https://scholars.lib.ntu.edu.tw/handle/123456789/478078
標題: | Benefits of antifungal therapy in asthma patients with airway mycosis: A retrospective cohort analysis | 作者: | Li E. CHU-LIN TSAI Maskatia Z.K. Kakkar E. Porter P. Rossen R.D. Perusich S. Knight J.M. Kheradmand F. Corry D.B. |
公開日期: | 2018 | 卷: | 6 | 期: | 2 | 起(迄)頁: | 264-275 | 來源出版物: | Immunity Inflammation and Disease | 摘要: | Introduction: Fungal airway infection (airway mycosis) is increasingly recognized as a cause of asthma and related disorders. However, prior controlled studies of patients treated with antifungal antibiotics have produced conflicting results. Our objective is to measure the effect of antifungal therapy in moderate to severe adult asthmatics with positive fungal sputum cultures in a single center referral-based academic practice. Methods: We retrospectively evaluated 41 patients with asthma and culture-proven airway mycosis treated with either terbinafine, fluconazole, itraconazole, voriconazole, or posaconazole for 4 to >12 weeks together with standard bronchodilator and anti-inflammatory agents. Asthma control (1 = very poorly controlled; 2 = not well controlled; and 3 = well controlled), peak expiratory flow rates (PEFR), serum total IgE, and absolute blood eosinophil counts before and after antifungal therapy were assessed. In comparison, we also studied nine patients with airway mycosis and moderate to severe asthma who received standard therapy but no antifungals. Results: Treatment with azole-based and allylamine antifungals was associated with improved asthma control (mean change in asthma control 1.72–2.25; p = 0.004), increased PEFR (69.4% predicted to 79.3% predicted, p = 0.0011) and markedly reduced serum IgE levels (1,075 kU/L to 463 kU/L, p = 0.0005) and blood eosinophil counts (Mean absolute count 530–275, p = 0.0095). Reduction in symptoms, medication use, and relapse rates decreased as duration of therapy increased. Asthmatics on standard therapy who did not receive antifungals showed no improvement in asthma symptoms or PEFR. Antifungals were usually well tolerated, but discontinuation (12.2%) and relapse (50%) rates were relatively high. Conclusion: Antifungals help control symptoms in a subset of asthmatics with culture-proven airway mycosis. Additional randomized clinical trials are warranted to extend and validate these findings. ? 2018 The Authors. Immunity, Inflammation and Disease Published by John Wiley & Sons Ltd. |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/478078 | ISSN: | 2050-4527 | DOI: | 10.1002/iid3.215 | SDG/關鍵字: | antifungal agent; bronchodilating agent; adult; aged; asthma; drug effect; eosinophil; female; human; immunology; leukocyte count; lung mycosis; male; microbiology; middle aged; peak expiratory flow; respiratory system; retrospective study; severity of illness index; sputum; treatment outcome; Adult; Aged; Antifungal Agents; Asthma; Bronchodilator Agents; Eosinophils; Female; Humans; Leukocyte Count; Lung Diseases, Fungal; Male; Middle Aged; Peak Expiratory Flow Rate; Respiratory System; Retrospective Studies; Severity of Illness Index; Sputum; Treatment Outcome |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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