The efficacy of antifungal therapy in fungal-associated severe asthma remains controversial. This study aimed to evaluate the clinical presentation differences and response to antifungal therapy between severe asthmatics with fungal sensitization and positive fungal isolates. This retrospective study included 73 patients with severe asthma from January 2004 to December 2017. We examined the presentation, medication, exacerbations, pulmonary function, serum IgE, blood eosinophils, and sputum culture results. Follow-up care was provided to each patient for a minimum of 3 years.

We classified the patients into four groups: group 1, neither fungal sensitization nor fungal isolates in the sputum (n=16); group 2, positive fungal sensitization (n=16); group 3, positive fungal isolates (n=31); and group 4, concomitant positive fungal sensitization and positive fungal isolates (n=10). There were four participants in group 2, 15 in group 3, and 6 in group 4 who had received itraconazole therapy for three months. Patients in group 3 presented with lower serum IgE levels than those in groups 2 and 4. Antifungal therapy significantly improved ACT score during the first year in groups 3 (from 18 to 24) and resulted in a long-lasting ACT improvement till the third year in group 3 (from 18 to 2).

Antifungal therapy could effectively control the symptoms in patients with severe asthma with positive fungal isolates, contrary to those with merely fungal sensitization; therefore, highlighting the need for a more precise treatment strategy in the future for fungal-associated severe asthma.