The National Aspergillosis Centre, 2nd Floor Education and Research Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
College of Medical Sciences, University of Calabar, Calabar, Nigeria.
Mycoses. 2019 Nov;62(11):1049-1055. doi: 10.1111/myc.12996.
Antifungal treatment options for allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) are largely limited to itraconazole based on the outcome of randomised controlled trials. It is unclear if nebulised amphotericin B deoxycholate (Fungizone ) is a viable therapeutic option. We evaluated the safety and efficacy of nebulised Fungizone in the long-term treatment of various forms of pulmonary aspergillosis. We assessed the records of 177 patients with various forms of pulmonary aspergillosis attending the National Aspergillosis Centre in Manchester who had received Fungizone . Patients first received a challenge test with nebulised Fungizone in hospital with spirometry pre/post-Fungizone and nebulised salbutamol given pre-Fungizone . Tolerability and changes in Aspergillus IgE, Aspergillus IgG and total IgE were evaluated. Sixty-six per cent (117/177) were able to tolerate the test dose of Fungizone and in all cases, the reason for discontinuation of the first test dose was worsening breathlessness. Twenty six (21%) stopped therapy within 4-6 weeks, and the commonest reason cited for discontinuation of therapy was increased breathlessness, hoarseness and cough. Eighteen (10.2%) patients continued the Fungizone for >3 months of which 5 (27.8%) recorded an improvement in total IgE, Aspergillus-specific IgE and Aspergillus IgG. Eleven had ABPA, four had SAFS, two had Aspergillus bronchitis and one had Aspergillus sensitisation with cavitating nodules. Among these 18 patients, sputum fungal culture results went from positive to negative in five patients, became positive in one patient, remained positive in three patients, and remained negative in seven patients. Nebulised Fungizone appears to be a poorly tolerated treatment for pulmonary Aspergillosis with high dropout rates. There appears to be both clinical and serological benefits following sustained treatment with nebulised Fungizone in some patients.
抗真菌治疗选择变应性支气管肺曲霉病 (ABPA) 和真菌致敏的严重哮喘 (SAFS) 在很大程度上仅限于伊曲康唑，这是基于随机对照试验的结果。目前尚不清楚雾化两性霉素 B 去氧胆酸盐 (Fungizone) 是否是可行的治疗选择。我们评估了雾化 Fungizone 在长期治疗各种形式的肺曲霉病中的安全性和疗效。我们评估了在曼彻斯特国家曲霉病中心就诊的 177 例各种形式的肺曲霉病患者的记录，他们接受了 Fungizone 治疗。患者首先在医院接受雾化 Fungizone 挑战试验，在 Fungizone 前后进行肺活量测定，在 Fungizone 前给予雾化沙丁胺醇。评估了耐受性和曲霉 IgE、曲霉 IgG 和总 IgE 的变化。66%（117/177）能够耐受 Fungizone 的测试剂量，在所有情况下，停止首次测试剂量的原因都是呼吸困难恶化。26%（21%）在 4-6 周内停止治疗，最常见的停止治疗的原因是呼吸困难、声音嘶哑和咳嗽加重。18%（10.2%）患者继续使用 Fungizone>3 个月，其中 5 例（27.8%）记录总 IgE、曲霉特异性 IgE 和曲霉 IgG 改善。11 例有 ABPA，4 例有 SAFS，2 例有曲霉性支气管炎，1 例有曲霉致敏伴空洞性结节。在这 18 例患者中，5 例痰真菌培养结果从阳性转为阴性，1 例转为阳性，3 例仍为阳性，7 例仍为阴性。雾化 Fungizone 似乎是一种耐受性差的治疗肺曲霉病的方法，脱落率很高。在一些患者中，持续使用雾化 Fungizone 似乎既有临床获益，也有血清学获益。
