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Management of chronic pulmonary aspergillosis

Koichi Izumikawa1, Masato Tashiro, Shigeru Kohno

  • 1Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. koizumik@nagasaki-u.ac.jp

Annals of the New York Academy of Sciences
|December 13, 2012
PubMed

Insights

Chronic pulmonary aspergillosis (CPA) management faces challenges due to insufficient evidence for oral azoles and rising azole resistance. Alternative strategies, including intravenous antifungals, are needed but require further evaluation.

Area of Science:

  • Mycology
  • Pulmonology
  • Infectious Diseases

Background:

  • Chronic pulmonary aspergillosis (CPA) is a rare, progressive lung disease caused by Aspergillus species.
  • Current management relies on oral azoles, but clinical evidence for their efficacy is limited.
  • Rising azole resistance in Aspergillus fumigatus poses a significant threat to CPA treatment.

Purpose of the Study:

  • To review the current challenges in managing CPA.
  • To explore alternative antifungal strategies beyond oral azoles.
  • To highlight the need for new antifungal agents and further research.

Main Methods:

  • Literature review of existing studies on CPA management.
  • Analysis of the impact of azole resistance on treatment outcomes.
  • Evaluation of potential alternative antifungal therapies, including intravenous options.

Main Results:

  • Oral azoles are the primary treatment but lack robust evidence of effectiveness.
  • Azole-resistant Aspergillus fumigatus is an increasing concern, potentially exacerbated by long-term azole use.
  • Intravenous antifungals like echinocandins and polyenes are potential alternatives but have limitations (cost, administration).

Conclusions:

  • There is a critical need for improved and evidence-based management strategies for CPA.
  • Alternative antifungal therapies and novel drug development are essential to combat CPA and azole resistance.
  • Further research is required to evaluate the utility and cost-effectiveness of alternative treatments.

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