Key milestone in antifungal treatment for severe asthma

University of Manchester researchers announced today that they have reached a key milestone in their study of the antifungal treatment of asthma.

It is hoped that the study, by clinical researchers based at Manchester’s Wythenshawe Hospital, will reduce steroid use and serious attacks requiring hospital intervention for asthma sufferers. It could also help those with cystic fibrosis and chronic sinusitis.

Severe asthma in adults affects 10 – 20% of the UK’s 5m asthmatics, and skin tests indicate that up to 70% of these sufferers are allergic to one or more common fungi in the air.

Previous studies have shown the benefits of one antifungal drug [itraconazole or Sporonoxâ] for the asthma subgroup known as ’allergic bronchopulmonary aspergillosis’ or ’ABPA’. The University of Manchester researchers are studying the more common association between fungal allergy and those with severe asthma who do not have ABPA. Volunteers are screened and, if testing shows allergy to one or more fungi, allocated itraconazole capsules or matching dummy capsules for 8 months. So far 26 patients (25% of the total required) have been enrolled.

Allergy to fungi is relatively common, affecting asthmatics, those with cystic fibrosis and others with chronic sinusitis (usually with nasal polyps). Fungi commonly implicated include airborne molds, such as Aspergillus, Cladosporium, Alternaria and Penicillium, with airborne fungal spores outnumbering pollen grains in outside air almost 1000-fold. Inside the home fungi are also very common, particularly in bedrooms and cellars, and compost is particularly rich in fungi.

The clinical study is funded by the charity The Moulton Trust as a grant to the University of Manchester. Its lead investigator Dr Robert Niven, of the North West Lung Centre, Wythenshawe Hospital, said: “We have few options for patients with severe asthma other than prescribing more steroids, and those we do have can have side effects worse than steroids themselves.

“Antifungal treatment for those sensitized to fungi may be a useful additional strategy to improve the breathing and overall health of these patients. Certainly our limited treatment experience with itraconazole suggests fewer admissions to hospital for asthma and reduced numbers of steroid courses.”

Four centres are currently enroling patients: The North West Lung Centre, Wythenshawe Hospital, Hope Hospital (Ronan O’Driscoll); North Manchester General Hospital (Dr J Miles) and Preston Hospital (Dr A Vyas). The study is expected to conclude in 2006 when the results will be analysed.

The importance of fungi to health will be highlighted at a conference in London on June 15th 2005 hosted by the Fungal Research Trust, a UK Charity devoted to education and research into fungal disease. The charity has supported research in Manchester and other UK centres.