This week in aspergillosis research
Each week we look at recently published research that may be relevant to people affected by aspergillosis, their families and healthcare professionals. Most new studies are early pieces of a much larger evidence base, so they rarely change treatment immediately. They can, however, point towards promising areas for future care.
Dupilumab and ABPA in children with cystic fibrosis
The most directly relevant paper this week is a small case series describing three children with cystic fibrosis (CF) and difficult-to-control allergic bronchopulmonary aspergillosis (ABPA).
ABPA is an allergic inflammatory reaction to Aspergillus in the airways. It can cause worsening asthma-like symptoms, mucus plugging, lung inflammation and repeated flare-ups. Treatment commonly includes steroid medicines and antifungal medication, but both can be difficult to use over the long term because of side effects, interactions or limited response.
In this report, the children received dupilumab, a biologic medicine that blocks parts of the type 2 allergic-inflammatory pathway. The authors reported falls in total IgE and that treatment was well tolerated.
This is encouraging, particularly for people whose ABPA remains active despite standard treatment or where steroids cause major problems. However, it is important to keep the finding in proportion: this was a report of only three children with CF, not a controlled clinical trial. It cannot yet show which patients will benefit, how it compares with other treatments, or whether the results apply to adults or people with ABPA who do not have CF.
Read the paper: Dupilumab for ABPA in three children with cystic fibrosis
COVID-19-associated pulmonary aspergillosis
A study from a Brazilian tertiary hospital examined Aspergillus isolates from critically ill patients with suspected COVID-19-associated pulmonary aspergillosis (CAPA). The researchers analysed 17 isolates from respiratory samples, focusing on species identification and susceptibility to antifungal medicines.
CAPA remains an important concern for people who are severely unwell with COVID-19 in intensive care. Studies like this help laboratories and clinical teams understand which Aspergillus species are involved locally and whether there are signs that treatment may be affected by antifungal resistance.
This is primarily a specialist and hospital-based study. It does not suggest that ordinary COVID-19 infection causes aspergillosis in otherwise well people, but it adds useful evidence about a serious complication in critically ill patients.
Read the paper: CAPA study from Brazil
Why antifungal resistance continues to matter
A new review looks at how Aspergillus fumigatus causes disease in people with different levels of immune function. It also discusses resistance to azole antifungal medicines, a group that includes commonly used treatments such as itraconazole, voriconazole, posaconazole and isavuconazole.
Resistance does not mean that antifungal treatment will fail for every person. It does underline why specialist care often includes identifying the fungus where possible, testing its susceptibility to treatment, monitoring medicine levels and reviewing treatment response carefully.
The paper is a narrative review rather than new clinical-trial evidence, but it is a useful overview of why resistance is an ongoing issue for clinicians and researchers.
Read the review: Aspergillus fumigatus, disease and triazole resistance
What this means for patients
The dupilumab report is a welcome early signal, but it is not yet enough to change usual ABPA treatment. If you have questions about biologic medicines, steroids, antifungal treatment or treatment side effects, discuss them with your aspergillosis or respiratory team. They can consider your diagnosis, test results, other medicines and individual circumstances.
Research helps build the evidence base, one study at a time. We will continue to share developments that are likely to be useful to the aspergillosis community.
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