Efficacy of itraconazole in the treatment of patients with chronic cough whose sputa yield basidiomycetous fungi-fungus-associated chronic cough (FACC).
OBJECTIVE
This controlled study was performed to clarify the therapeutic benefit of itraconazole for the treatment of patients with chronic cough, wherein a sputum culture yielded basidiomycetous (BM) fungi.


METHODS
Of the 171 patients who visited our hospital for the diagnosis and treatment of chronic cough, BM was detected in the sputum of 39 patients. Informed consents were obtained from 21 patients who were subsequently enrolled in this trial. After the administration of the standard therapy, all the patients were enrolled in a randomized placebo-controlled study with 2 weeks of treatment with a low dose of itraconazole (50 mg/day) (n = 10) in comparison with a corresponding period of treatment with matched placebo (ambroxol hydrochloride 45 mg/day) (n = 11). Coughing was assessed using subjective cough symptom scale and capsaicin cough challenging.


RESULTS
The treatment with itraconazole, but not placebo (p = 0.17), was associated with a significant improvement in the cough scale (p = 0.0051); moreover, the improvement achieved with itraconazole was significant (p < 0.001) when compared with that of the placebo.


CONCLUSIONS
Low-dose itraconazole was shown to be an effective antitussive in patients with chronic cough in which sputum examination yielded BM fungi. The 21 patients described here entailed the following manifestations: (1) chronic cough; (2) the presence of environmental fungi, particularly basidiomycetous (BM) fungi, in the sputum; and (3) good clinical response to antifungal drugs. These clinical features may constitute a unique disease concept called fungus-associated chronic cough (FACC).
Ogawa
Haruhiko
H
Division of Pulmonary Medicine, Ishikawa-ken Saiseikai Kanazawa Hospital Kanazawa, Japan. saiseikh@po3.nsknet.or.jp
Fujimura
Masaki
M
Takeuchi
Yasuo
Y
Makimura
Koichi
K
D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D001487:Basidiomycota / Q000302:isolation & purification*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002908:Chronic Disease; D003371:Cough / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005100:Expectorants / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017964:Itraconazole / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy*; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013183:Sputum / Q000382:microbiology; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000935:Antifungal Agents; D001993:Bronchodilator Agents; D005100:Expectorants; D017964:Itraconazole