Can You Cure Asthma With Antifungal Medicine?

For many people, asthma is a mysterious condition. Wheezing and shortness of breath may seem to come from nowhere. Health professionals frequently blame asthma on allergies. Perhaps a person is allergic to a beloved cat. Dust mites that live in mattresses or upholstered furniture may also be blamed. Whatever the presumed cause, this inflammatory condition can be a lifelong challenge. Once diagnosed, the most likely prescriptions will be inhaled corticosteroids and bronchodilators. What doctor would ever think to cure asthma with antifungal medication?

An Amazing and Unexpected Way to Cure Asthma:

Q. My wife had severe asthma for 35 years, from the time she was a little girl. She used all sorts of inhalers and sometimes she needed oral prednisone.

Then, in middle age, she developed nail fungus. The doctor finally prescribed oral itraconazole (Sporanox) to clear it up. She had to take this antifungal medicine for more than a year while the nails grew out.

Several months into the treatment, she realized that her asthma was better. By the end of the treatment, she no longer had asthma. She hasn’t needed any asthma medicine since, and that was decades ago. Have you ever heard of such a thing?

A. Until we heard your story we would have said there is no way to cure asthma with an antifungal drug. But then we started digging through the medical literature.

It turns out that some people with hard-to-manage asthma have an allergic response to a fungus that has colonized their airways (Journal of Asthma, Sept. 2016).  This condition can be treated with antifungal medicine (Medical Mycology Case Reports, April 25, 2017).

Such drugs are tricky, though, as they often interact with other medicines and carry a range of risks.

Drug Interactions Can be Deadly:

Anyone taking itraconazole must have the prescribing physician AND the pharmacist double and triple check for drug interactions. There is a black box warning with this medicine that says:

Drug Interactions:

“Coadministration of the following drugs are contraindicated with SPORANOX® Capsules: methadone, disopyramide, dofetilide, dronedarone, quinidine, isavuconazole, ergot alkaloids (such as dihydroergotamine, ergometrine (ergonovine), ergotamine, methylergometrine (methylergonovine)), irinotecan, lurasidone, oral midazolam, pimozide, triazolam, felodipine, nisoldipine, ivabradine, ranolazine, eplerenone, cisapride, naloxegol, lomitapide, lovastatin, simvastatin, avanafil, ticagrelor. In addition, coadministration with colchicine, fesoterodine and solifenacin is contraindicated in subjects with varying degrees of renal or hepatic impairment, and coadministration with eliglustat is contraindicated in subjects that are poor or intermediate metabolizers of CYP2D6 and in subjects taking strong or moderate CYP2D6 inhibitors. See PRECAUTIONS: DRUG INTERACTIONS Section for specific examples. Coadministration with itraconazole can cause elevated plasma concentrations of these drugs and may increase or prolong both the pharmacologic effects and/or adverse reactions to these drugs. For example, increased plasma concentrations of some of these drugs can lead to QT prolongation and ventricular tachyarrhythmias including occurrences of torsades de pointes, a potentially fatal arrhythmia.”

Make sure that if you are taking any other medications with Sporanox someone has checked carefully to eliminate any potential problems.

Another Unexpected Asthma Drug:

Another medication that may help hard-to-treat asthma is the antibiotic azithromycin. A randomized controlled trial (AMAZES) showed that people taking azithromycin along with asthma inhalers had fewer flare-ups and better quality of life (The Lancet, Aug. 12, 2017).

You will find much more information about this approach in the book, A Cure for Asthma? What Your Doctor Isn’t Telling You–and Why, by Dr. David Hahn. Here is a link.

Share your own asthma story in the comment section. Have you been able to cure asthma? If so, we would love to hear about it.