What is the current place of azoles in allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitization

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus that usually complicates the disease course of patients with asthma and cystic fibrosis. Oral corticosteroids are currently the treatment of choice for ABPA. Another active target is the use of azoles, which act by reducing the antigenic stimulus secondary to a decreased fungal burden. Studies suggest that itraconazole compared with placebo can improve symptoms in ABPA, decrease the immunological severity (IgE levels and total eosinophil counts), glucocorticoid requirement and the number of acute ABPA exacerbations. Severe asthma with fungal sensitization, a disorder closely related to ABPA, is a specific phenotype of asthma characterized by severe asthma and evidence of fungal sensitization after exclusion of ABPA. Again, oral itraconazole has been found to improve the quality of life in these steroid-dependent asthma patients. The current retrospective study evaluated the use of newer azoles (voriconazole and posaconazole) in adult asthmatic patients with either ABPA or severe asthma with fungal sensitization, and found the newer azoles to improve asthma control and reduce the severity of ABPA.