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.
“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 and severe asthma with fungal sensitization,” first author 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 percent) had positive fungal cultures.
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 percent) patients reported benefits. 50 percent reported less sputum production; 39 percent showed improved breathing; and 32 percent had less coughing. Only 9 of the 62 patients demonstrated true fungal sensitization or allergy via scratch test or radioallergosorbent testing.
“More research is needed to understand the role that antifungal agents play in asthma treatment, but our results are promising,” co-author David B. Corry, MD said.
