Majid Mirsadraei - Department of Internal Medicine, Medical School of Islamic Azad University- Mashhad Branch, Mashhad, Iran.
Sanaz Dehghan - Department of Internal Medicine, Medical School of Islamic Azad University- Mashhad Branch, Mashhad, Iran.
Shadi Ghaffari - Department of Internal Medicine, Medical School of Islamic Azad University- Mashhad Branch, Mashhad, Iran.

Introduction: Itraconazole was able to control severe asthma in those with fungal sensitization. The aim of this study was to determine the impact of anti-fungal therapy in severe asthma patients irrespective of fungal sensitization results. Materials and Methods: This is a single blinded active comparator study. One hundred and ten subjectswere enrolled in the study and randomly assigned into groups of case (receiving Itraconazole 200 mg twice daily for 4 months) and control groups (receiving 10 mg prednisolone daily after breakfast). Cough, dyspnea, and sleep disturbance was quantified on a Likert scale of 1-4, with 1 showing no symptom and 4 representing severe exhausting symptoms. Asthma control test (ACT) as a marker of global evaluation of treatment effectiveness was used as the primary endpoint. Simple spirometry were done in both groups. Side effects of Itraconazole were assessed in the case group. Results: Our study revealed 71% improvement of global evaluation of treatment effectiveness after 4 months of treatment. Itraconazole was able to suppress clinical symptoms including cough, dyspnea, and night symptoms, and normalize physical exam 60%. ACT score showed significant improvement in case group (mean 14 to > 20 after 4 months). Spirometry changed significantly from obstructive pattern to normal. Itraconazole side effects were observed in 6% of users. Control group showed improvement only in dyspnea. Conclusion: This clinical study suggests that antifungal therapy is an effective tool forcontrolling clinical condition of a subgroup of patients with severe steroidrefractory asthma.

Asthma control test, Itraconazole, Resistant asthma, Spirometry.