To evaluate the efficacy and safety of itraconazole on the advanced age patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pulmonary fungal infection.

Beijing Friendship Hospital information system was searched and the clinical data of patients with AECOPD complicated with pulmonary fungal infection who were hospitalized in Department of Emergency Medicine, Beijing Friendship Hospital from January 1st, 2013 to January 1st, 2016 were collected and analyzed retrospectively. The patients were divided into the advanced age group (≥ 80 year-old) and the middle age group (40-60 year-old). The dosage regimen included IV infusion of itraconazole 200 mg once per 12 hours in the first 2 days, then 200 mg once daily until to the end of observation in the Department of Emergency Medicine or changed to take itraconazole orally for consolidation. The clinical efficacy rate, fungal clearance rate and incidence of adverse drug reactions (ADR) were compared between the patients in the 2 groups.

A total of 132 patients were enrolled in the analysis. There were 60 and 72 cases in the advanced age group and the middle age group, respectively. The average time of using itraconazole in the advanced age group and the middle age group were (19±5)d and (16±3)d, the difference was statistically significant (P<0.01). The patients in the 2 groups received the symptomatic treatments which included meropenem or imipenem and cilastatin sodium for anti-infection, dyphylline for preventing asthma, and ambroxol hydrochloride for eliminating phlegm at the same time. The results of sputum culture showed that the case number of candida infection and aspergillus infection were 35 (58.3%) and 25 (41.7%) in the advanced age group, 48 (66.7) and 24 (33.3%) in the middle age group, respectively. At the end of intravenous medication of itraconazole, the body temperature, white blood cell count, and neutrophile granulocyte proportion in the 2 groups were lower than those before medication (all P<0.05), but the difference between them was not statistically significant (P>0.05). The proportion of cases with the symptoms or sign of cough, gasp for breath, and pulmonary rale in the 2 groups were lower than those before medication (all P<0.01), but the difference between 2 groups was not statistically significant (P>0.05). Imaging examination results were better obviously than those before medication, the difference was statistically significant (P<0.01). The clinical effective rate and the fungal clearance rate in the advanced age group and the middle age group were 78.3%(47/60) and 75.0%(45/60) , 80.6%(58/72) and 80.6%(58/72), respectively. The differences were not statistically significant (all P>0.05). One case in each group appeared gastrointestinal reactions on day 5 and 10 of IV infusion of itraconazole, respectively. The adverse reactions were disappeared on day 2 and 7 of symptomatic treatments, respectively.

Itraconazole has an affirmatory curative effect and also is safe in treatment of advanced patient who with AECOPD complicated with pulmonary fungal infection.

Itraconazole; Pulmonary disease, chronic obstructive; Lung diseases, fungal