The following is a summary of “Reply to: Nebulised liposomal amphotericin-B: a promising strategy for preventing ABPA relapse” published in the November 2022 Issue of Respiratory by  Godet, et al.

Regarding their initial point about the research population, researchers agree that maintenance treatment may be more necessary and more beneficial in patients who have experienced recurrent exacerbations in the past than in those who have not. To test this idea, researchers focused on people who had experienced exacerbations in the past, and the results backed up our hunch (i.e., in the past years). 

In patients who had experienced at least one severe exacerbation before inclusion, researchers found that 27% of those receiving active treatment experienced 2 or more severe exacerbations during the 24-month follow-up period, while 53% of those receiving placebo experienced 3 or more severe exacerbations (p=0.03). However, in the context of their randomized study, researchers chose to include a clearly defined cohort and to investigate without “a priori” the effect of a maintenance medication after a homogenous attack treatment. In reality, the success of maintenance treatment may be affected by factors other than the occurrence or absence of exacerbations in the past.

It could be instructive to assess the value of a maintenance approach and its effect on future relapse or complete remission in accordance with the computed tomography (CT) scan phenotype at inclusion. In addition, predictive indicators, such as high-attenuation mucus impactions, may also affect the likelihood of recurrence or complete remission in the future, which is an intriguing possibility.