Posaconazole works better than itraconazole and voriconazole against ABPA amongst Cystic Fibrosis patients

A recently published research paper suggests that Posaconazole works better than itraconazole and voriconazole against
allergic bronchopulmonary aspergillosis (ABPA) in patients with Cystic Fibrosis.

ABPA patients tend to have a hypersensitive response to Aspergillus species which results in inflammation, airway destruction and bronchiectasis. Cystic fibrosis (CF) patients are at risk of ABPA which then speeds up lung function decline. The current ‘gold standard’ treatment is prednisolone to reduce inflammation. Azoles have been used effectively as steroid alternatives but have various side effects and tolerance issues.

In the newly published paper the authors wanted to know if posaconazole, which is known to be less toxic and better absorbed than other azoles, was more effective at treating ABPA.

They analysed data from 596 CF patients, and reviewed the specific Aspergillus IgE levels and azole levels in blood samples. 32 patients were identified and included in the analysis. 11 had itraconazole alone, 12 had two different azoles and 9 received all three azoles. In total, 30 received itraconazole, 13 received voriconazole, 18 received posaconazole.

The authors found IgE levels to be significantly reduced when posaconazole was used, but not the other azoles, suggesting that monitoring posaconazole levels and altering the dose given to the patient to attain greater serum levels of IgE gives improved blood test results in ABPA patients.

Want to know more? Read the paper here!

Interviews with Patients and Carers

Stories from other patients form an important part of patient support. Many people report that listening to or reading about someone else who has the same infection, and thinking about their experiences, helps them feel less alone as they come to terms with their own illness. 

Carers are not forgotten, they are a very important group who also require support – in fact if we only supported patients we would be neglecting half of the people we need to help. Two of the videos below are given by carers.

If you would like to find more patient and carer stories, have a look at our written stories page.

Keep going! Keep going! Keep going!

At this month’s patient support meeting Phil Langridge, Specialist Physiotherapist at Manchester University NHS Foundation Trust, Wythenshawe Hospital, gave a fantastic talk all about spirometry and lung function tests.

He started the talk with a simple question “Do you look forward to lung function tests?” An audience member offered a simple reply “No, it’s purgatory”.

Lung function tests are hard. The thing is, they’re maximum function tests. The staff carrying out the tests sometimes sound a bit strict, firmly telling you to keep going and put more effort in. The tests are tough, and for some people they can take a while to recover from. That’s because they need maximum effort and it can take a lot out of some people.

Phil gave us an overview of most commonly used tests, starting with the spirometry test. Sometimes these tests can be done at your GP surgery with a practice nurse in a familiar setting. Sometimes they have to be done in hospital and this can lack privacy and be a bit intimidating. Try not to worry, staff understand this, just tell them you’re feeling nervous and they’ll do what they can to help so your test gives the best result possible.

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Yeast that live in the human gut can trigger the immune system to cause inflammation in the lung, especially in patients with ABPA.

The yeast Candida albicans lives in the gut as a commensal organism, usually without issue. C. albicans causes the body to produce a particular kind of immune cell, called Th17 sensitive cells, that stop the Candida from causing infections. A new research paper out this month shows that the Th17 cells that react to Candida in the gut also react to Aspergillus in the lung by a process called ‘cross reactivity’.

Cross reactivity was shown to increase the levels of Aspergillus reactive Th17 cells in the blood of patients with Cystic Fibrosis, COPD and asthma, especially during ABPA. This indicates that there is a direct link between the normal, protective Th17 responses against Candida in the gut, and harmful inflammation by Aspergillus in the lung.

In other words, problems in your lungs might be made worse by the normal immune response to Candida in your gut. This knowledge could affect the way we treat flare ups in future. For example, we already know that using antibiotics can increase the growth of Candida in the gut. This new information raises the possibility that increased Candida in the gut could cause increased lung inflammation or a ‘flare up’ of symptoms in patients with Aspergillosis, but further work would be needed to confirm this.

Read the paper here