Nebulised corticosteroid and amphotericin B: an alternative treatment for ABPA?

To the Editors: Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disease that results from a hypersensitivity response to Aspergillus fumigatus 1. It occurs in asthmatic and cystic fibrosis (CF) patients, with a prevalence among CF patients recently estimated at 7.8% 1. The natural course is characterised by acute exacerbations, which can be life-threatening 2, and progressive, irreversible, lung damage leading to long-term pulmonary fibrosis if the disease is not well controlled 1. Therapy for ABPA has two main targets. The first is the attenuation of the inflammation and immunological activity, for which oral corticosteroids are the mainstay of therapy 1. The second is the attenuation of the antigen burden arising from fungal colonisation of the bronchial tree, for which only itraconazole has shown limited evidence of its usefulness 1. However, long-term systemic corticotherapy predisposes to diabetes, osteopaenia, infections and growth retardation, especially in patients with CF, while itraconazole is associated with several drug interactions, suppression of adrenal …