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The mycobiome was determined in 238 patients by targeted amplicon shotgun sequencing of the 18S\u201328S rRNA internally transcribed spacer regions ITS1 and ITS2. Specific quantitative PCR for detection of and conidial quantification for a range of airway<jats:italic>Aspergillus<\/jats:italic>species was performed. Sputum galactomannan,<jats:italic>Aspergillus<\/jats:italic>specific IgE, IgG and TARC (thymus and activation regulated chemokine) levels were measured systemically and associated to clinical outcomes.<\/jats:p><jats:p>The bronchiectasis mycobiome is distinct and characterised by specific fungal genera, including<jats:italic>Aspergillus<\/jats:italic>,<jats:italic>Cryptococcus<\/jats:italic>and<jats:italic>Clavispora<\/jats:italic>.<jats:italic>Aspergillus fumigatus<\/jats:italic>(in Singapore\/Kuala Lumpur) and<jats:italic>Aspergillus terreus<\/jats:italic>(in Dundee) dominated profiles, the latter associating with exacerbations. High frequencies of<jats:italic>Aspergillus-<\/jats:italic>associated disease including sensitisation and allergic bronchopulmonary aspergillosis were detected. Each revealed distinct mycobiome profiles, and associated with more severe disease, poorer pulmonary function and increased exacerbations.<\/jats:p><jats:p>The pulmonary mycobiome is of clinical relevance in bronchiectasis. Screening for<jats:italic>Aspergillus<\/jats:italic>-associated disease should be considered even in apparently stable patients.<\/jats:p>","DOI":"10.1183\/13993003.00766-2018","type":"journal-article","created":{"date-parts":[[2018,6,7]],"date-time":"2018-06-07T17:15:16Z","timestamp":1528391716000},"page":"1800766","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":147,"title":["Immunological corollary of the pulmonary mycobiome in bronchiectasis: the CAMEB study"],"prefix":"10.1183","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1726-7700","authenticated-orcid":false,"given":"Miche\u00e1l","family":"Mac Aog\u00e1in","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravishankar","family":"Chandrasekaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert Yick 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