Randomized Controlled Trial of Oral Antifungal Treatment for Severe Asthma with Fungal Sensitization

• DOI: 10.1164/rccm.200805-737oc
• Publication Date: 2008-10-24T01:07:17Z
• Authors: David W. Denning; B. Ronan O'Driscoll; Georgina Powell; Fiona Chew; Graham T. Atherton; Aashish Vyas; John Miles; Julie Morris; Robert M. Niven
• Keywords: Antifungal Agents [blood]; Questionnaires; Adult; Male; Antifungal Agents; Adolescent; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Surveys and Questionnaires; Humans; Itraconazole [blood]; Candida; Aged; Penicillium; Alternaria; Middle Aged; Asthma; Respiratory Function Tests; 3. Good health; Aspergillus; Treatment Outcome; Quality of Life; Female; Asthma [drug therapy]; Itraconazole; Cladosporium

Some patients with severe asthma are immunologically sensitized to one or more fungi, a clinical entity categorized as fungal sensitization (SAFS). It is not known whether SAFS responds antifungal therapy.To evaluate the response of oral itraconazole.Patients at least seven fungi by skin prick specific IgE testing were recruited. All had total less than 1,000 IU/ml and negative Aspergillus precipitins. They treated itraconazole (200 mg twice daily) placebo for 32 weeks, follow-up 16 weeks.The primary end point was change in Asthma Quality Life Questionnaire (AQLQ) score, rhinitis IgE, respiratory function secondary points. Fifty-eight enrolled, whom 41% been hospitalized previous year. Baseline mean AQLQ score 4.13 (range, 1-7). At improvement (95% confidence interval) +0.85 (0.28, 1.41) group, compared -0.01 (-0.43, 0.42) group (P = 0.014). Rhinitis improved (-0.43) antifungal, deteriorated (+0.17) 0.013). Morning peak flow (20.8 L/minute, P 0.028) group. Total serum decreased (-51 IU/ml) but increased (+30 0.001). No adverse events observed, developed requiring discontinuation, five group.SAFS therapy judged large improvements quality life about 60% patients.