Rationale: Current data on the effectiveness of antifungal therapy in asthma and chronic sinusitis are conflicting. We hypothesize that symptoms of asthma and chronic sinusitis are fungal driven and can improve with antifungal therapy.
Methods: Data were collected retrospectively from patients seen in the Michael E. Debakey VA allergy clinic between 2012 and 2015 and who had provided sputum for fungal culture.
Results: 134 patients who provided sputum and had diagnoses of either asthma, chronic sinusitis, or both were included in the study. Of these patients a total of 112 (83.5%) had positive fungal cultures as defined by a minimum of 6 colony forming units growing within 2 weeks on culture plates. Of these 112 patients, 75 were treated with either voriconazole, terbinafine, fluconazole or a combination. Follow up data were available for 62 patients and of these, 23 had asthma only, 17 had chronic sinusitis only, and 22 had both. Of the treated patients that had follow up, 54 of 62 (87.1%) had subjective benefit, 31 of 62 (50.0%) produced less sputum, 24 of 62 (38.7%) had improved breathing, 20 of 62 (32.2%) had less cough, and 9 of 62 (14.5%) had less rescue inhaler use. Only 16% (9 of 55) of patients tested demonstrated fungal sensitization via scratch testing or radioallergosorbent testing.
Conclusions: This study suggests patients with asthma and chronic sinusitis may benefit from antifungal therapy regardless of fungal sensitization. These findings support the need for additional randomized clinical trials to clarify the utility of antifungal agents in asthma.