Pathogenesis of allergic bronchopulmonary aspergillosis and an evidence-based review of azoles in treatment.
نویسنده
چکیده
BACKGROUND Allergic bronchopulmonary aspergillosis (ABPA) is a complex condition that affects people with asthma and cystic fibrosis (CF). It results from exposure to the fungus Aspergillus fumigatus, which leads to worsening airway inflammation and progressive damage to the lungs. The aim of this review is to outline the pathogenesis of the disorder, diagnostic criteria and to discuss the use of anti-fungal agents in its treatment. METHODS The Cochrane library of systematic reviews and the Cochrane database of controlled trials were searched for controlled trials on ABPA and its treatment in both asthma and CF. In addition, articles included within the reviews were examined separately, and a separate search carried out using Medline. RESULTS A systematic review for the use of azole anti-fungal agents in ABPA was identified for their use in both CF and non-CF-related disease. The review of ABPA alone identified two randomized-controlled trials of itraconazole in chronic disease. These trials demonstrated improvements in symptoms and immune activation, but were short-term trials and failed to show a significant change in lung function. No trials were identified in CF. CONCLUSIONS The use of anti-fungal agents in ABPA seems to be a rational one, with short-term efficacy demonstrated for the use of itraconazole. Further investigations are required to identify individuals who will benefit most from treatment and to establish the correct dose and means of delivering treatment in ABPA. Longer-term studies are required to demonstrate that treatment modifies the progressive decline in lung function seen with the disease.
منابع مشابه
Allergic Bronchopulmonary Aspergillosis
Allergic bronchopulmonary aspergillosis (ABPA), a progressive fungal allergic lung disease, is a common complication of asthma or cystic fibrosis. Although ABPA has been recognized since the 1950s, recent research has underscored the importance of Th2 immune deviation and granulocyte activation in its pathogenesis. There is also strong evidence of widespread under-diagnosis due to the complexit...
متن کاملAllergic bronchopulmonary aspergillosis.
Allergic bronchopulmonary aspergillosis is an uncommon but serious respiratory condition characterized by chronic airway inflammation and airway damage resulting from persistent colonization by and sensitization to the fungus Aspergillus fumigatus. The immunopathogenesis of allergic bronchopulmonary aspergillosis involves several pathways. Aspergillus allergens stimulate an interleukin 5-mediat...
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Allergic Bronchopulmonary Aspergillosis (ABPA) is a hypersensitivity response to Aspergillus antigens in patients with asthma or cystic fibrosis (CF). The inhalation of spores from the environment is followed by growth of hyphae in the mucus of the bronchial tree and stimulates an immune response involving Th2 CD4+ T cells and IgE and IgG antibodies. Although diagnostic procedure for ABPA is a ...
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bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol 1999; 82: 511–516. 4 Salez F, Brichet A, Desurmont S, et al. Effect of itraconazole therapy in allergic bronchopulmonary aspergillosis. Chest 1999; 116: 1665–1668. 5 Montoya JG, Chaparro SV, Celis D, et al. Invasive aspergillosis in the setting of cardiac transplantation. Clin Infect Dis 2003; 37: 281–292. 6 Rijnders BJ, Cornelissen JJ,...
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ورودعنوان ژورنال:
- Respiratory medicine
دوره 98 10 شماره
صفحات -
تاریخ انتشار 2004