title: Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis.
abstract: 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.
authors: Stanford University School of Medicine, Palo Alto, CA, USA.
authors: Richard B
authors: RB
authors: Moss
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000666:Amphotericin B / Q000627:therapeutic use; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000382:microbiology / Q000628:therapy*; D001232:Aspergillus fumigatus; D001249:Asthma / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D002986:Clinical Trials as Topic; D006801:Humans; D007249:Inflammation; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D000935:Antifungal Agents; D014230:Triazoles; C026408:anti-IgE antibodies; D000666:Amphotericin B