BACKGROUND Sensitisation to thermotolerant fungi, including filamentous fungi and Candida albicans, is associated with poor lung function in adults with severe asthma. Data in children are lacking. Environmental exposure to fungi is linked with acute severe asthma attacks but there are few studies reporting the presence of fungi in the airways during asthma attacks. METHODS We investigated the association between fungal sensitisation and/or positive fungal sputum culture and markers of asthma severity in children with chronic and acute asthma. Sensitisation was determined using serum specific IgE and skin prick testing against a panel of five fungi. Fungal culture was focused toward detection of filamentous fungi from sputum samples. RESULTS We obtained sensitisation data and/or sputum from 175 children: 99 with chronic asthma, 39 with acute asthma and 37 controls. 34.1% of children with chronic asthma were sensitised to thermotolerant fungi compared to no children without asthma (p=<0.001). These children had worse pre-bronchodilator lung function compared to asthmatics without sensitisation including a lower FEV1 /FVC ratio (p<0.05). The isolation rate of filamentous fungi from sputum was higher in children with acute compared to chronic asthma. CONCLUSIONS Fungal sensitisation is a feature of children with chronic asthma. Children sensitised to thermotolerant fungi have worse lung function, require more courses of systemic corticosteroids and have greater limitation of activities due to asthma. Asthma attacks in children were associated with the presence of filamentous fungi positive sputum culture. Mechanistic studies are required to establish whether fungi contribute directly to the development of acute asthma.

中文翻译：

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哮喘儿童的真菌致敏和痰真菌培养阳性分别与肺功能下降和哮喘急性发作有关

背景对包括丝状真菌和白色念珠菌在内的耐热真菌的敏感性与患有严重哮喘的成人肺功能差有关。缺乏儿童数据。环境暴露于真菌与急性重症哮喘发作有关，但很少有研究报告哮喘发作期间气道中存在真菌。方法 我们调查了慢性和急性哮喘儿童真菌致敏和/或真菌痰培养阳性与哮喘严重程度标志物之间的关系。使用血清特异性 IgE 和针对一组五种真菌的皮肤点刺测试确定致敏性。真菌培养的重点是从痰液样本中检测丝状真菌。结果 我们获得了 175 名儿童的致敏数据和/或痰液：99 名患有慢性哮喘，39 名急性哮喘患者和 37 名对照者。与没有哮喘的儿童相比，34.1% 的慢性哮喘儿童对耐热真菌敏感（p=<0.001）。与未致敏的哮喘患者相比，这些儿童的支气管扩张剂前肺功能较差，包括较低的 FEV1/FVC 比率 (p<0.05)。急性哮喘患儿痰液中丝状真菌的分离率高于慢性哮喘患儿。结论 真菌致敏是慢性哮喘儿童的一个特征。对耐热真菌敏感的儿童肺功能更差，需要更多疗程的全身性皮质类固醇，并且由于哮喘而活动受限。儿童哮喘发作与痰培养丝状真菌阳性有关。