TORONTO, ON An estimated 4,837,000 asthmatics with allergic bronchopulmonary aspergillosis (ABPA) could benefit substantially from antifungal treatment, say researchers from the University of Toronto and Manchester University.
Their work, published today in the journal Medical Mycology, has also re-estimated the total number of asthmatics worldwide to reveal a staggering 193 million sufferers. Twenty-four million asthma sufferers live in the United States, 20 million each in India and China, and seven million in the United Kingdom.
Clinical studies have shown that oral antifungal drugs significantly improve symptoms and asthma control in asthmatics with ABPA, treatment endorsed by the Cochrane Collaboration. This is the first time that a global estimate of ABPA numbers has been made.
In national league tables of asthma rates in adults, only Australia and Sweden have a higher prevalence than the UK. In global league tables of ABPA occurrence, New Zealand tops the list with a 3.5% rate in new patients attending chest clinics at hospitals. The rates were 2.6% in Cape Town, 2.3% in Saudi Arabia, 2.5% in China and 0.7% in an older study from Ireland. No population-based studies have been done.
In addition to standard asthma therapy, the antifungal therapy used is itraconazole now a generic, inexpensive antifungal with a response rate of 60%. The researchers also found that antifungal therapy also benefits patients with severe asthma sensitized to fungi, called SAFS.
Alternatives include voriconazole and posaconazole, which have 75-80% response rates. In a recent assessment of voriconazole and posaconazole for both ABPA and SAFS, 75% of patients were able to stop taking oral corticosteroids, a major benefit, and 38% of patients had their asthma severity downgraded on antifungal therapy.
Professor David Denning, professor of medicine and medical mycology at the University of Manchester and Director of t
|Contact: Dominic Ali|
University of Toronto