Prevalence of Aspergillus Sensitization and Allergic Bronchopulmonary Aspergillosis Among Patients with Bronchial Asthma: A Hospital-Based Cross-Sectional Study

Background Aspergillus sensitization (AS) and Allergic Bronchopulmonary Aspergillosis (ABPA) are important complications of bronchial asthma that contribute to poor disease control, recurrent exacerbations, and irreversible airway damage. Despite their clinical significance, both conditions remain underdiagnosed because their manifestations frequently overlap with uncontrolled asthma. Early identification of Aspergillus-associated airway disease may facilitate timely intervention and prevent disease progression. The present study was undertaken to determine the prevalence of Aspergillus sensitization and ABPA among patients with bronchial asthma attending a tertiary care centre and to identify factors associated with fungal sensitization. Methods A hospital-based cross-sectional observational study was conducted in the Department of Pulmonary Medicine, Sree Balaji Medical College and Hospital, Chennai, from January 2025 to June 2026. A total of 250 adult patients with physician-diagnosed bronchial asthma were enrolled using consecutive sampling. Demographic details, clinical history, spirometry, peripheral eosinophil count, total serum IgE estimation, Aspergillus sensitization testing, and high-resolution computed tomography (HRCT) findings were recorded. Patients were evaluated for ABPA using the International Society for Human and Animal Mycology (ISHAM) diagnostic criteria. Data were analysed using IBM SPSS Statistics version 26.0. Logistic regression analysis was performed to identify independent predictors of Aspergillus sensitization. Results Among the 250 patients, Aspergillus sensitization was identified in 46 (18.4%), while 15 (6.0%) fulfilled the diagnostic criteria for ABPA. Aspergillus sensitization was significantly associated with longer asthma duration (OR=2.49, p=0.007), severe asthma (OR=3.18, p=0.001), history of atopy (OR=2.39, p=0.009), peripheral eosinophilia (OR=3.01, p=0.001), elevated total serum IgE (OR=5.21, p<0.001), bronchiectasis (OR=4.85, p<0.001), and recurrent exacerbations (OR=2.99, p=0.001). Multivariable analysis demonstrated that severe asthma (AOR=2.48, p=0.023), peripheral eosinophilia (AOR=2.16, p=0.048), elevated serum IgE (AOR=3.82, p=0.001), and bronchiectasis (AOR=3.14, p=0.012) were independent predictors of Aspergillus sensitization. Patients with ABPA had significantly higher frequencies of severe asthma, eosinophilia, elevated serum IgE, bronchiectasis, recurrent exacerbations, and lower mean FEV₁ than patients without ABPA. Conclusion Approximately one-fifth of patients with bronchial asthma demonstrated Aspergillus sensitization, while one in sixteen had ABPA. Severe asthma, elevated serum IgE, eosinophilia, and bronchiectasis were significant predictors of fungal airway disease. Routine screening of high-risk asthmatic patients may facilitate early diagnosis, optimize management, and reduce irreversible pulmonary complications.