Current pharmacotherapy of allergic bronchopulmonary aspergillosis

Although no well-designed studies have been carried out, the available data support the use of corticosteroids for acute exacerbations of allergic bronchopulmonary aspergillosis (ABPA). Neither the optimal steroid dose nor the duration of therapy has been standardised but limited data suggest the starting dose should be prednisone (approximately 0.5 mg/kg/day). The decision to taper steroids should be made on an individual basis, depending on clinical course. The available data suggest that clinical symptoms alone are inadequate to make such decisions, since significant lung damage may occur in asymptomatic patients. Increasing serum IgE levels, new or worsening infiltrate on chest radiograph and worsening spirometry suggest that steroids should be used. Multiple asthmatic exacerbations in a patient with ABPA suggest that chronic steroid therapy should be used. Itraconazole appears useful as a steroid sparing agent.