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For the first time, using a metagenomics approach, we assessed outdoor and indoor environmental allergen exposure in COPD. We identified key fungi in outdoor air and developed specific-IgE assays against the top culturable fungi, linking sensitisation responses to COPD outcomes. Indoor air and surface allergens were prospectively evaluated by metagenomics in the homes of 11 COPD patients and linked to clinical outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>High frequencies of sensitisation to a broad range of allergens occur in COPD. Fungal sensitisation associates with frequent exacerbations, and unsupervised clustering reveals a \u201chighly sensitised fungal predominant\u201d subgroup demonstrating significant symptomatology, frequent exacerbations and poor lung function. Outdoor and indoor environments serve as important reservoirs of fungal allergen exposure in COPD and promote a sensitisation response to outdoor air fungi. Indoor (home) environments with high fungal allergens associate with greater COPD symptoms and poorer lung function, illustrating the importance of environmental exposures on clinical outcomes in COPD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Fungal sensitisation is prevalent in COPD and associates with frequent exacerbations representing a potential treatable trait. Outdoor and indoor (home) environments represent a key source of fungal allergen exposure, amenable to intervention, in \u201csensitised\u201d COPD.<\/jats:p><\/jats:sec>","DOI":"10.1183\/13993003.00418-2020","type":"journal-article","created":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T17:28:25Z","timestamp":1588008505000},"page":"2000418","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":80,"title":["Environmental fungal sensitisation associates with poorer clinical outcomes in COPD"],"prefix":"10.1183","volume":"56","author":[{"given":"Pei Yee","family":"Tiew","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8454-0087","authenticated-orcid":false,"given":"Fanny Wai San","family":"Ko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8877-7532","authenticated-orcid":false,"given":"Sze Lei","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sri Anusha","family":"Matta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang Yie","family":"Sio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mau Ern","family":"Poh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenny J.X.","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miche\u00e1l","family":"Mac Aog\u00e1in","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tavleen Kaur","family":"Jaggi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fransiskus Xaverius","family":"Ivan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6601-0119","authenticated-orcid":false,"given":"Nicolas E.","family":"Gaultier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Uchida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela I.","family":"Drautz-Moses","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiying","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1230-0129","authenticated-orcid":false,"given":"Mariko Siyue","family":"Koh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Shu Cheong","family":"Hui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustine","family":"Tee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Arputhan","family":"Abisheganaden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan C.","family":"Schuster","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1337-5146","authenticated-orcid":false,"given":"Fook Tim","family":"Chew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0417-7607","authenticated-orcid":false,"given":"Sanjay H.","family":"Chotirmall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2020,4,27]]},"reference":[{"key":"2024102101351758000_56.2.2000418.1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/1465-9921-14-10","article-title":"Atopy is a risk factor for respiratory symptoms in COPD patients: results from the EUROSCOP study","volume":"14","author":"Fattahi","year":"2013","journal-title":"Respir Res"},{"key":"2024102101351758000_56.2.2000418.2","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1164\/rccm.201211-2103OC","article-title":"Effects of allergic phenotype on respiratory symptoms and exacerbations in patients with chronic obstructive pulmonary disease","volume":"188","author":"Jamieson","year":"2013","journal-title":"Am J Respir Crit Care Med"},{"key":"2024102101351758000_56.2.2000418.3","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00162912"},{"key":"2024102101351758000_56.2.2000418.4","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1164\/rccm.201602-0353OC","article-title":"Asthma-like features and clinical course of chronic obstructive pulmonary disease. 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