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1 School of Medicine, Manchester University, 2 Dept of Cardiothoracic Medicine, Wythenshawe Hospital, and 3 Hope Hospital, Manchester, UK, 4 Dept of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA.
CORRESPONDENCE: D. W. Denning, Education and Research Centre, Wythenshawe Hospital, Southmoor Rd, Manchester M23 9LT, UK. Fax: 44 1612915806. E-mail: ddenning{at}manchester.ac.uk
Keywords: Aspergillosis, asthma clinical/basic investigations, asthma epidemiology, asthma immunology, fungi
Received: June 27, 2005
Accepted November 12, 2005
There is current evidence to demonstrate a close association between fungal sensitisation and asthma severity. Whether such an association is causal remains to be confirmed, but this is explored by means of a detailed literature review. There is evidence from two randomised controlled trials that, in the example of allergic bronchopulmonary aspergillosis (ABPA), treatment with systemic antifungal therapy can offer a therapeutic benefit to
This paper describes the epidemiological evidence that associates severity of asthma with fungi and discusses possible pathogenetic mechanisms. Many airborne fungi are involved, including species of Alternaria, Aspergillus, Cladosporium and Penicillium, and exposure may be indoors, outdoors or both. The potential for a therapeutic role of antifungal agents for patients with severe asthma and fungal sensitisation is also explored.
Not only are many patients with severe asthma desperately disabled by their disease, but, in the UK alone, asthma accounts for 1,500 deaths per yr. The healthcare costs of these patients are enormous and any treatment option merits close scrutiny. Within this report, the case for the consideration of a new term related to this association is put forward. The current authors propose the term "severe asthma with fungal sensitisation". However, it is recognised that enhanced and precise definition of fungal sensitisation will require improvements in diagnostic testing.
60% of patients. ABPA is only diagnosed if a combination of clinical and immunological criteria is achieved. It is not known whether such cases are a discrete clinical entity or part of a spectrum of the pulmonary allergic response to fungi or fungal products.
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