title: Antifungals in severe asthma.
abstract: OBJECTIVE
  Despite guideline-based treatment, many patients with severe asthma continue to have uncontrolled disease. Fungal allergy is being increasingly recognized in the pathogenesis of severe asthma. Limited data exist on the approach to treatment of fungal asthma. This review summarizes existing evidence on the use of antifungal agents in allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS), and highlights needed areas of future investigation.
  
  
  RESULTS
  Recent studies evaluating oral triazole therapy in ABPA appear to support triazole use in a carefully considered clinical setting, whereas studies assessing triazole use in SAFS have yielded mixed results. Despite early encouraging findings that oral triazole use may improve asthma symptoms, stabilize lung function, decrease inhaled and systemic corticosteroid requirements, and alter serum biomarkers, overall data are limited. Appropriate patient selection, as well as choice of the optimal drug, dose, frequency, and duration of therapy, remains poorly defined.
  
  
  CONCLUSIONS
  The role of antifungal therapy in severe asthma remains unclear. Early studies have suggested a possible benefit of some antifungal agents, such as oral triazoles in ABPA and SAFS; however, routine clinical use of these agents in severe asthma without ABPA is not currently recommended. Further research is needed to better delineate the potential utility of antifungal medications in severe asthma and identify the asthma populations who benefit from such treatment.
authors.affiliation: aSection of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA bDepartment of Respiratory Medicine and Allergology, Skäne University Hospital, Sweden cDepartment of General Practice & QPS-NL, Groningen, the Netherlands.
authors.forename: Amit D
authors.initials: AD
authors.lastname: Parulekar
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Diamant
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Hanania
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000187:drug effects* / Q000276:immunology; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D006801:Humans; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D014230:Triazoles