Fungal bronchitis is a distinct clinical entity which is responsiveto antifungal therapy

摘要

Chronic productive cough in the context of exacerbations of airway disease can beassociated with positive sputum cultures for fungi, in particularAspergillus fumigatus and Candida spp.,suggesting fungal bronchitis, a condition not widely recognised, as a possiblecause for the exacerbation. Our objective was to determine the response toantifungal therapy in patients with suspected fungal bronchitis. Retrospectiveanalysis of data extracted from case records of patients under secondary carerespiratory clinics who had been treated with triazole therapy for suspectedfungal bronchitis between 2010–2017. Primary outcome was lung function responseafter 1 month of treatment. Nineteen patients with fungal bronchitis due toA. fumigatus and 12 patients due toCandida spp., were included in the study. Most of thepatients, particularly in the Aspergillus group, had allergicfungal airway disease on a background of asthma. All but one of the patients ineach group were recorded as showing clinical improvement with antifungaltherapy. In the majority of patients this was reflected in an improvement inlung function. Aspergillus group: FEV1 (1.44 ± 0.8 Lvs 1.6 ± 0.8 L: p < 0.02), FVC (2.49 ± 1.08 L vs 2.8 ± 1.1 L: p = 0.01), andPEF (260 ± 150L/min vs 297 ± 194ml/min: p < 0.02). Candidagroup: FEV1 (1.6 ± 0.76 L vs 2.0 ± 0.72 L: p < 0.004), FVC (2.69 ±0.91 L vs 3.13 ± 0.7 L: p = 0.05), and PEF (271± 139L/min vs 333 ± 156 L/min: p= 0.01). Side effects of treatment were common, but resolved on stoppingtreatment. This service improvement project supports the idea that fungalbronchitis is a distinct clinical entity which is responsive to treatment.Controlled clinical trials to confirm the clinical impression that this isrelatively common and treatable complication of complex airway disease arerequired.