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The aspergillis requires a heavy treatment. Are there scientific studies into the effectiveness and consequences of la (long-term) treatment with anti-fungal medication?
Dear questioner,

In cystic fibrosis, there are two Aspergillus related problems.

The first problem is called allergic bronchopulmonary aspergillosis, which means that the body develops an allergic reaction to the presence of Aspergillus in the airways and the flumes. The standard treatment consists of corticosteroids/cortisone plus antifungal medications. A corticone treatment in particular gives many known side effects, mainly on weight (fast weight gain), bones (bone loss), sugar metabolism (risk of diabetics) and etc. However, in many cases of ABPA, this part of the treatment is still necessary. We are looking for medicines or schedules with fewer side effects such as the administration of very high doses corticosteroids shortly (pulse steroids) or the use of new drugs such as Omalizumab / Xolair. Unfortunately, there are not many high-quality studies that compare the different treatment methods on efficiency and long-term safety.

The second problem is that Aspergillus can also cause a kind of bronchitis. We usually do not see deep lung infections (invasive aspergillosis) in cystic fibrosis. In an individual patient it is difficult to determine whether the present of bacteria (Staphylococcus, Pseudomoans etc) or the Aspergillus cause the complaints and lung damage. Evaluation should be done by a physician with a lot of experience with the disease. Here, treatment of antifungal medication usually occurs through the mouth (orally). Here as well, some medicines can give side effects such as liver disorders or hypersensitivity to sunlight (phototoxicity).

Sometimes antifungal in aerosol can have an additional benefit, but here too there are no high-quality clinical studies.

It is clear that treatment of Aspergillus with cystic fibrosis is a difficult clinical problem where treatment is mainly based on experience and expertise rather than on a large number of clinical trials. On the other hand, good guidelines have been formulated by experts within this field. On this platform we cannot give individual advice on your problem, but we hope that you are satisfied with the given information.
Best regards,
Prof. K. deBoeck