Monday, 5 January 2009

Antifungals for the Treatment of Asthma

Many asthma sufferers are known to the sensitised to fungi - a condition known as Severe Asthma with Fungal Sensitisation (SAFS). A similar series of studies on the more severe form of asthma known as Allergic Bronchopulmonary Aspergillosis (ABPA) has shown a beneficial effect of treatment with antifungals.

ABPA patients are known to have Aspergillus growing in their lungs so it is logical that antifungal medication will ease the infection - though it is very unusual that the antifungal would be able to eradicate the infection completely. ABPA is treated long term with steroids to control the inflammation caused by the fungus. Long term use of steroids can be very unpleasant as there are many potential side-effects. Treatment with antifungals lessens the symptoms and therefore allows a reduction in the use of steroids, bringing about a reduction in unpleasant side effects.

Of course antifungals such as itraconazole can also have side effects so close monitoring is required in the initial stages of treatment.

SAFS patients are not known to have fungi growing in their lungs and have much lower detected fungal contact as measured by IgE, so it is not as clear whether or not treatment with an antifungal drug would help ease the asthma symptoms.

Denning et al. sets out to assess whether patients with SAFS respond to treatment with an antifungal drug. Patients with sensitivity to at least one of a panel of seven fungi were recruited, but those with very high IgE were rejected so to exclude ABPA. Treatment with itraconazole for up to 32 weeks gave a significant improvement in quality of life and reduced IgE score.

Antifungal use to treat this group of patients does therefore have some evidence to support it as a viable treatment option, and hints at direct fungal involvment in some severe asthma.
Manchester University link


Anonymous said...

A personal acquaintance has been on Itraconazole for well over ten (10) years. This study is a welcome confirmation of similar results discovered based on suspicions. The subject is an extremely chronic and severe asthmatic with COPD symptoms (57 of 60 years). Initially, Ketaconazole seemed to help just before Itraconazole was released. It wasn't until after a '94 respiratory arrest that Itraconazole was tried. Since starting this therapy, there have been NO more life threatening asthma attacks. Hyper-reactivity and inflammation ceased. Virtually all Eye, Nose, Lung symptoms ceased. All methyl prednisolone, Theophyline, and the assortment of sprays were eliminated. Through trial and error, it was discovered that a full 90 days therapy was necessary to fully eliminate the subtle symptoms like higher tear viscocity. Upon termination of dosage, it took only 2 weeks to drop to a confirmed 50% lung capacity. Reintroduction of therapy quickly returned lung function. Effective therapy can be maintained at 100 mg/day, occasional 200mg/day to maintain a higher average. There have been no side effects after 10+ years continual therapy.

Care must be taken as Itraconazole is a potent CYP3A4 inhibitor and WILL increase methyl prednisolone levels substantially (Pubmed).

Itraconazole will give you your life back when there is little hope. I'm very thankful to all those who recognized this as an option and contributed to the study. I hope it benefits those who truly understand the term "disease of a 1000 deaths".

Anonymous said...

Thank You Dr. Deming,
My son and I both developed adult onset asthma after living and visiting in a home filled with the mold Chaetomium. Neither of us had prior pulmonary problems until the ages of 35 and 57 and neither had an elevated. My son was diagnosed four days after visiting in the home for one week. I was on antifungals for a toe nail infection and was not diagnosed until after going off antifungals eventhough I had a severe respiratory attack. Fortunate for the toe nail infection with Scopulariopsis brumptii which appears to be only susceptible to Vericonizole. I was able to be treated under insurance for my asthma indirectly because of the resistant no responsive toe nail infection. I was always much worse when I went off the antifungals because of treatment failure of the toe nail infection. I am now on vericonizole and feeling much better. I also developed peripheral neuropathy, inflamed joints and thyroid and chemical sensitivity as well as 8 neurological deficits and immunosupression which responded to Vitamin B. Another possible biomarker was a continually elevated BUN which finally came down to normal with antifungals. Yes I am a believer in fungal exposure and asthma causation.

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