Chronic pulmonary aspergillosis

Chronic pulmonary aspergillosis includes several types of pulmonary infection with Aspergillus species such as:Denning, 2016

  • chronic cavitary pulmonary aspergillosis
  • chronic fibrosing pulmonary aspergillosis
  • aspergilloma
  • Aspergillus nodules.

These infections usually occur in patients without immune compromise who have comorbid lung disease. Chronic pulmonary aspergillosis infections are less invasive than invasive pulmonary aspergillosis.

For patients with aspergilloma, consult a thoracic surgeon to discuss surgical resection. Surgery is often recommended to manage haemoptysis and may be curative for patients with a single lesion.

For chronic pulmonary aspergillosis in children, seek expert advice.

For chronic pulmonary aspergillosis in adults, useDenning, 2016:

1itraconazole (Lozanoc capsule) 100 mg orally, 12-hourly1. Monitor plasma concentration. See below for duration of therapy itraconazole itraconazole itraconazole

OR

1voriconazole 200 to 300 mg orally (or enterally2), 12-hourly. Take either 1 hour before or 1 hour after a meal. Monitor plasma concentration. See below for duration of therapy voriconazole voriconazole voriconazole

OR

2itraconazole (Sporanox oral liquid) 200 mg orally or (enterally3), 12-hourly1. For best absorption with oral administration, take on an empty stomach at least 1 hour before food. Monitor plasma concentration. See below for duration of therapyitraconazoleitraconazole itraconazole

OR

2itraconazole (eg Itracap, Itranox or other brands bioequivalent to Sporanox capsules) 200 mg orally, 12-hourly1. For best absorption, take with food (but not a rice meal) and do not take antacids within 2 hours. Monitor plasma concentration. See below for duration of therapy.itraconazole itraconazoleitraconazole

Compared to conventional itraconazole formulations (eg Itracap, Itranox or other brands bioequivalent to Sporanox capsules), there are limited clinical data to support the use of the Lozanoc formulation for chronic pulmonary aspergillosis. However, due to higher and more reliable bioavailability and ease of use, many experts prefer the Lozanoc formulation in practice.

Duration of therapy: seek expert advice for duration of therapy. The goal of treatment is to improve symptoms (eg haemoptysis) and prevent further fibrosis. A long duration of therapy is often required, but the benefits must be weighed against the adverse effects of long-term treatment.

1 Oral preparations of itraconazole are not bioequivalent; appropriate dosing and administration depends on the preparation.Return
2 For advice on optimising absorption of enterally administered voriconazole, consult Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
3 For advice on optimising absorption of enterally administered itraconazole (Sporanox oral liquid), consult Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return