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.