ABPA therapy - alternatives to cortisone

Question

In case of ABPA (allergic bronchopulmonary aspergillosis): are there any alternative therapies to cortisone? If there is no other possibility, what do I have to pay attention to in case of my daughter ( 9 1/2 years)?
Many thanks for your help,
Yours sincerely,

Answer

Hello,
indeed, the standard therapy of allergic bronchopulmonary aspergillosis (ABPA) consists of the treatment with cortisone (giving as a tablet) because only by this strategy one can really gain control over the excessive immune response ("allergic reaction") at the wall of the bronchus ("broncho-") in the form of asthmatic obstruction and in addtion in the lung tissue ("pulmonary") in the form of a pneumonia to the fungus (aspergillosis = disease of aspergillus). In the course of the last years treatment strategies came out more and more on the top implicating the use of a combination of cortisone with anti-mycotic agents, because the provocation due to aspergillus remaining in the system of bronchi is diminished as a consequence. Under this therapy similar good results can be obtained with less cortisone over a shorter period of time.
However, this is not totally indisputable in children, because the anti-mycotic agents are not free of side-effects.
Please talk to your CF-doctor in charge at your CF-center, that you can understand why this or another way is choosen for your daughter.
Yours sincerely,
Prof. Dr. TOF Wagner

10.11.2008