Pulse Intravenous Methylprednisolone for Resistant Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis

Allergic bronchopulmonary aspergillosis (ABPA) results from a hypersensitivity response to Aspergillus fumigatus. It is seen in a number of chronic respiratory conditions, particularly in association with cystic fibrosis (CF). Oral corticosteroids and itraconazole represent the mainstay of treatment. There is evidence for the use of pulse methylprednisolone in other respiratory conditions as well as a number of inflammatory conditions. This is the first reported use of pulse intravenous methylprednisolone in the treatment of ABPA in CF. We present the clinical course of four children with CF and severe ABPA, in whom pulse methyprednisolone was used to manage the disease because of relapses or marked side effects on high‐dose oral corticosteroids. Methylprednisolone pulses achieved disease control in 3 of the 4 children. However, troublesome side effects were experienced, in some cases necessitating discontinuation of therapy. Pulse methylprednisolone may represent a treatment option for children with CF and ABPA, where ABPA fails to respond adequately to routine therapy. Pediatr Pulmonol. © 2005 Wiley‐Liss, Inc.