Benefits of antifungal therapy in asthma patients with airway mycosis: A retrospective cohort analysis. Issue 2 (25th March 2018)

• Record Type: Journal Article
• Authors: Li, Evan; Tsai, Chu‐Lin; Maskatia, Zahida K.; Kakkar, Ekta; Porter, Paul; Rossen, Roger D.; Perusich, Sarah; Knight, John M.; Kheradmand, Farrah; Corry, David B.
• Is Part Of: Immunity, inflammation and disease. Volume 6:Issue 2(2018)
• Page Start: 264
• Page End: 275
• Publication Date: 2018-03-25
• Subjects: Airway mycosis -- antifungal -- asthma; Immunology -- Periodicals; Immunity -- Periodicals; Inflammation -- Periodicals; 616.079
• DOI: 10.1002/iid3.215
• Languages: English
• ISSNs: 2050-4527

Abstract

Abstract: 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. Abstract : Fungal airway infection (airway mycosis) is increasingly recognized as a cause of asthma and related disorders, but existing clinical trials fail to clarify the utility of antifungal antibiotics in severe asthma. Our retrospective analysis of patients receiving antifungal therapy at a single institution indicate that azole‐based and allylamine antifungal antibiotics improve asthma control and lung function while decreasing serum IgE levels and blood eosinophil counts. Additional randomized clinical trials are warranted to extend and validate these findings.