title: Management of invasive aspergillosis in patients with COPD: rational use of voriconazole.
abstract: Invasive pulmonary aspergillosis (IPA) is an important cause of mortality in patients with hematologic malignancies. The reported incidence of IPA in the context of chronic obstructive pulmonary disease (COPD) seems to increase. Approximately 1%-2% of overall fatal cases of IPA occur in COPD patients. The combination of factors such as lung immune imbalance, long-term corticosteroid use, increasing rate of bacterial exacerbations over time, and malnutrition are responsible for the emergence of IPA in these patients. The diagnosis of IPA is difficult to establish, which explains the delay in implementing accurate antifungal therapy and the high mortality rate. Persistent pneumonia nonresponsive to appropriate antibiotic treatment raises the concern of an invasive fungal infection. Definite diagnosis is obtained from tissue biopsy evidencing Aspergillus spp. on microscopic examination or in culture. Culture and microscopy of respiratory tract samples have a sensitivity and specificity of around 50%. Other diagnostic tools can be useful in documenting IPA: computed tomography (CT) scan, nonculture-based tests in serum and/or in bronchoalveolar lavage such as antibody/antigen tests for Aspergillus spp. More recent tools such as polymerase chain reaction or [1-->3]-beta-D-glucan have predictive values that need to be further investigated in COPD patients. Antifungal monotherapy using azole voriconazole is recommended as a first-line treatment of IPA. This review assesses the use of voriconazole in COPD patients.
authors.affiliation: Service des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Hôpital de La Croix-Rousse, Lyon, France. florence.ader@univ-lyon1.fr
authors.forename: Florence
authors.initials: F
authors.lastname: Ader
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Bienvenu
authors.forename: Blandine
authors.initials: B
authors.lastname: Rammaert
authors.forename: Saad
authors.initials: S
authors.lastname: Nseir
mesh_terms: D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole
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