Benefits of antifungal therapy in asthma patients with airway mycosis: A retrospective cohort analysis

Autor:	Zahida Khan Maskatia, Roger D. Rossen, John M. Knight, Ekta Kakkar, Sarah Perusich, Paul Porter, David B. Corry, Evan Li, Chu-Lin Tsai, Farrah Kheradmand
Rok vydání:	2018
Předmět:	Voriconazole medicine.medical_specialty Posaconazole Antifungal antibiotic Itraconazole medicine.drug_class business.industry Immunology medicine.disease respiratory tract diseases 3. Good health 03 medical and health sciences 0302 clinical medicine 030228 respiratory system Internal medicine Bronchodilator medicine Immunology and Allergy business Mycosis Fluconazole 030215 immunology medicine.drug Asthma
Zdroj:	Immunity, Inflammation and Disease. 6:264-275
ISSN:	2050-4527
Popis:	Introduction Fungal airway infection (airway mycosis) is increasingly recognized as a cause of asthma and related disorders. However, prior controlled studies of patients treated with antifungal antibiotics have produced conflicting results. Our objective is to measure the effect of antifungal therapy in moderate to severe adult asthmatics with positive fungal sputum cultures in a single center referral-based academic practice. Methods We retrospectively evaluated 41 patients with asthma and culture-proven airway mycosis treated with either terbinafine, fluconazole, itraconazole, voriconazole, or posaconazole for 4 to >12 weeks together with standard bronchodilator and anti-inflammatory agents. Asthma control (1 = very poorly controlled; 2 = not well controlled; and 3 = well controlled), peak expiratory flow rates (PEFR), serum total IgE, and absolute blood eosinophil counts before and after antifungal therapy were assessed. In comparison, we also studied nine patients with airway mycosis and moderate to severe asthma who received standard therapy but no antifungals. Results Treatment with azole-based and allylamine antifungals was associated with improved asthma control (mean change in asthma control 1.72-2.25; p = 0.004), increased PEFR (69.4% predicted to 79.3% predicted, p = 0.0011) and markedly reduced serum IgE levels (1,075 kU/L to 463 kU/L, p = 0.0005) and blood eosinophil counts (Mean absolute count 530-275, p = 0.0095). Reduction in symptoms, medication use, and relapse rates decreased as duration of therapy increased. Asthmatics on standard therapy who did not receive antifungals showed no improvement in asthma symptoms or PEFR. Antifungals were usually well tolerated, but discontinuation (12.2%) and relapse (50%) rates were relatively high. Conclusion Antifungals help control symptoms in a subset of asthmatics with culture-proven airway mycosis. Additional randomized clinical trials are warranted to extend and validate these findings.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_________::97ad716a429a99c978a446c7c58744c2 https://doi.org/10.1002/iid3.215 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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