Azoles for allergic bronchopulmonary aspergillosis
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Updated: Oct 15, 2026
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
P Wark1, A W Wilson, P G Gibson
1Department of Respiratory Medicine, John Hunter Hospital, Locked Bag No 1, Hunter Region Mail Centre, NSW, Australia, 2310. pwark@mail.newcastle.edu.au
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. The mainstay of treatment for ABPA remains oral corticosteroids, though this does not completely prevent exacerbations and may not prevent the decline in lung function.
Objectives:
The purpose of this review is to determine the efficacy of azoles in the treatment of ABPA SEARCH STRATEGY: An initial search was carried out using the Cochrane Airways Group Asthma RCT register. The register was searched using the following terms: (asthma or wheeze) and (allergic bronchopulmonary aspergillosis or aspergillosis or allergic pulmonary aspergillosis or allergic fungal and disease or allergic mycotic and disease) and (azole or triazole or itraconazole or ketoconazole).
Selection Criteria:
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. Studies in languages other than English were included.
Data Collection And Analysis:
All identified trials were independently reviewed by both reviewers & all data collected. Trial quality was scored by the Cochrane assessment of allocation concealment & the Jadad scale of methodological quality.
Main 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 400 mg daily for 12 months and demonstrated a reduction in immunological markers of disease activity and symptom scores, there was no significant improvement in lung function. The other trial examined the use of itraconazole for 16 weeks. This demonstrated a reduction in corticosteroid usage, an improvement in immunological markers, an improvement in pulmonary function and exercise tolerance. This study was only available as an abstract and limited details were available.
Reviewer'S Conclusions:
There is insufficient information available to recommend the use of azole anti-fungal agents in the routine treatment of patients with ABPA.
Insights
Azoles show some promise for Allergic Broncho-pulmonary Aspergillosis (ABPA) by improving symptoms and reducing corticosteroid needs. However, more research is needed to confirm their effectiveness in routine ABPA treatment.
Area of Science:
- Pulmonology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Allergic Broncho-pulmonary Aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus Fumigatus.
- It complicates asthma and cystic fibrosis, leading to increased symptoms and potential lung function decline.
- Current treatments, primarily oral corticosteroids, do not fully prevent exacerbations or lung function deterioration.
Purpose of the Study:
- To evaluate the efficacy of azole antifungal agents in treating ABPA.
- To synthesize findings from controlled trials comparing azoles to placebo or standard care.
Main Methods:
- A systematic review of controlled trials was conducted.
- Searches included the Cochrane Airways Group Asthma RCT register using specific keywords.
- Included studies assessed azoles in ABPA patients of any age or severity, regardless of language.
Main Results:
- Eleven trials were identified, but only two were prospective controlled trials.
- Ketoconazole showed reduced immunological markers and symptoms but no lung function improvement.
- Itraconazole demonstrated reduced corticosteroid use, improved immunological markers, lung function, and exercise tolerance.
Conclusions:
- Current evidence is insufficient to recommend azoles for routine ABPA treatment.
- Further high-quality research is necessary to establish the role of azoles in ABPA management.
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