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Itraconazole improves lung function and symptoms in treatment resistant asthma

June 02 2020

Since 2000, we have known that itraconazole benefits over 50% of patients with allergic bronchopulmonary aspergillosis (ABPA) and asthma, and from 2009 that the same is true of patients with severe asthma with fungal sensitization (SAFS).

Late in 2019, Dr Majid Mirsadraee and colleagues from Mashhad (Iran) found that itraconazole benefitted the majority of patients who had treatment-resistant severe asthma without any fungal biomarkers. The authors randomised 110 therapy-resistant asthmatic patients to receive 200 mg itraconazole twice a day for 4 months, or 10 mg prednisolone for 1 month, with evaluations at 1 and 4 months.

  • At 4 months, 71% of the itraconazole group demonstrated a marked improvement in suppression of cough, dyspnea, and night symptoms, and remarkable improvement in lung function. In the parallel prednisolone group, only dyspnea improved
  • The Asthma Control Test scores were 14.1 at baseline and at 1 month improved to 19.8 with itraconazole but were unchanged at 14 with prednisolone
  • At 4 months the itraconazole group ACT score was 20.9
  • There was no appreciable change in eosinophils or total IgE
  • It is important to note that CT scans of the chest were done before enrolment and we normal in 83% (100% of the prednisolone group, excluding bronchiectasis in most patients. In Stevens et al (2000), 40% of patients had bronchiectasis and this group of patients did not respond as well.

In the recent ABPA study by Agarwal et al (2018) 93% of patients had bronchiectasis, with good responses. So it is not clear if this is important, but is an important difference in the trial populations.

 

At present, clinical guidelines for severe asthma do not support the use of itraconazole, except for some patients with ABPA and as a last resort. This study raises questions as to whether that stance should be altered.

Picture by Cleveland Clinic