Managment of abpa with azoles and steroid therapy

We treated patients with ABPA, an allergic lung disease provoked by Aspergillus fumigatus (Af), with a combined therapy of voriconazole and prednisolone. We used voriconazole at a dose of 200 mg twice a day for 4 months, while the initial prednisolone dose was 0.75 mg/kg/day for 1 month, then 0.25 mg/kg/day for 1 month, then progressive tapering (5 mg each fortnight) until the minimum dose of 5 mg/day, maintained until the fourth month. We evaluated patients at 6 months from the end of therapy. We enrolled 59 patients in the disease acute phase, who had never used azol therapy before, with a sudden asthmatic worsening. The mean  patients’ FEV1 value was 63% of predicted, total IgE were 1,765 IU/ml, blood eosinophils were 2,006 cell/ml, specific IgE for Af were 86 KU/L and IgG specific for Af were 3.66 KU/L. 57/59 patients had central bronchiectasis with dense mucus plugs. Results. There was a statistically significant reduction (p<0.0001) of total IgE values, of IgE specific for Af, of circulating eosinophils. FEV1, exhaled nitric oxide and Asthma Control Test improved in a statistically significant way (p<0.0001). No patient had a further re-exacerbation. The only parameter that didn’t change was IgG specific for Af. In bronchoalveolar lavage fluid (BAL) we saw a significant reduction in lymphocytes and eosinophils number (p<0.005). The Spearman correlation showed: a positive trend between eosinophil change in BAL and serum (r=0.6, p=0.07), BAL limphocytic and serum eosinophil change (r=0.68, p=0.04), similar to serum IgE change (r=0.8, p=0.008) and BAL and serum eosinophil baseline (r=0.55, p=0.005).