Antifungal Treatment: A New Approach to Asthma Care?

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Research at AAAAI Annual Meeting shows asthma patients could benefit from antifungal therapy

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Presenting at the 2016 AAAAI Annual Meeting, researchers from Baylor College of Medicine in Houston, Texas, have found that patients with asthma or chronic sinusitis benefited from antifungal therapies – even in patients who weren’t particularly sensitive or allergic to fungi.

Sensitization to fungi is an important risk factor in patients with allergic respiratory tract diseases, like asthma, because it plays a major role in the development, persistence and severity of lower airway disease. While the human lung is not sterile from a fungal perspective, excess mucus and airway architecture distortion invites fungal germination which can interrupt regular immune system responses or spark an inflammatory reaction. (i)

“Current data on the effectiveness of antifungal therapy in asthma and chronic sinusitis is limited but there is indication that antifungals are effective in treating severe asthmatics – specifically for patients with allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS),” first author and AAAAI member Evan Li, MD, said. “We hypothesized that antifungal therapy could provide immediate clinical benefits, even for those without sensitivity.”

Li and his team collected data from patients who visited the Michael E. Debakey VA Allergy Clinic between 2012 and 2015 and provided sputum samples for fungal cultures. Of the 134 patients included in the study, 112 (83.5%) had positive fungal cultures. “When performing the cultures in our labs, we defined a positive fungal culture as one where we saw at least six colony forming units growing within two weeks on culture plates,” Li explained.

75 (62 after 13 were lost to follow-up) of these patients with either asthma, chronic sinusitis, or both were treated with either voriconazole, terbinafine, fluconazole or some combination of these antifungals.

Of the antifungal-treated patients who had follow up data available, the majority saw improvements. Overall, 54 out of 62 (87.1%) patients reported benefits. Many reported less sputum production (31/62 or 50%), improved breathing (24/62 or 38.7%), less cough (20/62 or 32.2%) and less frequent rescue inhaler use (9/62 or 14.5%). Only a portion (9) of patients demonstrated true fungal sensitization or allergy via scratch test or radioallergosorbent testing.

“More research and clinical trials are needed to understand the role that antifungal agents play in asthma maintenance and treatment, but our results are very promising,” co-author David B. Corry, MD, concluded.

For more information on asthma or the AAAAI Annual Meeting, visit the AAAAI website. Research presented at the AAAAI Annual Meeting has been published in an online supplement to The Journal of Allergy and Clinical Immunology.

The AAAAI represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 6,800 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.

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i. Fungi and allergic lower respiratory tract diseases. Knutsen, Alan P. et al. Journal of Allergy and Clinical Immunology: Volume 129 (Issue 2): 280 – 291.

Editor's notes:

  • This study was presented during the 2016 Annual Meeting of the American Academy of Allergy, Asthma & Immunology, March 4-7 in Los Angeles. However, it does not necessarily reflect the policies or the opinions of the AAAAI.
  • A link to all abstracts presented at the 2016 Annual Meeting is available at annualmeeting.aaaai.org. Onsite Press Room number is (213) 743-6242.

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