Nebulised amphotericin in allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS)

Ref ID: 19439

Author:

L. Chishimba, M. Niven, L. Powell, W. Denning and J. Langridge

Author address:

University Hospital of South Manchester, United Kingdom

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Background and rationale Allergic bronchopulmonary aspergillo-
sis (ABPA) and severe asthma with fungal sensitization (SAFS) are
debilitating lung diseases whose treatment is not yet fully established.
Some published case reports/series suggest that nebulised amphoteri-
cin (liposomal) may have a role in the treatment of cystic fibrosis
(CF) ABPA but little is known regarding its appropriateness in asth-
matic ABPA and SAFS patients. We assessed the efficacy and safety
of nebulised Amphotericin as second and third line therapy.
Methods 20 adult asthmatics with SAFS (n = 11) and ABPA
(n = 9) were treated with nebulised amphotericin between January
2011 and May 2013. All patients had either failed itraconazole
(n = 8), voriconazole preceded by itraconazole (n = 5) or developed
adverse events (AEs) to either agent (n = 7). 10 mg of Nebulised
amphotericin B (Fungizone) was administered using a Pari LC plus
nebulizer twice/day, preceded by salbutamol, under direct physiother-
apist observation. We audited clinical, radiological and immunologi-
cal response, including change in the Asthma Quality of Life
Questionnaire (AQLQ-J) scores .We also examined Asthma Control
Questionnaire (ACQ) scores, change in lung function (FEV1), change
in IgE (total and specific) and healthcare utilization. Patients were
followed up for 12 months during which they were evaluated at 2,
4, 6, 9 and 12 months.
Results There were 20 patients analysed (SAFS, n = 11) and (ABPA
n = 9), M: F = 8:12, median age 65.5 yrs (range = 24-78). The
median duration of therapy was 30 days (IQR, 0.0-142). Clinical
benefit was observed in 2 (10%) in which mean ACQ score improved
from 6 to 2, overall mean AQLQ score improved by 0.95 and mean
FEV1 improved by 1.2 L(63.1%). Seven (35%) failed the challenge
due to adverse events (bronchospasm). 11 (55%) discontinued within
12 months of therapy due to delayed bronchospasm (n = 3, within
4 weeks), equipment problems/patient inconvenience (n = 4) and
lack of clinical benefit (n = 4) (fig 1). There were no significant
changes in immunological and radiological outcomes.
Conclusion Our data suggests that the overall efficacy of nebulised
amphotericin in this group of patients may be poor and is associated
with high frequency of adverse events. However, the responses were excellent in 2 (10%) patients. It is not clear which patients are likely
to respond. Further studies need to be conducted to establish the
optimal dose range (dose, frequency), nebulizer type, pressures and
identification of patients who may respond.

Abstract Number: p380

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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