The role of antifungals in the management of patients with severe asthma
| Autor: | W. Garth Rapeport, David W. Denning, Kazuhiro Ito |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Pulmonary and Respiratory Medicine Severe asthma medicine.medical_specialty Allergy FUNGAL SENSITIZATION Itraconazole 030106 microbiology Immunology Review Biologics THERAPY ITRACONAZOLE CLASSIFICATION 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Immunology and Allergy ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS PREDICTORS Mycosis Asthma Voriconazole Antifungals Science & Technology FUMIGATUS Bronchiectasis Inhalation business.industry RC581-607 ABPA FILAMENTOUS FUNGI medicine.disease RANDOMIZED-TRIAL respiratory tract diseases Aspergillus 030228 respiratory system Immunologic diseases. Allergy Allergic bronchopulmonary aspergillosis BURDEN business Life Sciences & Biomedicine medicine.drug |
| Zdroj: | Clinical and Translational Allergy, Vol 10, Iss 1, Pp 1-15 (2020) Clinical and Translational Allergy |
| ISSN: | 2045-7022 |
| DOI: | 10.1186/s13601-020-00353-8 |
| Popis: | In patients with asthma, the inhalation of elevated amounts of fungal spores and hyphae may precipitate the onset of asthma or worsen control to the extent of being life-threatening. Sensitisation to fungi, especially Aspergillus fumigatus, is found in 15% to 48% of asthmatics in secondary care and is linked to worse asthma control, hospitalisation, bronchiectasis and fixed airflow obstruction, irrespective of whether allergic bronchopulmonary aspergillosis (ABPA) is diagnosed. ABPA represents a florid response to the presence of Aspergillus spp. but up to 70% of patients with severe asthma exhibit sensitisation to different fungi without meeting the diagnostic criteria for ABPA. The presence of persistent endobronchial colonisation with fungi, especially A. fumigatus, is linked to significantly higher rates of radiological abnormalities, lower post-bronchodilator FEV1 and significantly less reversibility to short acting bronchodilators. The therapeutic benefit for antifungal intervention in severe asthma is based on the assumption that reductions in airway fungal burden may result in improvements in asthma control, lung function and symptoms (especially cough). This contention is supported by several prospective studies which demonstrate the effectiveness of antifungals for the treatment of ABPA. Significantly, these studies confirm lower toxicity of treatment with azoles versus high dose oral corticosteroid dosing regimens for ABPA. Here we review recent evidence for the role of fungi in the progression of severe asthma and provide recommendations for the use of antifungal agents in patients with severe asthma, airways fungal infection (mycosis) and fungal colonisation. Documenting fungal airways colonisation and sensitisation in those with severe asthma opens up alternative therapy options of antifungal therapy, which may be particularly valuable in low resource settings. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink