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Study finds nearly 5 million asthmatics worldwide could benefit from antifungal therapy

May 8, 2013

TORONTO, ON – An esti­mat­ed 4,837,000 asth­mat­ics with aller­gic bron­chopul­monary aspergillo­sis (ABPA) could ben­e­fit sub­stan­tial­ly from anti­fun­gal treat­ment, say researchers from the Uni­ver­si­ty of Toron­to and Man­ches­ter Uni­ver­si­ty.

Their work, pub­lished today in the jour­nal Med­ical Mycol­o­gy, has also re-esti­mat­ed the total num­ber of asth­mat­ics world­wide – to reveal a stag­ger­ing 193 mil­lion suf­fer­ers. Twen­ty-four mil­lion asth­ma suf­fer­ers live in the Unit­ed States, 20 mil­lion each in India and Chi­na, and sev­en mil­lion in the Unit­ed King­dom.

Clin­i­cal stud­ies have shown that oral anti­fun­gal drugs sig­nif­i­cant­ly improve symp­toms and asth­ma con­trol in asth­mat­ics with ABPA, treat­ment endorsed by the Cochrane Col­lab­o­ra­tion. This is the first time that a glob­al esti­mate of ABPA num­bers has been made.

In nation­al league tables of asth­ma rates in adults, only Aus­tralia and Swe­den have a high­er preva­lence than the UK. In glob­al league tables of ABPA occur­rence, New Zealand tops the list with a 3.5% rate in new patients attend­ing chest clin­ics at hos­pi­tals. The rates were 2.6% in Cape Town, 2.3% in Sau­di Ara­bia, 2.5% in Chi­na and 0.7% in an old­er study from Ire­land. No pop­u­la­tion-based stud­ies have been done.

In addi­tion to stan­dard asth­ma ther­a­py, the anti­fun­gal ther­a­py used is itra­cona­zole – now a gener­ic, inex­pen­sive anti­fun­gal – with a response rate of 60%. The researchers also found that anti­fun­gal ther­a­py also ben­e­fits patients with severe asth­ma sen­si­tized to fun­gi, called SAFS.

Alter­na­tives include voricona­zole and posacona­zole, which have 75–80% response rates. In a recent assess­ment of voricona­zole and posacona­zole for both ABPA and SAFS, 75% of patients were able to stop tak­ing oral cor­ti­cos­teroids, a major ben­e­fit, and 38% of patients had their asth­ma sever­i­ty down­grad­ed on anti­fun­gal ther­a­py.

Pro­fes­sor David Den­ning, pro­fes­sor of med­i­cine and med­ical mycol­o­gy at the Uni­ver­si­ty of Man­ches­ter and Direc­tor of the Uni­ver­si­ty Hos­pi­tal of South Manchester’s Nation­al Aspergillo­sis Cen­tre, led the study into the total num­ber of asth­mat­ics world­wide. He said the study results implied that asth­ma admis­sions and deaths could be avoid­ed with more exten­sive use of anti­fun­gal ther­a­py.

“We were sur­prised by the num­ber of patients with ABPA, and by the lack of com­mu­ni­ty based stud­ies done,” he said. “Our Nation­al Aspergillo­sis Cen­tre treats hun­dreds of these patients each year, gen­er­al­ly with major improve­ment, and so a con­scious pro­gram to seek out ABPA from all asth­mat­ics is required.”

Pro­fes­sor Don­ald Cole of the Dal­la Lana School of Pub­lic Health at the Uni­ver­si­ty of Toron­to was the senior author of the study and con­tributed his expert epi­demi­o­log­i­cal knowl­edge to the devel­op­ment of the mod­el and pro­vid­ed a ‘real­i­ty’ check of the model’s esti­mates.

To view the paper enti­tled, Glob­al bur­den of asth­ma in adults and ABPA, click here: (


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