Antifungal therapy may benefit patients with asthma, chronic sinusitis

LOS ANGELES — Patients with asthma and chronic sinusitis could benefit from antifungal therapy, regardless of fungal sensitization, according to study findings presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“Current data on the effectiveness of antifungal therapy in asthma and chronic sinusitis is limited but there is indication that antifungals are effective in treating severe asthmatics – specifically for patients with allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization,” researcher Evan Li, MD, of the Baylor College of Medicine, said in a press release. “We hypothesized that antifungal therapy could provide immediate clinical benefits, even for those without sensitivity.”

To determine the efficacy of antifungal therapy in these patient populations, Li and colleagues collected data from patients who had visited the Michael E. Debakey VA Allergy Clinic between 2012 and 2015 and had provided sputum samples for fungal cultures. The researcher included patients (n=134) who provided sputum as well as diagnoses of either asthma, chronic sinusitis, or both.

“What we found was pretty striking: Of the patients that carried the diagnosis of asthma and chronic sinusitis, over 80% had evidence of fungal growth in their sputum which contrasts with the fact that, of these patients, only 14-15% showed positive IgE testing for fungal sensitivity,” Li said in a press conference.

Among patients with evidence of fungal growth (n=112), 75 were treated with either voriconazole, terbinafine, fluconazole or a combination. Follow-up data were available for 62 patients and of these, 23 had asthma only, 17 had chronic sinusitis only, and 22 had both.

According to study results, of the treated patients that had follow up, 87.1% exhibited subjective benefit, 50.0% produced less sputum, 38.7% had improved breathing, 32.2% exhibited less cough, and 14.5% had less need for albuterol use.

David B. Corry

The researchers noted that only 16% of patients tested demonstrated fungal sensitization via scratch testing or radioallergosorbent testing.

“We need more prospective controlled studies to validate the utility of antifungals, and we need solid protocols for how to administer these agents safely – protocols which are not in place today,” co-author David B. Corry, MD, of the Baylor College of Medicine, said during the press conference. “It leaves the private practitioner in a difficult position if they cannot really do the diagnostic work-up required or they are not familiar with giving antifungals or aware of the hazards of giving these agents. We need solid information for the future to guide the practitioner, not only in how to administer these agents but how to proceed with the diagnostic work-up.”– by Bob Stott

Reference:

Li E, et al. Abstract 697. Presented at: the American Academy of Allergy, Asthma & Immunology Annual Meeting; March 4-7, 2016; Los Angeles.

Disclosure: Drs. Li and Corry reported no relevant financial disclosures.