Abstract
Objective: To evaluate interactive effects of pulmonary coccidioidomycosis and asthma.
Methods: We identified three groups of 33 age- and sex-matched patients: Group 1 (both asthma and coccidioidomycosis), Group 2 (asthma only), and Group 3 (pulmonary coccidioidomycosis only). Predetermined end points included: rate of disseminated coccidioidomycosis, duration of symptoms and antifungal therapy, hospitalization, death, and escalation of asthma therapies.
Results: Baseline characteristics were similar across groups. Group 1 patients had worsening asthma outcomes (except forced expiratory volume in 1 s) with coccidioidomycosis. They required more asthma medications (median, 2.0 vs 0.0; p < 0.001), more corticosteroids (mean [SD], 0.9 [4.2] vs 0.3 [0.6]; p < 0.001), and more healthcare visits (mean [SD], 0.2 [0.4] vs 0.1 [0.3]; p = 0.03). Groups 1 and 3 had no differences in coccidioidal end points, including rates of dissemination (1 vs 0; p > 0.99), symptom duration (mean, 15.2 vs 23.6 weeks; p = 0.24), antifungal treatment (n = 21 [63.6%] vs n = 24 [72.7%]; p = 0.60), and treatment duration (median, 26.5 vs 11 weeks; p = 0.09). Ten patients in Group 1 versus none in Group 3 required systemic corticosteroids for coccidioidomycosis (p < 0.001).
Conclusions: Active pulmonary coccidioidomycosis significantly worsens asthma outcomes. Asthma (or its treatment) does not worsen coccidioidal outcomes, despite increasing the likelihood of treatment with systemic corticosteroids.
Declaration of interest
The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Notes
* Presented at the American Thoracic Society International Conference, Denver, CO, 19 May 2015.