigatus antigen in asthmatic patients seen at a tertiary healthcare center. Indian J Allergy, Asthma & Immunology. 2019; 33:19-24. doi: 10.4103/ijaai.ijaai_31_18
57. Goh KJ, Yii AC, Lapperre TS, Chan AK, Chew FT, Chotirmall SH, et al. Sensitization to Aspergillus species is associated with frequent exacerbations in severe asthma. J Asthma and Allergy. 2017; 10:131-140. doi:10.2147/JAA.S130459.