High‐dose local steroid treatment in bronchopulmonary aspergillosis

Heinig, J. H.; Weeke, Eva; Groth, S.; Schwartz, B.

doi:10.1111/j.1398-9995.1988.tb02040.x

Cited by 29 publications

(12 citation statements)

References 17 publications

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“…However, this study used low doses of ICS (400 μg beclomethasone per day) and spacers were not employed. Small case studies have suggested variable benefits of ICS in the management of ABPA (17)(18)(19)(20). Thus, the exact role of ICS in ABPA is poorly defined.…”

Section: Introductionmentioning

confidence: 99%

Role of Inhaled Corticosteroids in the Management of Serological Allergic Bronchopulmonary Aspergillosis (ABPA)

et al. 2011

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Background and Aim The treatment of choice for allergic bronchopulmonary aspergillosis (ABPA) is oral corticosteroids (OCS). However, they are associated with numerous adverse effects. Inhaled corticosteroids (ICS) are associated with fewer side-effects; however, their role in the management of ABPA remains controversial. In this retrospective study, we evaluate the role of high doses of ICS in serological ABPA (ABPA-S). Methods Patients with ABPA-S were treated with a combination of formoterol/budesonide (24-1600 micrograms per day), and followed up with history, physical examination, chest radiograph and total IgE levels at 6, 12, 18 and 24 weeks. Asthma control was evaluated using the Global Initiative for Asthma (GINA) criteria. OCS were initiated if the IgE levels continued to rise after six months of therapy with ICS. Results There were 8 men and 13 women with a mean (SD) age of 39.3 (12.9) years. There was subjective improvement in all patients treated with ICS but none had complete control of asthma. After six months of therapy with ICS, the median IgE levels increased by 99.3%. After the initiation of OCS, there was complete resolution of asthma symptoms in 19 patients, and IgE levels fell by a median of 52.6% at six weeks. The median duration of follow-up was 15 months after OCS therapy. Eighteen patients achieved complete remission and three patients had a relapse in the first three months after stopping OCS. One patient required longterm OCS and was classified as glucocorticoid-dependent ABPA. Conclusion High doses of ICS alone have no role in the management of ABPA-S and should not be used as first-line therapy. In patients receiving OCS or alternate therapy, ICS can be used as an add-on therapy for the control of symptoms of asthma.

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Section: Introductionmentioning

confidence: 99%

Role of Inhaled Corticosteroids in the Management of Serological Allergic Bronchopulmonary Aspergillosis (ABPA)

et al. 2011

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“…Inhaled corticosteroids, while useful for concomitant asthma management in patients with ABPA, do not control the pathophysiology or clinical manifestations of ABPA [116][117][118][119][120]. In contrast, ''pulse'' steroid therapy (10-20 mg?kg -1 ?day -1 i.v.…”

Section: Alternative Corticosteroid Regimesmentioning

confidence: 99%

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Moss

2013

European Respiratory Journal

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Severe asthma with fungal sensitisation and allergic bronchopulmonary aspergillosis encompass two closely related subgroups of patients with severe allergic asthma. Pulmonary disease is due to pronounced host inflammatory responses to noninvasive subclinical endobronchial infection with filamentous fungi, usually Aspergillus fumigatus. These patients usually do not achieve satisfactory disease control with conventional treatment of severe asthma, i.e. high-dose inhaled corticosteroids and long-acting bronchodilators. Although prolonged systemic corticosteroids are effective, they carry a substantial toxicity profile. Supplementary or alternative therapies have primarily focused on use of antifungal agents including oral triazoles and inhaled amphotericin B. Immunomodulation with omalizumab, a humanised anti-IgE monoclonal antibody, or "pulse" monthly high-dose intravenous corticosteroid, has also been employed. This article considers the experience with these approaches, with emphasis on recent clinical trials. @ERSpublications Treatment of fungal asthma includes glucocorticoids, azoles, amphotericin and anti-IgE. Trial validation is needed.

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“…Prednisone remains the mainstay of therapy for ABPA [8,9]. High dose of inhaled steroids may be useful in some patients and may allow reduction in the dose of oral corticosteroids [14].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Allergic Bronchopulmonary Aspergillosis with Fluconazole and Itraconazole

Rai

Panda²,

Bhargava

2004

Medical Journal Armed Forces India

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High‐dose local steroid treatment in bronchopulmonary aspergillosis

Cited by 29 publications

References 17 publications

Role of Inhaled Corticosteroids in the Management of Serological Allergic Bronchopulmonary Aspergillosis (ABPA)

Role of Inhaled Corticosteroids in the Management of Serological Allergic Bronchopulmonary Aspergillosis (ABPA)

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Treatment of Allergic Bronchopulmonary Aspergillosis with Fluconazole and Itraconazole

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