Antifungals in the treatment of allergic bronchopulmonary aspergillosis

Objective: The primary objective of this article was to review the therapy of allergic bronchopulmonary aspergillosis (ABPA), especially to determine if antifungal therapy has a role in treatment of the disease. Data Sources: We researched MEDLINE for all published studies on the use of antifungal therapy in ABPA. We also surveyed the literature for articles pertinent in the diagnosis and treatment of ABPA. We included all publications from MEDLINE written in English and non-English publications with English abstracts. Study selection: All studies were reviewed. Case reports and small studies are presented. No well placebo-controlled, blinded, parallel studies were located for review. Results: Oral corticosteroids are still the therapy of choice for ABPA. Itraconazole may have a role in therapy, but controlled studies are needed. At this time itraconazole should be limited to cases where oral corticosteroids are contraindicated or refused by the patient. In patients requiring large doses of oral steroids, itraconazole may allow a reduction in dose, but should not replace the need to treat with oral corticosteroids. Conclusions: Antifungal agents, in particular itraconazole may have a role in the treatment of ABPA, but more data are necessary to confirm the efficacy of itraconazole in ABPA.