We would like to thank Seghal et al. for their interest in our study and acknowledge their contribution to our understanding of the role of fungal allergy in lung disease.^1,2 They express two concerns. Firstly they question the appropriateness of the term fungal bronchitis and secondly the novelty of the report because they believe it is well-established that anti-fungal therapy is effective in allergic bronchopulmonary aspergillosis (ABPA). Bronchitis is a descriptive term meaning inflammation of the bronchi. This can be qualified by persistence (acute versus chronic), pathology (eosinophilic, neutrophilic) or cause (bacterial, viral, fungal). Symptoms of bronchitis include cough which may be productive of discoloured sputum (often brown or creamy if there is a fungal cause), and impaired lung function. Bronchiectasis is defined structurally as dilated bronchi with the diagnosis made radiologically. Episodes of bronchitis can occur with and without bronchiectasis and bronchiectasis can occur with and without bronchitis. The two are associated, but independent. As our case series described people with a clinical picture of bronchitis caused by fungal infection, the term ‘fungal bronchitis’ appears to us rather apposite. With regards originality we should first say that we question the value of the term ABPA to describe the endotype of airway disease characterised by lung damage due to allergy to airway colonising, thermotolerant, filamentous fungi such as A. fumigatus.³ ABPA, which is defined according to restrictive and relatively arbitrary criteria, excludes the great majority of people with this pattern of disease. We therefore prefer the inclusive term allergic fungal airway disease (AFAD), the criteria for which are IgE sensitisation to A. fumigatus or related fungi and the presence of airway disease.⁴ It is the case that some, though far from all the subjects in our series had AFAD, a point made in the paper. Irrespective of the nomenclature used, notwithstanding the studies quoted by the authors, the benefits of anti-fungal therapy in this condition are uncertain. Blinded, placebo controlled trials have shown either no improvement or modest benefit at best.⁵ Clinical experience suggests that while the majority of patients with AFAD/ABPA/SAFS (Severe asthma with fungal sensitisation.) do not respond to anti-fungal therapy, some do, at least some of the time. The main aim of our paper was to make the point that a positive fungal culture is a biomarker for response to anti-fungal therapy, whether or not fungal allergy is involved. For the record 7 of the 19 subjects in the Aspergillus group and 1 of the 12 in the Candida group met the ISHAM criteria for ABPA.

中文翻译：

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真菌性支气管炎和非过敏性支气管肺曲霉病

我们要感谢 Seghal 等人。感谢他们对我们的研究感兴趣，并感谢他们对我们理解真菌过敏在肺部疾病中的作用的贡献。^1,2他们表达了两个担忧。首先，他们质疑术语真菌性支气管炎的适当性，其次质疑该报告的新颖性，因为他们认为抗真菌治疗对过敏性支气管肺曲霉病 (ABPA) 有效是公认的。支气管炎是一个描述性术语，意思是支气管发炎。这可以通过持续性（急性与慢性）、病理（嗜酸性粒细胞、中性粒细胞）或原因（细菌、病毒、真菌）来限定。支气管炎的症状包括咳嗽，可能会咳出变色的痰（如果是真菌引起的，通常呈棕色或奶油状）和肺功能受损。支气管扩张在结构上被定义为扩张的支气管，并通过放射学进行诊断。支气管炎发作可伴有或不伴有支气管扩张，支气管扩张可伴有或不伴有支气管炎。两者是相关联的，但又是独立的。由于我们的病例系列描述了由真菌感染引起的支气管炎的临床表现，因此术语“真菌性支气管炎”在我们看来相当合适。关于原创性，我们首先应该说我们质疑术语 ABPA 的价值，以描述气道疾病的内型，其特征是由于对气道定植、耐热、丝状真菌等过敏导致的肺损伤烟曲霉。³ ABPA 根据限制性和相对任意的标准定义，排除了绝大多数患有这种疾病的人。因此，我们更喜欢包含性术语过敏性真菌气道疾病 (AFAD)，其标准是 IgE 对烟曲霉或相关真菌的敏感性以及气道疾病的存在。⁴情况是这样的，尽管我们系列中的所有主题远非所有主题都有 AFAD，这是论文中提出的一个观点。无论使用何种命名法，尽管作者引用了这些研究，但在这种情况下抗真菌治疗的益处尚不确定。盲法、安慰剂对照试验显示，要么没有改善，要么充其量只是适度的益处。⁵临床经验表明，虽然大多数 AFAD/ABPA/SAFS（真菌过敏的重度哮喘）患者对抗真菌治疗没有反应，但有些患者至少在某些时候是有反应的。我们论文的主要目的是表明真菌培养阳性是对抗真菌治疗反应的生物标志物，无论是否涉及真菌过敏。根据记录，曲霉菌组19 名受试者中的 7 名和念珠菌组12名受试者中的1名符合 ABPA 的 ISHAM 标准。