Itraconazole Offers Great
Benefits To Some With Severe Asthma
ScienceDaily (Dec. 30, 2008) —
Some patients with severe asthma who also have allergic sensitivity to
certain fungi enjoy great improvements in their quality of life and on other
measures after taking an antifungal drug, according to new research from The
University of Manchester in England.
The findings were reported in
the first issue for January of the American Thoracic Society's American
Journal of Respiratory and Critical Care Medicine.
"We knew that many people with
severe asthma are sensitized to several airborne fungi which can worsen
asthma without overt clinical signs. The question was: does antifungal
therapy provide any clinical benefit," said David Denning, F.R.C.P.,
F.R.C.Path., professor of medicine and medical mycology at The University of
Manchester and lead investigator of the study.
In 2006, the most recent year
for which official statistics are available, there were more than 16 million
adults with self-reported asthma in the U.S.; about 20 percent of them have
A small number of severe
asthmatics—about one percent— are known to have a syndrome called allergic
bronchopulmonary aspergillosis, an extreme allergy to Aspergillus fumigatus
fungus that is associated with the long-term colonization of their
respiratory tracts with the fungus. But many more — 20 to 50 percent— are
sensitized to a variety of fungi without showing overt clinical signs or
demonstrable colonization. It is these patients with severe asthma with
fungal sensitization, or "SAFS", as the researchers named the syndrome, who
are most likely to enjoy marked improvement with the antifungal therapy.
In the prospective double-blind
study, 58 patients with severe asthma and allergic sensitivity to at least
one of seven different common fungi (confirmed by a skin-prick test and/or
an IgE blood test for the study) were randomized to receive either an oral
dose of itraconazole (200mg twice a day) or a placebo.
After 32 weeks of treatment, 18
of the 29 patients (62 percent) who were randomized to receive the drug
experienced significant improvements on their Asthma Quality of Life
Questionnaires, and in runny nose and morning lung function. However, 11 of
the patients who received the drug left the trial before completion, some
citing side effects that included nausea, breathlessness and muscle
weakness. Unfortunately, four months after stopping antifungal treatment,
symptoms had returned.
"This study indicates that
fungal allergy is important in some patients with severe asthma, and that
oral antifungal therapy is worth trying in difficult-to-treat patients.
Clearly itraconazole will not suit everyone and is not always helpful, but
when it is the effect is dramatic," said Dr. Denning. "These findings open
the door to a new means of helping patients with severe asthma, and raise
intriguing questions related to fungal allergy and asthma."
John Heffner, M.D., past
president of the ATS, reflected that the recent Severe Asthma Research
Program report describes severe asthma as a entirely different form of the
disease. "Patients with severe asthma may have unique triggers for
bronchospasm, which remain unidentified. This study suggests that
colonization with fungal species may generate immunologic responses in
patients with asthma that perpetuate airway inflammation and blunt the
effectiveness of drug therapy. One can't help but wonder if antifungal
therapy would benefit all severe asthmatics regardless of sensitivity to
American Thoracic Society
(2008, December 30). Anti-fungal Drug Offers Great Benefits To Some With
Severe Asthma, Study Suggests. ScienceDaily. Retrieved January 3,
2009, from http://www.sciencedaily.com
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