Fungal Sensitization in Bronchial Asthma: Epidemiological Insights and Clinical Correlates from an Indian Cohort

Abstract

Background: Fungal sensitization is increasingly recognized as an important contributor to poor asthma control and disease severity, particularly in patients with severe asthma. Data from Indian populations remains limited, necessitating region-specific epidemiological and clinical insights.
Objectives: To determine the prevalence of fungal sensitization in patients with bronchial asthma and to evaluate its association with clinical severity, spirometric parameters, and immunological markers.
Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine at a tertiary care center in western India. About 70 diagnosed bronchial asthma patients aged ≥12 years were enrolled. Clinical assessment, spirometry with bronchodilator reversibility testing, skin prick testing for fungal allergens, absolute eosinophil count, and serum IgE levels were performed. Asthma severity scores were correlated with lung function and immunological parameters using appropriate statistical analyses.
Results: Fungal sensitization was identified in 11 patients (15.7%). Aspergillus fumigatus was the most common sensitizing fungus (11.43%), followed by Mucor mucedo (5.71%), while no sensitization was observed to several other fungal species. Spirometric indices showed significant improvement post-bronchodilator, confirming reversible airflow obstruction. Fungal sensitization demonstrated a strong positive correlation with asthma severity and an inverse relationship with lung function parameters, particularly FEV₁/FVC. Absolute eosinophil count and serum IgE levels showed significant positive correlations with both fungal sensitization and asthma severity, highlighting an underlying IgE-mediated inflammatory mechanism.
Conclusion: Fungal sensitization, especially to A. fumigatus, is present in a significant subset of asthma patients and is associated with increased disease severity and impaired lung function. Early identification of fungal sensitization, along with immunological profiling, may aid in better phenotyping and targeted management of bronchial asthma in the Indian setting.