Article type
Year
Abstract
Background: Allergic Broncho-pulmonary Aspergillosis (ABPA) is hypersensitivity to the fungus Aspergillus Fumigatus that complicates patients with asthma and cystic fibrosis. The condition usually results in an increase in symptoms, a greater reliance on corticosteroids to control the disease process and may lead to a progressive decline in lung function. Objectives: The purpose of this review is to determine the efficacy of azoles in the treatment of ABPA.
Methods: An initial search was carried out using the Cochrane Airways Group Asthma RCT register. All controlled trials that assessed the effect of Azole antifungal agents compared to placebo or other standard, for any duration or dose regimen in subjects with ABPA of any age or severity were reviewed. All identified trials were independently reviewed by the reviewers & all data collected. Trial quality was scored by the Cochrane assessment of allocation concealment & the Jadad scale of methodological quality.
Results: A total of 11 trials were identified concerning the use of Azoles in ABPA. Only two prospective controlled trials were identified. The first trial examined the use of Ketoconazole 400mg daily for 12 months and demonstrated a reduction in immunological markers of disease activity and symptom scores, there was no significant improvement in luing function. The other trial examined the use of Itraconazole for 16 weeks, in steroid dependent subjects. This demonstrated a reduction in corticosteroid usage, an improvement in immunological markers, an improvement in pulmonary function and exercise tolerance.
Conclusions: There is insufficient information available to recommend the use of Azole anti-fungal agents in the routine treatment of patients with ABPA.
Methods: An initial search was carried out using the Cochrane Airways Group Asthma RCT register. All controlled trials that assessed the effect of Azole antifungal agents compared to placebo or other standard, for any duration or dose regimen in subjects with ABPA of any age or severity were reviewed. All identified trials were independently reviewed by the reviewers & all data collected. Trial quality was scored by the Cochrane assessment of allocation concealment & the Jadad scale of methodological quality.
Results: A total of 11 trials were identified concerning the use of Azoles in ABPA. Only two prospective controlled trials were identified. The first trial examined the use of Ketoconazole 400mg daily for 12 months and demonstrated a reduction in immunological markers of disease activity and symptom scores, there was no significant improvement in luing function. The other trial examined the use of Itraconazole for 16 weeks, in steroid dependent subjects. This demonstrated a reduction in corticosteroid usage, an improvement in immunological markers, an improvement in pulmonary function and exercise tolerance.
Conclusions: There is insufficient information available to recommend the use of Azole anti-fungal agents in the routine treatment of patients with ABPA.