Document Detail


Voriconazole and posaconazole improve asthma severity in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization.
MedLine Citation:
PMID:  22380765     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Rationale and objectives. Severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA) are progressive allergic fungal lung diseases whose effective treatment remains to be established. Current treatment with itraconazole is associated with a 40% failure rate and adverse events (AEs). We assessed the effect of voriconazole or posaconazole as second- and third-line therapies. Methods. We conducted a retrospective review of adult asthmatic patients with either ABPA or SAFS receiving voriconazole or posaconazole. Clinical, radiological, and immunological evaluation was used to assess response. Results. There were 25 patients, ABPA (n = 20) or SAFS (n = 5), 10 males, median age = 58 years. All patients had failed itraconazole (n = 14) or developed AEs (n = 11). There were 33 courses of therapy analyzed, 24 with voriconazole and 9 with posaconazole. Clinical response to voriconazole was observed in 17/24 (70%) patients at 3 months, 15/20 (75%) at 6 months, and 12/16 (75%) at 12 months compared with 7/9 (78%) at 3, 6, and 12 months for posaconazole. Eighteen of 24 (75%) patients discontinued oral corticosteroids (OCS), 12 of them within 3 months of therapy. Asthma severity was downgraded from severe to moderate (n = 8) and moderate to mild (n = 1) asthma in 9 of 24 (38%) asthmatic patients. There was a marked reduction in OCS and short-acting beta-2 agonist use, health-care utilization due to asthma, and improvement in overall health status. Furthermore, there was a statistically significant reduction in immunological markers appearing at 9 months (p = .008) for total IgE and at 12 months for radioallergosorbent test IgE for Aspergillus fumigatus (p = .0056). Six of 23 (26%) patients on voriconazole had AEs requiring discontinuation before 6 months compared with none on posaconazole (p = .15). Four relapsed (57%), one at 3 months and three at 12 months after discontinuation. Conclusion. Both voriconazole and posaconazole are potentially effective alternative treatment options for SAFS and ABPA and may improve asthma control and reduce severity, though larger prospective studies are required to support these retrospective study findings.
Authors:
Livingstone Chishimba; Robert M Niven; John Cooley; David W Denning
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Publication Detail:
Type:  Journal Article     Date:  2012-03-02
Journal Detail:
Title:  The Journal of asthma : official journal of the Association for the Care of Asthma     Volume:  49     ISSN:  1532-4303     ISO Abbreviation:  J Asthma     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-06-21     Completed Date:  2012-09-04     Revised Date:  2013-11-25    
Medline Journal Info:
Nlm Unique ID:  8106454     Medline TA:  J Asthma     Country:  England    
Other Details:
Languages:  eng     Pagination:  423-33     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adrenal Cortex Hormones / therapeutic use
Adult
Aged
Aged, 80 and over
Antifungal Agents / administration & dosage,  adverse effects,  therapeutic use*
Aspergillosis, Allergic Bronchopulmonary / complications,  drug therapy*,  psychology
Asthma / complications,  drug therapy*,  psychology
Comorbidity
Drug Utilization
Female
Health Services / utilization
Humans
Lung Diseases, Fungal / complications,  drug therapy
Male
Middle Aged
Pyrimidines / administration & dosage,  adverse effects,  therapeutic use*
Quality of Life
Radiography, Thoracic
Retrospective Studies
Severity of Illness Index
Socioeconomic Factors
Spirometry
Triazoles / administration & dosage,  adverse effects,  therapeutic use*
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Antifungal Agents; 0/Pyrimidines; 0/Triazoles; 0/voriconazole; 6TK1G07BHZ/posaconazole
Comments/Corrections
Comment In:
Expert Rev Respir Med. 2012 Aug;6(4):363-71   [PMID:  22971061 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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