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How important is antifungic treatment in ABPA (voriko)? Is it more beneficial for the outcome if it is added to steroid treatment?
How do you monitor outcome/relapses of ABPA?
Dear Sir

Anti-fungal is important in the treatment of ABPA. ABPA is essentially a reaction to fungal antigens within the airway and has some similarities to asthma. It is usually treated with oral corticosteroids but studies outside of CF have shown that using an anti-fungal drug such as Voriconazole is helpful in reducing the amount of steroids needed to control the disease. It may have some benefit on its own but is probably best used with oral corticosteroid treatment. There are a few direct studies in CF with regard to treatment but this approach would be supportive from the treatment of ABPA when it occurs outside of the context of CF as well as limited data available for cystic fibrosis.

ABPA is monitored by taking a combination of clinical symptoms, chest radiograph images and blood test measurements of immunoglobulin E and immunoglobulin G antibodies against aspergillus antigens. The critical part of the monitoring is how the individual is with measurements of lung function and the blood tests are supportive. Symptoms of an episode of ABPA are very similar to CF symptoms and it is often difficult to distinguish between an infective exacerbation or an episode of ABPA. The specific symptoms of wheeze and the support of blood tests of eosinophil count and antibody measurements are helpful in this context.

Kind Regards

Stuart Elborn
The answer is edited by: Prof Stuart Elborn