Characteristics of Severe Asthma With Fungal Sensitization in Korea

Purpose: Severe asthma with fungal sensitization (SAFS) is associated with life-threatening exacerbation and severe airflow limitation. We aimed to investigate the prevalence of fungal sensitization in asthma and clinical characteristics of SAFS. Methods: This study analyzed data from the Cohort for Reality and Evolution of Adult Asthma in Korea and the Korean Severe Asthma Registry cohorts. Study subjects were classified based on fungal sensitization and asthma severity. Clinical characteristics of patients with severe asthma were compared according to fungal sensitization status. Results: The rate of skin test positivity to fungi was 14.1% and 7.1% in severe asthma (n = 270) and non-severe asthma (n = 2,605). Patients with SAFS were diagnosed with asthma earlier than those with severe asthma without fungal sensitization (SANFS) (P = 0.019), and had a lower body mass index compared to the SANFS group (P = 0.044). Factional exhaled nitric oxide levels and sputum eosinophilia/neutrophilia showed significant differences between the SAFS and SANFS groups (all P < 0.05). Patients with SAFS were more frequently treated with biologics (36.8% vs. 24.6%, P = 0.116) than those with SANFS. Multivariate analysis revealed that early diagnosed asthma was significantly associated with SAFS. Conclusions: The prevalence of fungal sensitization in severe asthma is approximately twice as high as in non-severe asthma. Early diagnosed asthma may be a risk factor for SAFS, and patients with SAFS face a greater burden of additional treatment compared to those with SANFS. SAFS has a distinct airway inflammation profile that differentiates it from SANFS.