Difficulty breathing because of asthma—a condition that narrows airways and increases mucous production —is scary, uncomfortable and even life-threatening. But now it appears that many of the 24 million people in the United States who have the condition might be helped by adding an antifungal therapy to their asthma medications.
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Researchers at the University of Toronto in Canada and the University of Manchester in England have found that oral antifungal drugs improve asthma symptoms and control in 60 percent of asthmatics, when used in addition to standard asthma therapy. Seventy-five percent of patients were able to stop taking oral corticosteroids, which reduce swelling and inflammation but can have problematic side effects. And in 38 percent, their asthma symptoms became less severe.
“Patients began to get better within one month. They were much better after four months and stable at eight months,” says lead author Dr. David Denning, University of Manchester professor of medicine and medical mycology, and director of the National Aspergillosis Centre at the University Hospital of South Manchester. “But once they went off the therapy, their asthma got worse again.”
Why Anti-Fungals May Help
“Most asthma patients have a low level of fungus in their airways,” says Denning. “The fungus produces allergens, so there is an ongoing allergic response in the body. If you take an anti-fungal medication, you get rid of that allergic response.” Allergies worsen asthma by increasing inflammation in the airways.
Antifungals also help ease asthma symptoms by boosting the effect of inhaled—but not oral–steroid medications, the mainstay of asthma therapy, says Denning.
The result is easier breathing, less mucous and less need of other medications, says Denning. “The need for both inhaled and oral steroids goes down,” he says.
That’s a good thing for two reasons, says Denning: Steroids are not completely effective at controlling asthma symptoms in many patients, and long-term steroid use has serious side effects, including high blood pressure, thinning skin and osteoporosis.
Right now, three antifungals are available: itraconazole (Sporanox, Onmel)—a generic and the least expensive of the three—which helped 60 percent of asthmatics who tried it; voriconazole (Vfend) and posaconazole (Noxafil), which had 75-80 percent response rates.
The three expensive medications are only licensed by the U.S. Food and Drug Administration to use on fungal infections, and are primarily for transplant patients and those with leukemia, says Denning.
The drugs also come with side effects. Posaconazole is the best tolerated, although it can cause nausea, diarrhea, or constipation. All three drugs can cause numbness in the fingers and toes and in rare cases, liver injury.
Although roadblocks remain, and more investigations are needed, the study results suggest that wider use of the anti-fungal therapies could reduce asthma suffering and even deaths.