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Background  Recent studies have shown that the microbiome, namely  Aspergillus  species, play a previously unrecognized role in both stable and exacerbated chronic obstructive pulmonary disease (COPD). Galactomannan is a major component of the  Aspergillus  cell wall that has been widely used as a diagnostic marker.    Objectives  To explore whether serum levels of  Aspergillus -galactomannan antigen could be used to evaluate the risk of severe acute exacerbation of COPD (AE-COPD).    Methods  We measured the  Aspergillus -galactomannan antigen levels of 191 patients with stable COPD, and examined its clinical relevance including AE-COPD.    Results  There were 77 (40.3%) patients who were positive for serum  Aspergillus -galactomannan antigen (≥0.5). High  Aspergillus -galactomannan antigen level (≥0.7) was associated with older age and presence of bronchiectasis and cysts on computed tomography images. Compared to patients with low  Aspergillus -galactomannan antigen level (&lt;0.7), patients with high  Aspergillus -galactomannan antigen level had significantly higher incidence of severe AE-COPD ( P  = 0.0039, Gray’s test) and respiratory-related mortality ( P  = 0.0176, log-rank test). Multivariate analysis showed that high  Aspergillus -galactomannan antigen level was independently associated with severe AE-COPD (hazard ratio, 2.162; 95% confidence interval, 1.267−3.692;  P  = 0.005).    Conclusion  Serum  Aspergillus -galactomannan antigen was detected in patients with COPD, and elevated serum  Aspergillus -galactomannan antigen was associated with severe AE-COPD.

Utility of serum Aspergillus-galactomannan antigen to evaluate the risk of severe acute exacerbation in chronic obstructive pulmonary disease