A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma

• Published in: The European respiratory journal Vol. 47; no. 2; pp. 490 - 498
• Main Authors: Agarwal, Ritesh, Aggarwal, Ashutosh N., Dhooria, Sahajal, Singh Sehgal, Inderpaul, Garg, Mandeep, Saikia, Biman, Behera, Digambar, Chakrabarti, Arunaloke
• Format: Journal Article
• Language: English
• Published: England 01.02.2016
• Subjects: Acute Disease; Adult; Aspergillosis, Allergic Bronchopulmonary - complications; Aspergillosis, Allergic Bronchopulmonary - diagnostic imaging; Aspergillosis, Allergic Bronchopulmonary - drug therapy; Aspergillosis, Allergic Bronchopulmonary - physiopathology; Asthma - complications; Asthma - diagnostic imaging; Asthma - drug therapy; Asthma - physiopathology; Bronchiectasis - complications; Bronchiectasis - diagnostic imaging; Bronchiectasis - drug therapy; Bronchiectasis - physiopathology; Disease Progression; Female; Forced Expiratory Volume; Glucocorticoids - administration & dosage; Humans; Male; Prednisolone - administration & dosage; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Vital Capacity; Young Adult
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/13993003.01475-2015

Whether use of high-dose steroids in acute-stage allergic bronchopulmonary aspergillosis (ABPA) is associated with superior outcomes is not known. Herein, we compare the efficacy and safety of two glucocorticoid protocols in ABPA. Treatment-naive ABPA subjects randomly received either high-dose or medium-dose oral prednisolone. The primary outcomes were exacerbation rates and glucocorticoid-dependent ABPA after 1 and 2 years, respectively, of treatment. The secondary end-points were composite response rates after 6 weeks, improvement in lung function, time to first exacerbation, cumulative dose and adverse effects. 92 subjects (high-dose n=44, medium-dose n=48) were included in the study. The numbers of subjects with exacerbation after 1 year (high-dose 40.9% versus medium-dose 50%, p=0.59) and glucocorticoid-dependent ABPA after 2 years (high-dose 11.4% versus medium-dose 14.6%, p=0.88) were similar in the two groups. Although composite response rates were significantly higher in the high-dose group, improvement in lung function and time to first exacerbation were similar in the two groups. Cumulative glucocorticoid dose and side-effects were significantly higher in the high-dose group. Medium-dose oral glucocorticoids are as effective and safer than high-dose in treatment of ABPA.