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The diagnostic criteria for IPA in COPD patients suggested by Bulpa et?al. [5] were used as a modified reference in this study, and IPA in COPD patients was carefully monitored in our hospital. Proven cases required histopathological or cytopathological confirmation. Probable cases required both host factors (COPD patient, had recent Selleckchem UMI-77 exacerbation of dyspnoea and suggestive chest imaging, and typically had poor response to conventional treatment) and microbiological factors (isolation of Aspergillus in the lower respiratory track (LRT) samples, or two consecutive positive serum galactomannan (GM) tests). Possible cases required host factors, but without microbiological proof. Colonization was defined as asymptomatic and isolation of Aspergillus in LRT samples. Possible patients were excluded from this study. Because we could not guarantee that all the patients had a chest X-ray every 3?months, we only compared chest imaging with the final results before admission for some patients. We did not restrict patients to those with COPD stage III or IV. Case group patients were admitted to the hospital with an initial diagnosis of acute exacerbations of COPD (AECOPD), and were diagnosed as ��probable IPA�� after relevant examinations. Control group patients met the following conditions: (i) had a primary discharge diagnosis of COPD (International Classification of Diseases, tenth revision Nintedanib supplier (ICD-10) codes J44.0, J44.1, J44.9); (ii) had exacerbations of baseline symptoms of COPD, such as dyspnoea, cough and/or sputum, at admission; (iii) had an aetiology examination with LRT samples more than twice and Aspergillus was negative; and (iv) did not receive any antifungal therapy during hospital stay. Patients were excluded for: (i) concurrent malignant tumour; (ii) concurrent haematological system diseases; (iii) organ transplantation; (iv) apparent immunodeficiency (e.g. AIDS or immunosuppressive drugs); and (v) long-term CYTH4 use of glucocorticoid for reasons other than COPD. A sputum sample with >25 polymorphonuclear leukocytes and