Systemic or topical treatment with
antifungal agents are applied for the treatment of chronic
pulmonary aspergillosis (fungus ball type, mural thickness type). Recently, the concomitant treatment with
elastase inhibitor has been studied for the purpose of relieving tissue destruction by inhibiting
elastase derived from aspergillus species. In the present study, we have examined the clinical effect of the topical treatment with
Amphotericin B in patients with chronic
pulmonary aspergillosis, and the concomitant use of
Ulinastatin has also been examined in patients with symptoms such as hemosputum and
hemoptysis.
Amphotericin B was administered by transcatheter intracavity injection or transbronchial intrapulmonary injection. In some patients, inhalation was concomitantly employed.
Amphotericin B was challenged by inhalation before starting the topical treatment, and if the patient experienced an
asthma like attack, the present
therapies were not conducted.
Ulinastatin was administered by
intravenous drip infusion concomitantly with
antifungal agents and
hemostatics. As a result, improvements regarding antifungal effects and clinical symptoms were found in 12 out of 15 patients treated with
Amphotericin B. Further, early disappearance of hemosputum and
hemoptysis was seen in 11 out of 23 episodes in 14 patients concomitantly treated with
Ulinastatin. The treatment-related side effects, leading to discontinuation of those
therapies, did not occur. Immunoresponse of
allergy was studied in the patients ineligible for
Amphotericin B topical treatment and the non-responders to
Ulinastatin, and aspergillus specific
IgE antibodies in serum were increased in the majority of patients. From the above results, it is desirable to carry out the topical treatment in chronic
pulmonary aspergillosis. Also, it was considered valuable to apply the concomitant treatment with
Ulinastatin,
elastase inhibitor, to patients with severe clinical symptoms of hemosputum and
hemoptysis.