Clinical Impact of Fungal Domestic Environmental Exposure on COPD Patients
Condition: COPD; Pulmonary Fungal Diseases; Environmental Exposure
MeSH terms: Mycoses; Lung Diseases, Fungal
Study type: Observational

Summary: 
      Fungal infections could play a role in chronic obstructive pulmonary disease (COPD) patient's
      exacerbations and in lung function impairment. In fact, Aspergillus fumigatus is often
      isolated from respiratory samples, but few data are available about its clinical
      significance. Aspergillus colonization could be associated to a higher risk of invasive
      pulmonary aspergillosis (IPA), which, in COPD patients, is characterized by a 2% incidence
      (probably underestimated) and a high mortality (72 to 95%). Similarly, detection of
      anti-Aspergillus antibodies is quite frequent in COPD patients but its significance and
      usefulness for aspergillosis diagnosis and follow-up have not been assessed. Furthermore,
      several studies suggest a frequent carriage of Pneumocystis jirovecii, reaching 37-55%, with
      a higher frequency in the most severe COPD stages and a possible role of colonisation in the
      occurrence and progression of COPD.

      As these colonization and sensitization phenomena could be related to domestic exposure to
      airborne or, for P. jirovecii, to human reservoirs, the investigators set-up a study in order
      to (i) Evaluate how domestic exposure to mould or to P. jirovecii could impact fungal
      colonization and sensitization frequency in COPD patients, (ii) Study the relationship
      between these fungal colonization/sensitization phenomena and lung function impairment in the
      course of COPD and (iii) Have a better understanding of mould and P. jirovecii circulation in
      the close environment of patients (between airborne, human reservoirs and patients).

      In fine, this study will provide data (i) On fungal contamination levels (species and conidia
      concentration) of COPD patient's homes in a French region, (ii) On the relationship between
      fungal exposure level and colonization/sensitization phenomena, (iii) On the role of fungal
      colonization/sensitization in lung function impairment, (iv) To design diagnostic,
      therapeutic, and preventive options for the management of COPD patients, taking into account
      fungal environmental exposure and colonization/sensitization impact on the evolution of the
      disease.
    

Detailed description: 
      The investigators will focus on both the patient and its domestic environment. More
      precisely, for 80 patients, the investigators will measure mould domestic exposure
      (determination of mould frequency during an environmental investigation at the patient's
      home), search for mould sensitization and colonization (complete bio clinical check-up
      including spirometry, inflammatory and mycological markers at inclusion), and do a clinical
      follow-up of exacerbation's (frequency and severity). At last, clinical and environmental
      mould and P. jirovecii isolates will be characterized at the phenotypic and genotypic level.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Primary care clinic
      
Biospecimen description: 
      Sputum, serum, oropharyngeal washing, Dust catchers