title: Antifungal therapies for allergic bronchopulmonary aspergillosis in people with cystic fibrosis.
abstract: BACKGROUND
  Allergic bronchopulmonary aspergillosis (ABPA) is an allergic reaction to colonisation of the lungs with the fungus Aspergillus fumigatus and affects around 10% of people with cystic fibrosis. ABPA is associated with an accelerated decline in lung function. High doses of corticosteroids are the main treatment for ABPA; although the long-term benefits are not clear, their many side effects are well-documented. A group of compounds, the azoles, have activity against Aspergillus fumigatus and have been proposed as an alternative treatment for ABPA. Of this group, itraconazole is the most active. A separate antifungal compound, amphotericin B, has been employed in aerosolised form to treat invasive infection with Aspergillus fumigatus, and may have potential for the treatment of ABPA. Antifungal therapy for ABPA in cystic fibrosis needs to be evaluated.
  
  
  OBJECTIVE
  The review aimed to test the hypotheses that antifungal interventions for the treatment of ABPA in cystic fibrosis:1. improve clinical status compared to placebo or standard therapy (no placebo);2. do not have unacceptable adverse effects.If benefit was demonstrated, we aimed to assess the optimal type, duration and dose of antifungal therapy.
  
  
  METHODS
  We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings.In addition, pharmaceutical companies were approached.Date of the most recent search of the Group's Trials Register: 17 March 2014.
  
  
  METHODS
  Published or unpublished randomised controlled trials, where antifungal treatments have been compared to either placebo or no treatment, or where different doses of the same treatment have been used in the treatment of ABPA in people with cystic fibrosis.
  
  
  METHODS
  Four trials were identified by the searches; none of which was judged eligible for inclusion in the review.
  
  
  RESULTS
  No completed randomised controlled trials were included.
  
  
  CONCLUSIONS
  At present, there are no randomised controlled trials to evaluate the use of antifungal therapies for the treatment of ABPA in people with cystic fibrosis, although trials in people who do not have cystic fibrosis have shown clinical and serological evidence of improvement and a reduction in the use of corticosteroids with no increase in adverse effects. Trials with clear outcome measures are needed to properly evaluate this potentially useful treatment for cystic fibrosis.
authors.affiliation: Respiratory Unit, Sheffield Children's Hospital, Western Bank, Sheffield, UK, S10 2TH.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Elphick
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Southern
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000188:drug therapy*; D001232:Aspergillus fumigatus / Q000187:drug effects; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications*; D006801:Humans
chemical_list: D000935:Antifungal Agents