Chronic pulmonary aspergillosis in France: prevalence, associated chronic pulmonary diseases and prognosis in a 10-year retrospective study of the French nationwide administrative hospital database

<b>Background:</b> Chronic pulmonary aspergillosis (CPA) is an emergent disease occurring in immunocompetent patients with common chronic pulmonary diseases (CPD). Its prevalence is linked to tuberculosis (TB) epidemiology in endemic countries. Epidemiologic and prognostic data are lacking in low TB incidence countries such as those in Western Europe. <b>Objectives:</b> To describe the epidemiological and prognostic data of CPA patients (pts) hospitalized in France between 2008 and 2017. <b>Results:</b> Annual CPA prevalence increased from 1,960 in 2008 to 2,931 cases in 2017. Mean age was 59 years. Males were predominant (61%). Annual mortality remained stable at around 20% of hospitalized CPA cases. Hemoptysis and thoracic surgery concerned approximately 10% of pts. Malnutrition and chronic obstructive pulmonary disease (COPD) were respectively observed for 5 years in 50 and 46% of the 2,931 CPA pts hospitalized in 2017. Emphysema, lung cancer, lung fibrosis, and pulmonary sarcoidosis were observed in 21, 10, 8 and 3% of pts respectively, and TB and other non-TB lung diseases in 4 and 5% of pts respectively. Among the 2,605 CPA pts hospitalized in 2012, the cumulative five-year hemoptysis, thoracic surgery, relapse, and mortality rates were 15, 10, 27 and 41% respectively. <b>Conclusions:</b> We report the largest retrospective nationwide cohort of patients hospitalized for CPA. In France, CPA is more commonly associated with COPD, emphysema, lung cancer or fibrosis than with TB. The alarming CPA morbidity and mortality rates observed should justify specific screening for CPA in some CPDs.