Respiratory InfectionsThe Importance of Aspergillus species Infection in Chronic Obstructive Pulmonary Disease ExacerbationsSoler, Néstor MD; Huerta, Arturo MD; Torres, Antoni MDAuthor Information Servei de Pneumologia. Institut Clínic del Tòrax (ICT), Hospital Clínic-IDIBAPS. Universitat de Barcelona, CIBER de Enfermedades Respiratorias (CIBERes), Spain Address correspondence to: Néstor Soler, MD, Servei de Pneumologia, Institut del Tòrax, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Villarroel 170, 08036—Barcelona, Spain. e-mail: firstname.lastname@example.org. Clinical Pulmonary Medicine: July 2011 - Volume 18 - Issue 4 - p 161-168 doi: 10.1097/CPM.0b013e31822182b2 Buy Metrics Abstract Aspergillus fumigatus is the most prevalent airborne fungal pathogen in developed countries, responsible for a broad spectrum of illness, from saprophytic colonization of lower airways to invasive and life-threatening disseminated pulmonary diseases. Patients with severe chronic obstructive pulmonary disease (COPD) who are receiving broad-spectrum antimicrobials and corticosteroids are becoming one of the main risk groups for pulmonary aspergillosis. The significance of positive sputum cultures for A. fumigatus in COPD patients with exacerbation is not clearly established. The possibility of risk of pulmonary aspergillosis should be taken into consideration in COPD patients experiencing severe exacerbations resistant to conventional antibiotic treatment. The recovery of several consecutive positive cultures samples for A. fumigatus in the course of a COPD exacerbation could be suggestive of this etiologic origin. The finding of sequentially positive galactomannan test in serum or bronchoalveolar fluid in a patient with persisting pulmonary infection who carries ≥1 risk factors, is highly indicative for invasive pulmonary disease. However, the measurement of galactomannan test and the detection of Aspergillus DNA by polymerase chain reaction as serologic and molecular markers cannot be recommended for routine use in COPD patients. Although future studies are needed to provide a complete understanding of pathogenic mechanisms of infection and inflammatory profile in COPD exacerbations due to fungal organisms such as Aspergillus, antifungal treatment should be considered in patients with severe COPD chronically colonized by Aspergillus species that present with recurrent exacerbations. The second-generation triazole, voriconazole is the standard of care for this infection. © 2011 Lippincott Williams & Wilkins, Inc.