ABPA PATIENTS: 3 YEARS FOLLOW UP

We treated 59 patients affected by ABPA with a combined therapy of voriconazole at a dose of 200 mg twice a day for 4 months and prednisolone at dose of 0.75 mg/kg/day tapering in 4 months. At baseline mean patients’ FEV1 value was 63% of predicted, total IgE were 1,765 IU/ml, blood eosinophils were 2,006 cell/ml, specific IgE for Af were 86 KU/L and IgG specific for Af were 3.66 KU/L. At 6 months after therapy, the clinical, immunological and functional response was completed. 40 patients reached 3 years of follow up and we evaluate the response. 6 patients experienced a loss of control of the disease with a flare-up of asthmatic symptoms: they showed clinical symptoms of asthma, increase in total IgE, specific IgE for Aspergillus fumigatus and increased peripheral eosinophils. In all the 40 patients we performed chest CT and bronchoscopy at 3 years. In patients under control the central bronchiectasis remained clean at 3 years, while in 6 non controlled patients we had mucus plugs. In bronchoalveolar lavage fluid (BAL) we saw a significant increase of eosinophils numbers in patients without control. In patients under control the values were these: total IgE 186 IU/ml; blood eosinophils were 289 cell/ml, specific IgE for Af were 1,01 KU/L and IgG specific for Af were 3.58 KU/L. FEV1 82%. In patients without control the values were: total IgE 1.896 IU/ml blood eosinophils 1.457 cell/ml, specific IgE for Af were 77 KU/L and IgG specific for Af were 3.49 KU/L. FEV1 57%. We treated lost control patients with biological therapy: 4 with anti IL-5 therapy and 2 with anti IL4/13, obtaining clinical stabilization of the disease, without the need of further systemic steroidal therapy.