LIVING WITH UK BURDEN OF FUNGAL ASTHMA GREATLY EXCEEDS PRIOR ESTIMATES NEW STUDY WARNS

Experts at the National Aspergillosis Centre and Manchester Academic Health Science Centre are warning of a significant increase in the number of people in the UK who are living with invasive and serious fungal diseases that affect the lungs, bloodstream and brain and can sometimes lead to death.

While invasive fungal infections were estimated by the Health Protection Agency in 20061 a new report published today* is the first comprehensive attempt to capture how many people in the UK suffer from fungal asthma.

Asthma in adults is common in the UK with over 4 million reported cases, and researchers in Manchester believe as many as 300,000 of them are affected by fungal asthma.

The research from the National Aspergillosis Centre and MAHSC (Manchester Academic Health Sciences Centre), based at The University of Manchester – is published by the British Infection Association.

Fungal asthma is such a big problem because the UK has one of the highest rates of asthma internationally. The range of estimate reflects uncertainty as no community study has ever been done, despite the large number affected. Asthmatics allergic to and exposed to higher amounts of fungi that they breathe in usually have poor asthma control and require steroid boosters. Antifungal therapy benefits these people, and may prevent deaths from asthma, doctors believe.

Invasive aspergillosis is the commonest missed infectious diagnosis in intensive care in the UK. It is always fatal without therapy and affects from 3,288 to 4,257 patients each year, most undiagnosed. Treated invasive aspergillosis has a 30-85 per cent mortality depending on the patient group.

Dr Bradford Winters in 2012 analysed deaths in intensive care, and invasive aspergillosis was the commonest missed infectious diagnosis2.

Pneumocystis pneumonia has been increasing, especially in the non-HIV group, and probably affects over 500 annually. 15-50 per cent of these patients die, even if treated.

Although 1,700 cases of Candida bloodstream infections are reported annually, the actual estimate of tissue invasive cases in hospitalised and critically ill people is 5,124. This carries a ~45% mortality, if diagnosed and treated.

A Health Protection Agency report from 2006 estimated that ~66 per cent of those who die of fungal infection could have been saved with faster recognition and rapid diagnosis.

Experts believe rarer infections and antifungal resistant infections are probably on the increase, including Candida auris and multi-resistant Aspergillus fumigatus derived from the environment.

Professor David Denning Director of the National Aspergillosis Centre at the University Hospital of South Manchester, explained: ‘While the UK is rich in data sources, there is a remarkable poverty of contemporary studies of fungal diseases. An accurate estimate of total burden will ultimately rely on improved diagnostic testing and laboratory reporting.

“This report gets us closer to true burden of fungal diseases in the UK – necessary for improved diagnosis and reducing death. The scale of the ‘fungal asthma’ problem is staggering, and potentially remediable with antifungal therapy, as I know from treating hundreds of affected patients,” he added.

 

For more in formation please contact Susan Osborne, Director of Communications at The Goodwork Organisation on 07836 229208.

Note to Editors

1.http://webarchive.nationalarchives.gov.uk/20140714084352/http://www.hpa.org.uk/webc/hpawebfile/hpaweb_c/1196942156347

2. Winters B, Custer J, Galvagno SM Jr, Colantuoni E, Kapoor SG, Lee H, Goode V,  Robinson K, Nakhasi A, Pronovost P, Newman-Toker D. Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf. 2012 Nov;21(11):894-902. Link http://qualitysafety.bmj.com/content/21/11/894

Fungal asthma is an umbrella term for allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitization (SAFS) and fungal-associated airways disease. Almost all patients are adults, as these condictions are rare in children. Patients sensitized (ie allergic) to fungi have much worse asthma, attend and are admitted to hospital more often, need more corticosteroids and probably are more likely to die of asthma. About 197 million adults have asthma across the world and an estimated 4.8 million have ABPA and over 6.5 million (3%) have SAFS.

Cases of fungal disease compared with other health problems in the UK:

TB – 5,758 cases in 2015

Malaria – 1,400 cases in 2015

New HIV diagnoses - 6,151 in 2014

Meningococcal (meningitis) disease – 805 cases in 2015/16

Multiple sclerosis – 107,000 in 2016

Breast cancer - 53,696 in 2013, with 11,433 deaths

Rheumatoid arthritis 297,600 in 2002