1. Randomized Controlled Trial of Oral Antifungal Treatment for Severe Asthma with Fungal Sensitization
- Author
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Fiona Chew, Georgina Powell, Aashish Vyas, David W. Denning, Julie Morris, B Ronan O'Driscoll, Graham T. Atherton, Robert Niven, and John Miles
- Subjects
Adult ,Antifungal Agents [blood] ,Male ,Questionnaires ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Antifungal Agents ,Adolescent ,Itraconazole ,Critical Care and Intensive Care Medicine ,Placebo ,law.invention ,Young Adult ,Randomized controlled trial ,law ,Surveys and Questionnaires ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Respiratory function ,Itraconazole [blood] ,Sensitization ,Candida ,Aged ,Asthma ,business.industry ,Penicillium ,Alternaria ,Middle Aged ,medicine.disease ,Respiratory Function Tests ,Clinical trial ,Aspergillus ,Treatment Outcome ,medicine.anatomical_structure ,Immunology ,Quality of Life ,Female ,Asthma [drug therapy] ,business ,Cladosporium ,medicine.drug - Abstract
Rationale: Some patients with severe asthma are immunologically sensitized tooneormorefungi, a clinical entity categorized as severe asthma with fungal sensitization (SAFS). It is not known whether SAFS responds to antifungal therapy. Objectives: To evaluate the response of SAFS to oral itraconazole. Methods: Patients with severe asthma sensitized to at least one of seven fungi by skin prick or specific IgE testingwererecruited. Allhad total IgE less than 1,000 IU/ml and negative Aspergillus precipitins. They were treated with oral itraconazole (200 mg twice daily) or placebo for 32 weeks, with follow-up for 16 weeks. Measurements and Main Results: The primary end point was change in the Asthma Quality of Life Questionnaire (AQLQ) score, with rhinitis score, total IgE, and respiratory function as secondary end points. Fifty-eight patients were enrolled, of whom 41% had been hospitalized in the previous year. BaselinemeanAQLQscorewas4.13 (range, 1-7). At 32 weeks, the improvement (95% confidence interval) in AQLQ score was +0.85 (0.28, 1.41) in the antifungal group, compared with a -0.01 (-0.43, 0.42) change in the placebo group (P = 0.014). Rhinitis score improved (-0.43) in the antifungal, and deteriorated (+0.17) in the placebo group (P = 0.013). Morning peak flow improved (20.8 L/minute, P = 0.028) in the antifungal group. Total serum IgE decreased in the antifungal group(-51 IU/ml) but increased in placebo group (+30 IU/ml) (P = 0.001). No severe adverse events were observed, but seven patients developed adverse events requiring discontinuation, five in the antifungal group. Conclusions: SAFS responds to oral antifungal therapy as judged by large improvements in quality of life in about 60% of patients. Clinical trial registeredwithwww.controlled-trials.com (ISRCTN61552714).
- Published
- 2009