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Treatment of Allergic Bronchopulmonary Aspergillosis with Fluconazole and Itraconazole
S P Rai1, B N Panda2, S Bhargava3
1Classified Specialist (Medicine and Respiratory Medicine), Military Hospital Namkum, Ranchi.
Abstract:
Treatment of allergic bronchopulmonary aspergillosis (ABPA) has remained both problematic as well as controversial. Although the sheet anchor in treatment of ABPA still remains steroids, various workers have tried oral antifungals (fluconazole and itraconazole) with encouraging results. This study evaluates the effect of fluconazole or itraconazole in the treatment of ABPA patients and compares them with the patients who had received palliative therapy other than antifungals. Case records of 44 proven cases of ABPA treated at our referral service hospital during February 1998 to April 2001 were analyzed. In addition to oral and inhaled bronchodilators, 16 patients received fluconazole 150 mg OD and 13 patients itraconazole 200 mg OD for six months. Response to therapy was assessed clinically, radiologically and by spirometry every 3 months. Patients who did not receive antifungals had chronic course characterized by airway obstruction, recurrent pulmonary consolidation and obstructive defect on pulmonary function test (PFT). Patients treated with itraconazole had better control of asthma symptoms, less requirement of reliever inhalers, steroids and lesser exacerbations of asthma during follow-up even after stopping antifungal. Fluconazole group had better control of symptoms but improvement in other parameters was not statistically significant. From this study it was evident that itraconazole improved the symptoms of airway obstruction, pulmonary functions, pulmonary opacities and decreased exacerbations during follow up.
Insights
Itraconazole offers better outcomes for allergic bronchopulmonary aspergillosis (ABPA) than fluconazole or supportive care alone. This antifungal improved asthma symptoms, lung function, and reduced exacerbations in ABPA patients.
Area of Science:
- Pulmonology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) treatment remains challenging, with corticosteroids as the primary therapy.
- Oral antifungals like fluconazole and itraconazole have shown promise in managing ABPA.
- Limited comparative studies exist on the efficacy of different antifungal agents in ABPA management.
Purpose of the Study:
- To evaluate the effectiveness of fluconazole and itraconazole in treating ABPA patients.
- To compare the outcomes of antifungal therapy with palliative care in ABPA.
- To assess the impact of antifungals on clinical, radiological, and spirometric parameters in ABPA.
Main Methods:
- Retrospective analysis of 44 proven ABPA cases treated between February 1998 and April 2001.
- Patients received either fluconazole (150 mg OD) or itraconazole (200 mg OD) for six months, alongside standard care.
- Therapeutic response was monitored clinically, radiologically, and via spirometry every three months.
Main Results:
- The itraconazole group demonstrated superior control of asthma symptoms, reduced need for reliever inhalers and steroids, and fewer exacerbations.
- Patients receiving itraconazole showed improvements in airway obstruction symptoms, pulmonary function, and reduced pulmonary opacities.
- While the fluconazole group showed symptom improvement, other parameters did not reach statistical significance compared to itraconazole.
Conclusions:
- Itraconazole is more effective than fluconazole in managing allergic bronchopulmonary aspergillosis, offering significant clinical and functional benefits.
- Antifungal therapy, particularly with itraconazole, provides a valuable addition to standard care for ABPA, improving patient outcomes.
- Further research is warranted to establish optimal antifungal strategies for ABPA treatment.
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