title: Wheezes and desert breezes: when asthma and valley fever collide.
abstract: OBJECTIVE
  To evaluate interactive effects of pulmonary coccidioidomycosis and asthma.
  
  
  METHODS
  We identified three groups of 33 age- and sex-matched patients: Group 1 (both asthma and coccidioidomycosis), Group 2 (asthma only), and Group 3 (pulmonary coccidioidomycosis only). Predetermined end points included: rate of disseminated coccidioidomycosis, duration of symptoms and antifungal therapy, hospitalization, death, and escalation of asthma therapies.
  
  
  RESULTS
  Baseline characteristics were similar across groups. Group 1 patients had worsening asthma outcomes (except forced expiratory volume in 1 s) with coccidioidomycosis. They required more asthma medications (median, 2.0 vs 0.0; p < 0.001), more corticosteroids (mean [SD], 0.9 [4.2] vs 0.3 [0.6]; p < 0.001), and more healthcare visits (mean [SD], 0.2 [0.4] vs 0.1 [0.3]; p = 0.03). Groups 1 and 3 had no differences in coccidioidal end points, including rates of dissemination (1 vs 0; p > 0.99), symptom duration (mean, 15.2 vs 23.6 weeks; p = 0.24), antifungal treatment (n = 21 [63.6%] vs n = 24 [72.7%]; p = 0.60), and treatment duration (median, 26.5 vs 11 weeks; p = 0.09). Ten patients in Group 1 versus none in Group 3 required systemic corticosteroids for coccidioidomycosis (p < 0.001).
  
  
  CONCLUSIONS
  Active pulmonary coccidioidomycosis significantly worsens asthma outcomes. Asthma (or its treatment) does not worsen coccidioidal outcomes, despite increasing the likelihood of treatment with systemic corticosteroids.
authors: a Department of Internal Medicine .
authors: Natalya
authors: N
authors: Azadeh
authors: b Division of Allergy , Asthma, and Clinical Immunology .
authors: Matthew A
authors: MA
authors: Rank
authors: b Division of Allergy , Asthma, and Clinical Immunology .
authors: John C
authors: JC
authors: Lewis
authors: c Division of Pulmonary Medicine .
authors: Lewis J
authors: LJ
authors: Wesselius
authors: d Department of Biostatistics , Mayo Clinic , Scottsdale , Arizona , USA , and.
authors: Meng-Ru
authors: MR
authors: Cheng
authors: e Division of Infectious Diseases (Dr Blair) , Mayo Clinic Hospital , Phoenix , Arizona , USA.
authors: Janis E
authors: JE
authors: Blair
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001249:Asthma / Q000453:epidemiology*; D016022:Case-Control Studies; D003047:Coccidioidomycosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012135:Respiratory Sounds; D055815:Young Adult
keywords: Coccidioidomycosis; corticosteroids; exacerbation; forced expiratory volume; fungal infection