PMID- 22380765
OWN - NLM
STAT- MEDLINE
DCOM- 20120904
LR  - 20181201
IS  - 1532-4303 (Electronic)
IS  - 0277-0903 (Linking)
VI  - 49
IP  - 4
DP  - 2012 May
TI  - Voriconazole and posaconazole improve asthma severity in allergic 
      bronchopulmonary aspergillosis and severe asthma with fungal sensitization.
PG  - 423-33
LID - 10.3109/02770903.2012.662568 [doi]
AB  - Rationale and objectives. Severe asthma with fungal sensitization (SAFS) and 
      allergic bronchopulmonary aspergillosis (ABPA) are progressive allergic fungal 
      lung diseases whose effective treatment remains to be established. Current 
      treatment with itraconazole is associated with a 40% failure rate and adverse 
      events (AEs). We assessed the effect of voriconazole or posaconazole as second- 
      and third-line therapies. Methods. We conducted a retrospective review of adult 
      asthmatic patients with either ABPA or SAFS receiving voriconazole or 
      posaconazole. Clinical, radiological, and immunological evaluation was used to 
      assess response. Results. There were 25 patients, ABPA (n = 20) or SAFS (n = 5), 
      10 males, median age = 58 years. All patients had failed itraconazole (n = 14) or 
      developed AEs (n = 11). There were 33 courses of therapy analyzed, 24 with 
      voriconazole and 9 with posaconazole. Clinical response to voriconazole was 
      observed in 17/24 (70%) patients at 3 months, 15/20 (75%) at 6 months, and 12/16 
      (75%) at 12 months compared with 7/9 (78%) at 3, 6, and 12 months for 
      posaconazole. Eighteen of 24 (75%) patients discontinued oral corticosteroids 
      (OCS), 12 of them within 3 months of therapy. Asthma severity was downgraded from 
      severe to moderate (n = 8) and moderate to mild (n = 1) asthma in 9 of 24 (38%) 
      asthmatic patients. There was a marked reduction in OCS and short-acting beta-2 
      agonist use, health-care utilization due to asthma, and improvement in overall 
      health status. Furthermore, there was a statistically significant reduction in 
      immunological markers appearing at 9 months (p = .008) for total IgE and at 12 
      months for radioallergosorbent test IgE for Aspergillus fumigatus (p = .0056). 
      Six of 23 (26%) patients on voriconazole had AEs requiring discontinuation before 
      6 months compared with none on posaconazole (p = .15). Four relapsed (57%), one 
      at 3 months and three at 12 months after discontinuation. Conclusion. Both 
      voriconazole and posaconazole are potentially effective alternative treatment 
      options for SAFS and ABPA and may improve asthma control and reduce severity, 
      though larger prospective studies are required to support these retrospective 
      study findings.
FAU - Chishimba, Livingstone
AU  - Chishimba L
AD  - Manchester Academic Health Science Centre, The University of Manchester, 
      Manchester, UK.
FAU - Niven, Robert M
AU  - Niven RM
FAU - Cooley, John
AU  - Cooley J
FAU - Denning, David W
AU  - Denning DW
LA  - eng
PT  - Journal Article
DEP - 20120302
PL  - England
TA  - J Asthma
JT  - The Journal of asthma : official journal of the Association for the Care of 
      Asthma
JID - 8106454
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Antifungal Agents)
RN  - 0 (Pyrimidines)
RN  - 0 (Triazoles)
RN  - 6TK1G07BHZ (posaconazole)
RN  - JFU09I87TR (Voriconazole)
SB  - IM
CIN - Expert Rev Respir Med. 2012 Aug;6(4):363-71. PMID: 22971061
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Antifungal Agents/administration & dosage/adverse effects/*therapeutic use
MH  - Aspergillosis, Allergic Bronchopulmonary/complications/*drug therapy/psychology
MH  - Asthma/complications/*drug therapy/psychology
MH  - Comorbidity
MH  - Drug Utilization
MH  - Female
MH  - Health Services/statistics & numerical data
MH  - Humans
MH  - Lung Diseases, Fungal/complications/drug therapy
MH  - Male
MH  - Middle Aged
MH  - Pyrimidines/administration & dosage/adverse effects/*therapeutic use
MH  - Quality of Life
MH  - Radiography, Thoracic
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Socioeconomic Factors
MH  - Spirometry
MH  - Triazoles/administration & dosage/adverse effects/*therapeutic use
MH  - Voriconazole
EDAT- 2012/03/03 06:00
MHDA- 2012/09/05 06:00
CRDT- 2012/03/03 06:00
PHST- 2012/03/03 06:00 [entrez]
PHST- 2012/03/03 06:00 [pubmed]
PHST- 2012/09/05 06:00 [medline]
AID - 10.3109/02770903.2012.662568 [doi]
PST - ppublish
SO  - J Asthma. 2012 May;49(4):423-33. doi: 10.3109/02770903.2012.662568. Epub 2012 Mar 
      2.