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Antifungals in severe asthma

Parulekar, Amit D.; Diamant, Zuzana LU and Hanania, Nicola A. (2015) In Current Opinion in Pulmonary Medicine 21(1). p.48-54
Abstract
Purpose of review Despite guideline-based treatment, many patients with severe asthma continue to have uncontrolled disease. Fungal allergy is being increasingly recognized in the pathogenesis of severe asthma. Limited data exist on the approach to treatment of fungal asthma. This review summarizes existing evidence on the use of antifungal agents in allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS), and highlights needed areas of future investigation. Recent findings Recent studies evaluating oral triazole therapy in ABPA appear to support triazole use in a carefully considered clinical setting, whereas studies assessing triazole use in SAFS have yielded mixed results. Despite early... (More)
Purpose of review Despite guideline-based treatment, many patients with severe asthma continue to have uncontrolled disease. Fungal allergy is being increasingly recognized in the pathogenesis of severe asthma. Limited data exist on the approach to treatment of fungal asthma. This review summarizes existing evidence on the use of antifungal agents in allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS), and highlights needed areas of future investigation. Recent findings Recent studies evaluating oral triazole therapy in ABPA appear to support triazole use in a carefully considered clinical setting, whereas studies assessing triazole use in SAFS have yielded mixed results. Despite early encouraging findings that oral triazole use may improve asthma symptoms, stabilize lung function, decrease inhaled and systemic corticosteroid requirements, and alter serum biomarkers, overall data are limited. Appropriate patient selection, as well as choice of the optimal drug, dose, frequency, and duration of therapy, remains poorly defined. Summary The role of antifungal therapy in severe asthma remains unclear. Early studies have suggested a possible benefit of some antifungal agents, such as oral triazoles in ABPA and SAFS; however, routine clinical use of these agents in severe asthma without ABPA is not currently recommended. Further research is needed to better delineate the potential utility of antifungal medications in severe asthma and identify the asthma populations who benefit from such treatment. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
antifungals, azoles, fungal asthma, severe asthma, triazoles
in
Current Opinion in Pulmonary Medicine
volume
21
issue
1
pages
48 - 54
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000345912400008
  • scopus:84918583355
ISSN
1531-6971
DOI
10.1097/MCP.0000000000000117
language
English
LU publication?
yes
id
87b3bc14-0775-4fc1-8a4c-9f0f25007c30 (old id 4950714)
date added to LUP
2015-02-03 07:05:19
date last changed
2017-04-09 03:13:30
@article{87b3bc14-0775-4fc1-8a4c-9f0f25007c30,
  abstract     = {Purpose of review Despite guideline-based treatment, many patients with severe asthma continue to have uncontrolled disease. Fungal allergy is being increasingly recognized in the pathogenesis of severe asthma. Limited data exist on the approach to treatment of fungal asthma. This review summarizes existing evidence on the use of antifungal agents in allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS), and highlights needed areas of future investigation. Recent findings Recent studies evaluating oral triazole therapy in ABPA appear to support triazole use in a carefully considered clinical setting, whereas studies assessing triazole use in SAFS have yielded mixed results. Despite early encouraging findings that oral triazole use may improve asthma symptoms, stabilize lung function, decrease inhaled and systemic corticosteroid requirements, and alter serum biomarkers, overall data are limited. Appropriate patient selection, as well as choice of the optimal drug, dose, frequency, and duration of therapy, remains poorly defined. Summary The role of antifungal therapy in severe asthma remains unclear. Early studies have suggested a possible benefit of some antifungal agents, such as oral triazoles in ABPA and SAFS; however, routine clinical use of these agents in severe asthma without ABPA is not currently recommended. Further research is needed to better delineate the potential utility of antifungal medications in severe asthma and identify the asthma populations who benefit from such treatment.},
  author       = {Parulekar, Amit D. and Diamant, Zuzana and Hanania, Nicola A.},
  issn         = {1531-6971},
  keyword      = {antifungals,azoles,fungal asthma,severe asthma,triazoles},
  language     = {eng},
  number       = {1},
  pages        = {48--54},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Current Opinion in Pulmonary Medicine},
  title        = {Antifungals in severe asthma},
  url          = {http://dx.doi.org/10.1097/MCP.0000000000000117},
  volume       = {21},
  year         = {2015},
}