Severe Asthma with Fungal Sensitisation

Case number: 



A 50-year-old lady who has had asthma since childhood is diagnosed with bronchiectasis and later presumed ABPA (allergic broncho-pulmonary aspergillosis). She is commenced on itraconazole. Her symptoms persist and her respiratory function worsens. For the first 3 years of treatment the serum itraconazole levels are undetectable despite increased dosage. Therapeutic levels are eventually obtained on conversion to itraconazole syrup rather than tablet form. Following this her symptoms dramatically improve. Review of her immunology and serology suggests a diagnosis of SAFS (severe asthma with fungal sensitisation) rather than ABPA.


  • Aspergillus fumigatus