Sensitisation to Aspergillus fumigatus is linked to worse outcomes in patients with COPD; however, its prevalence and clinical implications in domestic (residential) settings remains unknown.

Individuals with COPD (n=43) recruited in Singapore had their residences prospectively sampled and assessed by shotgun metagenomic sequencing including indoor air, outdoor air and touch surfaces (a total of 126 specimens). The abundance of environmental A. fumigatus and the occurrence of A. fumigatus (Asp f) allergens in the environment were determined and immunological responses to A. fumigatus allergens determined in association with clinical outcomes including exacerbation frequency. Findings were validated in 12 individuals (31 specimens) with COPD in Vancouver, Canada, a climatically different region.

157 metagenomes from 43 homes were assessed. 11 and nine separate Aspergillus spp. were identified in Singapore and Vancouver, respectively. Despite climatic, temperature and humidity variation, A. fumigatus was detectable in the environment from both locations. The relative abundance of environmental A. fumigatus was significantly associated with exacerbation frequency in both Singapore (r=0.27, p=0.003) and Vancouver (r=0.49, p=0.01) and individuals with higher Asp f 3 sensitisation responses lived in homes with a greater abundance of environmental Asp f 3 allergens (p=0.037). Patients exposed and sensitised to Asp f 3 allergens demonstrated a higher rate of COPD exacerbations at 1-year follow-up (p=0.021).

Environmental A. fumigatus exposure in the home environment including air and surfaces with resulting sensitisation carries pathogenic potential in individuals with COPD. Targeting domestic A. fumigatus abundance may reduce COPD exacerbations.

对烟曲霉敏感与 COPD 患者预后较差有关;然而，其在家庭（住宅）环境中的患病率和临床意义仍然未知。

在新加坡招募的 COPD 患者 （n=43） 对他们的住所进行了前瞻性采样，并通过鸟枪法宏基因组测序进行评估，包括室内空气、室外空气和触摸表面（共 126 个标本）。确定了环境中烟曲霉的丰度和环境中烟曲霉 （Asp f） 过敏原的发生，并确定了对烟曲霉过敏原的免疫反应与临床结果（包括恶化频率）相关。在气候不同的地区加拿大温哥华的 12 名 COPD 患者 （31 个标本） 中验证了研究结果。

评估了来自 43 个家庭的 157 个宏基因组。在新加坡和温哥华分别发现了 11 个和 9 个独立的曲霉属。尽管气候、温度和湿度变化，但从两个位置都可以在环境中检测到烟曲霉。在新加坡 （r=0.27， p=0.003） 和温哥华 （r=0.49， p=0.01） 中，环境烟曲霉的相对丰度与恶化频率显著相关，并且 Asp f 3 敏化反应较高的个体生活在环境 Asp f 3 过敏原丰度较高的家中 （p=0.037）。暴露于和对 Asp f 3 过敏原敏感的患者在 1 年随访中表现出更高的 COPD 恶化率 （p=0.021）。

环境 烟曲霉暴露于家庭环境（包括空气和表面）中，导致致敏作用，对 COPD 患者具有潜在的致病性。针对国内的烟曲霉丰度可能会减少 COPD 恶化。