Details

Autor(en) / Beteiligte

• Warris, Adilia
• Armstrong-James, Darius

Titel

Antifungal therapy for chronic pulmonary aspergillosis

Ist Teil von

• The Lancet infectious diseases, 2022-07, Vol.22 (7), p.924-926

Ort / Verlag

United States: Elsevier Ltd

Erscheinungsjahr

2022

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• In The Lancet Infectious Diseases, Inderpaul Singh Sehgal and colleagues report the results of an open-label randomised controlled trial showing that a 12-month course of itraconazole (400 mg/day) was superior to a 6-month course at reducing relapses.4 The results of this study are of great importance to provide evidence-based management guidance on how to prevent progressive lung damage and lung function decline in patients with chronic pulmonary aspergillosis. Invasive pulmonary aspergillosis is mainly observed in patients who are neutropenic (eg, those receiving chemotherapy or a stem cell transplantation), whereas chronic pulmonary aspergillosis is a complication observed in patients with chronic lung diseases, who are not neutropenic.1 For both invasive pulmonary aspergillosis and chronic pulmonary aspergillosis, physicians are confronted with major diagnostic challenges, with specific diagnostic tests performing differently between the various patient populations.5 Although the objective for treatment of invasive pulmonary aspergillosis is microbiological cure, the main aim for patients with chronic pulmonary aspergillosis is reduction of respiratory symptoms and prevention of further lung damage and development of lung fibrosis. Considering the potentially negative impact of long-term oral azole treatment (eg, development of resistance and toxicity), finding ways to modulate the immune response are worth exploring.8 A small case series showed that salvage treatment with interferon gamma in patients with chronic pulmonary aspergillosis reduced the number of acute exacerbations from 3·1 to 1·4 episodes/year.9 A recent study including 133 patients with chronic pulmonary aspergillosis supported those initial observations, as defective interferon gamma responses were associated with worse outcomes.10 Improving our understanding of the immunopathogenesis of chronic pulmonary aspergillosis will allow us to identify adjunctive, novel management approaches.