An international research team led by the University of Technology Nanyang, Singapore (NTU Singapore) found that patients with lung disease often show breast arthritis in the air, and highlighted the particular role of fungi.
Their finding suggests that patients should be examined by doctors for a range of allergies, since allergic treatment is already in place and may prevent them from deteriorating.
Bronchiectasis is a chronic disease where some of the airways are increased, due to irreversible damage to the lungs. Patients find it difficult to cough on phlegm and are more at risk of bacterial, viral or fungal infection. These difficulties can be fatal if left untreated, and the disease itself has no effective cure.
Directed by Assistant Professor Sanjay Haresh Chotirmall from Lee Kong Chian Medical School (LKCMedicine) at NTU, researchers from Tan Tock Seng Hospital, Singapore General Hospital, Changi General Hospital, National University of Singapore, were the Agency for Science, Technology and Research ( A * STAR), National University of Malaysia and University of Dundee in Scotland. Their findings were published in the peer reviewed medical journal American Journal of Respiratory Medicine and Critical Care 1 April 2019.
They assessed fungal infection in over 200 bronchiectasis patients from Singapore, Malaysia and Scotland. While previous bronchiectasis research focused on non-Asian populations, this new study matched patients in Asia (Singapore and Malaysia) with patients in Europe (Scotland) in terms of age, gender and severity of bronchiectasis.
The matching of patients enabled researchers to control the impact of these factors and thus show that the types and causes of allergies associated with bronchiectasis vary across regions.
They found that bronchiectasis patients have high allergy rates on fungi and the common household dust tissue. The study showed that 58 per cent of bronchiectasis patients were sensitive to at least one allergen, compared to a group of patients with allergic rhinitis (also known as grass fever) where 27 per cent were sensitive.
Professor Chotirmall, Chairman of the NTU Molecular Medicine, said, "We often found that bronchiectasis involves allergic reactions to fungi and the domestic dust mite. Existing treatments for these allergies, for example, are commonly used steroids. It is important to find a fungal allergy to improve the quality of life of people with bronchiectasis, as at present there is no licensed treatment. "
While there is no data on the prevalence of bronchiectasis in Singapore, the disease sometimes suffers from chronic obstructive pulmonary disease (COPD).
Published studies elsewhere have shown that bronchiectasis among COPD patients can be between 4 per cent and 69 per cent. According to data from the Singapore Ministry of Health website, COPD ranks 10th among the main causes of death in 2017.
Allergies are different in regions
While allergy in respiratory diseases such as asthma is well studied, the link to bronchiectasis is limited to patients in individual places and in smaller cohort sizes. In addition, while the genetic make-up of bacteria or viruses is well known, few people have looked at the fungus's sequencing of the fungal population in bronchiectasis patients, made by the same group of authors first from Singapore. and published in the. t European Respiratory Journal in July 2018.
The NTU-led study compared over 100 patients from two regions. Bronchiectasis patients in Singapore and Malaysia showed greater sensitivity to the domestic dust mite and to the major allergens of the species Aspergillus fumigatus, while patients from Scotland showed greater sensitivity to the small allergens Aspergillus fumigatus. A major allergen refers to the specific protein of the fungus where allergy has become more common, and the allergy is also caused by a small allergy.
As Professor Chotirmall said, "It is clear that we need to get a better understanding of the local diseases, as the results of our research clearly show that Asian patients with bronchiectasis crust are different from those that are seen in other countries.
Associate Professor John Arputhan Abisheganaden, Head of Division, Respiratory Medicine and Critical Care, Tan Tock Seng Hospital, Singapore, co-author of both studies, said, "These results could change the way we treat patients with In Tan Tock Seng Hospital manages approximately 30 current and new cases each week in our clinics. The high prevalence of allergens will be available to us to target environmental factors and therapeutic interventions in appropriate patients.
An example of intervention, if patients were found to be allergic to the household dust mite, to reduce household dust in their own home, by using measures such as using allergy bed covers, or regular vacuum cleanups.
Assistant Professor Pamela McShane, who focuses on bronchiectasis research at the University of Chicago and is not part of either study, said, "Dr. Chotirmall's research presents a new approach to demonstrating the pathosiology of bronchisasis. The acquisition of the disease by traditionally exposing allergic mechanisms as a pathway through which bronchiectasis patients develop is also traditionally accepted and has the potential to provide a basis for new therapies that may be effective in the management of bronchiectasis. "
The research, which included over 30 months, was funded by the Ministry of Health's National Medical Research Council Transitional Award, which was acquired by Asst Prof Chotirmall in 2016.
The research is part of the Academic Lung Health Respiratory Initiative (TARIPH), a research initiative with LKCMedicine with local and international partners aimed at improving Singaporeans' lung health.
Singapore staff will consider understanding further differences in Singapore patients and the environmental factors that influence bronchiectasis.
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