Is bronchial thermoplasty safe in allergic bronchopulmonary aspergillosis or severe asthma with fungal sensitization?

Excerpt

We read with interest the case presented by Sasada et al., describing the occurrence of aspergillosis in a patient who underwent bronchial thermoplasty (BT) [1]. The isolation of Aspergillus fumigatus, the presence of elevated serum total IgE, and possible eosinophilic inflammation (high FeNO) suggest allergic sensitization to A.fumigatus. However, the diagnosis remains unproven as specific IgE or skin test against A.fumigatus was not performed in the index case. The authors mention that there was a remarkable improvement after BT. With only two sessions of BT being completed, the observed improvement is likely the effect of itraconazole therapy. Itraconazole offers excellent results in patients with severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA) [2, 3]. The absence of bronchiectasis on computed tomography does not rule out ABPA and therefore, immunological investigations are required [4]. The prevalence of Aspergillus sensitization is about 28% in asthmatics and maybe as high as 50% in those with severe asthma [5, 6]. …