Efficacy of nebulised liposomal amphotericin B in the attack and maintenance treatment of ABPA: Figure 1–

Abstract

To the Editors: Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that results from a hypersensitivity reaction to Aspergillus spp. It has been estimated to occur in 1–3% of people with chronic asthma and 2–15% of those with cystic fibrosis [1]. The natural history of ABPA is characterised by exacerbations that can threaten the patient’s survival and prognosis [1]. Repetition of such exacerbations is responsible for the development of bronchiectasis, permanent obstructive ventilation defect or fibrotic lung lesions. Prognosis mainly depends on the very early treatment of exacerbations before bronchiectasis sets in. In 2008, the guidelines of the Infectious Diseases Society of America advised combination therapy in ABPA [2]: systemic glucocorticoids to limit the inflammatory component and antifungals to limit mycelium proliferation. However, even though glucocorticoid therapy and antifungals are the treatment of choice for acute-stage ABPA and exacerbations, there are no data to guide the duration of this treatment. Therefore, the current objectives for the management of ABPA are a decrease in the frequency and duration of exacerbations, and a limited solicitation of glucocorticoids. Consequently, the maintenance treatment in the management of ABPA remains a current and progressive problem for pneumologists. We describe a case of ABPA that was difficult to control using the standard treatment regimen, but which improved dramatically and durably following administration of nebulised liposomal amphotericin B (LAmB). In May 2010, a 67-yr-old female presented with fever and productive cough, with sputum plugs and a history of epilepsy treated with phenobarbital. In the preceding 3 months, she had presented recurrent chest infections resistant to amoxicillin and ciprofloxacin; glucocorticoids (1 mg·kg−1·day …