What is the current place of azoles in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization

Abstract

Evaluation of: Chishimba L, Niven RM, Cooley J, Denning DW. Voriconazole and posaconazole improve asthma severity in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization. J. Asthma 49(4), 423–433 (2012).

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus that usually complicates the disease course of patients with asthma and cystic fibrosis. Oral corticosteroids are currently the treatment of choice for ABPA. Another active target is the use of azoles, which act by reducing the antigenic stimulus secondary to a decreased fungal burden. Studies suggest that itraconazole compared with placebo can improve symptoms in ABPA, decrease the immunological severity (IgE levels and total eosinophil counts), glucocorticoid requirement and the number of acute ABPA exacerbations. Severe asthma with fungal sensitization, a disorder closely related to ABPA, is a specific phenotype of asthma characterized by severe asthma and evidence of fungal sensitization after exclusion of ABPA. Again, oral itraconazole has been found to improve the quality of life in these steroid-dependent asthma patients. The current retrospective study evaluated the use of newer azoles (voriconazole and posaconazole) in adult asthmatic patients with either ABPA or severe asthma with fungal sensitization, and found the newer azoles to improve asthma control and reduce the severity of ABPA.

Keywords::

• ABPA
• allergic bronchopulmonary aspergillosis
• asthma
• azoles
• steroids

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.