Hello,
Thank you for your query at DoctorSpring.com
I understand your concern.
I am a pulmonologist and have handled such cases before. So I will give you my opinion.
Any fungal infection can flare up a previously controlled asthma.
I suggest you to get a tissue diagnosis/ smear/ culture of the fungus to direct better treatment.
There is a condition called allergic bronchopulmonary aspergilloses.
That might be the most possible reason for your flare up of asthma.
I will suggest skin prick test for aspergillus, serum IgE, and IGM for aspergillus.
For topical tinea, consider terbinafine, for 21 days , oral /, topical- if you don't have photo sensitivity. I feel Terbinafine will be more helpful in your case.
Feel free to discuss further,
Hope that helps.
Dr. Jacob George P
MD IDCCM FCCP
Patient replied :
Dear Dr. George,
The information on diagnosis was helpful. Thank you for that.
As to medication, as I said above, I had already tried the terbinafine. As I recall, it was for about 4 weeks, and it did not seem to have any effect.
I have upped my itraconazole from 200 mg to 400 mg/day, It may be that recent winter rain and wind here has aggravated environmental mold spores.
Further comments welcome.
Best Regards,
J.D. Bear
Dear Mr Bear,
The recommendations for tinea in most cases remain griseofulvin and terbinafin. However as you did not obtain satisfactory results with terbinafin, not could you continue griseofulwin , I suggest to continue itraconazole around 5 mg per kg body weight , take it along with food.
Consider topical terbinafine also along with itravonazole.
Continue treatment for 4-6 weeks.
Regards