Background IgE sensitisation to Aspergillus fumigatus and a positive sputum fungal culture are common in refractory asthma. It is not clear whether these patients would benefit from anti-fungal treatment.
Objectives To determine if a three-month course of voriconazole improved asthma related outcomes in people with asthma who are IgE sensitised to A. fumigatus.
Methods Asthmatics IgE sensitised to A fumigatus with a history of at least two severe exacerbations in the previous twelve months were treated for three months with voriconazole two hundred milligrams twice daily, followed by observation for nine months, in a double blind, placebo controlled, randomised design. Primary outcomes were improvement in quality of life at the end of the treatment period and a reduction in the number of severe exacerbations over the twelve months of the study.
Results 65 patients were randomised. 59 patients started treatment (32 voriconazole and 27 placebo) and were included in an intention to treat analysis. 56 patients took the full three months of medication. There was no significant difference in the number of severe exacerbations between the voriconazole and placebo groups (1.25 vs 1.52/patient/year; mean difference 0.27; 95% CI 0.24 to 0.31) respectively, quality of life (change in AQLQ 0.44 vs 0.35, mean difference between groups 0.08; 95% CI 0.07–0.09), or in any of our secondary outcome measures between the two groups.
Conclusion We were unable to show a beneficial effect of three months treatment with voriconazole in people with moderate to severe asthma who were IgE sensitised to A fumigatus on either the rate of severe exacerbations, quality of life or other markers of asthma control.
Fairs A, Agbetile J, Hargadon B, Bourne M, Monteiro WR, Brightling CE, et al. IgE sensitisation to Aspergillus fumigatus is associated with reduced lung function in asthma. Am J Respir Crit Care Med. 2010;182(11):1362–8.
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