Antifungal Treatment for Severe Asthma

Fungus is in the air; © PHIL

Severe asthma in adults affects 10 - 20% of the UK's 5 million asthmatics, and skin tests indicate that up to 70% of these sufferers are allergic to one or more common fungi in the air. University of Manchester researchers are studying the association between fungal allergy and those with severe asthma who do not have 'allergic bronchopulmonary aspergillosis' (ABPA). Volunteers are screened and, if testing shows allergy to one or more fungi, allocated itraconazole capsules or matching dummy capsules for 8 months. So far 26 patients (25% of the total required) have been enrolled.

Allergy to fungi is relatively common, affecting asthmatics, those with cystic fibrosis and others with chronic sinusitis. Fungi commonly implicated include airborne molds, such as Aspergillus, Cladosporium, Alternaria and Penicillium, with airborne fungal spores outnumbering pollen grains in outside air almost 1000-fold. Inside the home fungi are also very common, particularly in bedrooms and cellars, and compost is particularly rich in fungi.

Lead investigator Dr Robert Niven, of the North West Lung Centre, Wythenshawe Hospital, said: "We have few options for patients with severe asthma other than prescribing more steroids, and those we do have can have side effects worse than steroids themselves. Antifungal treatment for those sensitized to fungi may be a useful additional strategy to improve the breathing and overall health of these patients. Certainly our limited treatment experience with itraconazole suggests fewer admissions to hospital for asthma and reduced numbers of steroid courses."

The study is expected to conclude in 2006 when the results will be analysed.; Source: University of Manchester