pulmicort and Candidiasis

Allergic Bronchopulmonary Mycosis (ABPM) is an exagregated immunologic response to fungal colonization in the lower airways. It may cause by many kinds of fungal, but Aspergillus fumigatus is the most common cause of ABPM, although other Aspergillus and other fungal organisms, like Candida albicans, have been implicated. Aspergllus fumigatus and Candida albicans may be found as outdoor and indoor fungi, and cause the sensitization, elicitation of the disease pathology, and its clinical manifestations. Several diagnostic procedurs may be impicated to support the diagnosis of ABPM caused by Aspergillus fumigatus and Candida albicans. A case of allergic bronchopulmonary mycosis caused by Aspergillus fumigatus and Candida albicans in a 48 year old man was discussed. The patient was treated with antifungal, corticosteroids, and antibiotic for the secondary bacterial infection. The patient's condition is improved without any significant side effects.

Topics: Ambroxol; Anti-Bacterial Agents; Antifungal Agents; Aspergillus fumigatus; Bronchodilator Agents; Budesonide; Candida albicans; Candidiasis; Ethanolamines; Expectorants; Fluconazole; Formoterol Fumarate; Glucocorticoids; Humans; Invasive Pulmonary Aspergillosis; Itraconazole; Lung Diseases, Fungal; Male; Methylprednisolone; Middle Aged; Ofloxacin

Over the last few decades, inhaled corticosteroids (ICs) became the cornerstone in the treatment of persistent asthma. Their use improved asthma control, decreased mortality and also minimized adverse reactions associated with systemic steroid. Esophageal candidiasis is a rare complication resulting from the use of ICs. Although, in recent years, as their prescriptions has increased, more cases have been reported, especially in Japan. Listed are 4 case reports regarding esophageal candidiasis in asthmatic patients associated with inhaled budesonide administration. In the cases reported herein, the use of a different device of dry powder budesonide might have favored esophageal drug deposition and Candida infection. Patients denied using systemic corticosteroids in the previous 6 months. Furthermore, none of the patients presented Diabetes mellitus, malignant disease, HIV infection, or other immunosuppressive conditions. We conclude that patients treated with high doses of ICs are at higher risk of developing esophageal candidiasis. These patients should undergo upper gastrointestinal endoscopy whenever they present symptoms. Nevertheless, we must keep in mind that infection might also be asymptomatic and esophageal candidiasis prevalence may be higher than that reported thus far.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Aged; Asthma; Budesonide; Candidiasis; Dose-Response Relationship, Drug; Esophageal Diseases; Ethanolamines; Female; Follow-Up Studies; Formoterol Fumarate; Humans; Immunocompromised Host; Male; Middle Aged; Risk Assessment; Sampling Studies

Nine of 14 asthmatic patients who presented with persistent dysphonia while taking inhaled corticosteroids had a bilateral adductor vocal cord deformity with bowing of the cords on phonation. This causes the dysphonia and usually occurs without candidiasis. It was seen with beclomethasone dipropionate (in both pressurised aerosol and dry powder preparations), betamethasone valerate, and budesonide. It was related to the dose and potency of inhaled steroid and may represent a local steroid myopathy. It was reversed when the inhaled steroid was stopped, although resolution sometimes took weeks. Laryngeal candidiasis may have contributed to the vocal cord abnormality in two of these nine patients. Of the five patients without vocal cord deformity, laryngeal candidiasis was the sole cause of dysphonia in three. In the remaining two dysphonia was thought to be psychogenic. The vocal cord deformity may exist subclinically. Of nine patients who started to take aerosol steroid and who were examined monthly for one year, three developed vocal cord deformity but only one had persistent dysphonia. Vocal abuse did not appear to contribute to dysphonia.

Topics: Adult; Aged; Beclomethasone; Betamethasone Valerate; Budesonide; Candidiasis; Female; Glucocorticoids; Humans; Laryngeal Diseases; Larynx; Male; Middle Aged; Pharynx; Pregnenediones; Vocal Cords; Voice Disorders

This is a preliminary report on the first half of a study designed to assess the ability of two different spacer devices to improve the results of aerosol steroid treatment in chronic asthmatic patients given budesonide in low and high dosages. The spacers significantly reduced oropharyngeal candidiasis but did not affect dysphonia - possibly because the incidence of the latter was so low throughout the study. The spacers augmented the airway response to budesonide in these patients without materially increasing systemic absorption of the drug (assessed indirectly in terms of the change in blood eosinophil counts). Pretreatment with inhaled terbutaline did not significantly affect the performance of the spacers, either in terms of the airways responses or the amount of budesonide systemically absorbed. When used properly, these spacers can improve the cost effectiveness of aerosol steroid treatment. Since only adults were studied, it is not known whether these findings apply equally well to children with asthma.

Topics: Aerosols; Budesonide; Candidiasis; Dose-Response Relationship, Drug; Female; Humans; Male; Pregnenediones; Respiratory Therapy; Risk; Statistics as Topic