Wheezes and desert breezes: when asthma and valley fever collide

Natalya Azadeh, Matthew A Rank, John C. Lewis, Lewis J. Wesselius, Meng Ru Cheng, Janis E. Blair

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Objective: To evaluate interactive effects of pulmonary coccidioidomycosis and asthma. Methods: We identified three groups of 33 age- and sex-matched patients: Group 1 (both asthma and coccidioidomycosis), Group 2 (asthma only), and Group 3 (pulmonary coccidioidomycosis only). Predetermined end points included: rate of disseminated coccidioidomycosis, duration of symptoms and antifungal therapy, hospitalization, death, and escalation of asthma therapies. Results: Baseline characteristics were similar across groups. Group 1 patients had worsening asthma outcomes (except forced expiratory volume in 1 s) with coccidioidomycosis. They required more asthma medications (median, 2.0 vs 0.0; p < 0.001), more corticosteroids (mean [SD], 0.9 [4.2] vs 0.3 [0.6]; p < 0.001), and more healthcare visits (mean [SD], 0.2 [0.4] vs 0.1 [0.3]; p = 0.03). Groups 1 and 3 had no differences in coccidioidal end points, including rates of dissemination (1 vs 0; p > 0.99), symptom duration (mean, 15.2 vs 23.6 weeks; p = 0.24), antifungal treatment (n = 21 [63.6%] vs n = 24 [72.7%]; p = 0.60), and treatment duration (median, 26.5 vs 11 weeks; p = 0.09). Ten patients in Group 1 versus none in Group 3 required systemic corticosteroids for coccidioidomycosis (p < 0.001). Conclusions: Active pulmonary coccidioidomycosis significantly worsens asthma outcomes. Asthma (or its treatment) does not worsen coccidioidal outcomes, despite increasing the likelihood of treatment with systemic corticosteroids.

Original languageEnglish (US)
JournalJournal of Asthma
DOIs
StateAccepted/In press - Aug 26 2015

Keywords

  • Coccidioidomycosis
  • corticosteroids
  • exacerbation
  • forced expiratory volume
  • fungal infection

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Immunology and Allergy
  • Pediatrics, Perinatology, and Child Health

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    Azadeh, N., Rank, M. A., Lewis, J. C., Wesselius, L. J., Cheng, M. R., & Blair, J. E. (Accepted/In press). Wheezes and desert breezes: when asthma and valley fever collide. Journal of Asthma. https://doi.org/10.3109/02770903.2015.1070861