Treatments to fight fungal infections which cause allergic bronchopulmonary aspergillosis in people with cystic fibrosis

Allergic bronchopulmonary aspergillosis (ABPA) is an allergic lung reaction to a type of fungus (usually Aspergillus fumigatus) in some people with cystic fibrosis. It causes cough and wheezing and sometimes fever. If left untreated it can lead to chronic lung damage. ABPA is usually treated with a high dose of corticosteroids (also known as steroids). However, it has not been proved that corticosteroids can prevent lung function deteriorating in the long term. Also, long-term use of these drugs is linked to some serious side effects. Treating the fungus which causes ABPA may be an alternative to using high doses of steroids to combat the allergic reaction. No trials were found which we could include in the review. There are trials in people without cystic fibrosis which have shown that if treatment is given to reduce the fungus, the steroid dose can be reduced with no adverse effects. However, in one CF centre researchers observed that when treated with an anti-fungal agent in addition to steroids, several people became unable to produce enough cortisol (a hormone) in their adrenal glands in response to stress. There is not enough evidence for us to recommend the use of antifungal drugs in people with CF and ABPA. There should be a trial of these drugs to assess their effects in the long and the short term.