Authors: Danielle Cassidy, Pharm.D., BCPS, Laney Jorgenson, Pharm.D., & Jennifer Hamner, Pharm.D. Audience: Pediatric Pharmacy Advocacy Group (PPAG) Conference in Balitmore, MD October 2008; Children's Hospital Colorado medical staff January 2009.

1. A Retrospective Review of Treatment for Allergic Bronchopulmonary
Aspergillosis in Patients with Cystic Fibrosis Affiliated with
Danielle Cassidy, Pharm.D., Laney Jorgenson, Pharm.D., & Jennifer Hamner, Pharm.D. University of Colorado Denver
The Children’s Hospital, Denver, CO
Background Patient Characteristics
Results Limitations
(n=50)
• Patients with cystic fibrosis
Treatment Regimens Treatment Tolerance 1) Missing or incomplete charting of
(CF) are at increased risk for Methods Gender (n)
parameters collected
multiple infections, including Male 46 Treatment Patients Dose Hospital Out-
• Retrospective medical chart (n) (mg) Treatment patient 2) Improper chart interpretation
Aspergillus fumigatus. Female 4
review Mean (days) Rx (n)
• The presence of Aspergillus • Study period 10 years (01/97- Age (years) 3) Small sample size
leads to a constellation of [range] Mean
10/07) Mean 15.2 ± 6.2 [range] 4) Unable to determine contribution
symptoms referred to as • Reviewed and approved by of treatment response from other
Weight (kg)
allergic bronchopulmonary the Colorado Multiple Prednisone 23 (46%) 25.6 10.6 15
Mean 59.4 ± 4.1 [10-30] [5-21] standard CF therapies
aspergillosis (ABPA). Institutional Review Board
• ABAP may lead to a faster Admission Symptoms (%)
• Informed consent was not Itraconazole 42 (84%) 160.71 11.79 32
decline in pulmonary function. required Worsening Cough 80 [100-300] [1-30]
• Current treatment guidelines Increased sputum 42
Voriconazole 13 (26%) 138.45 8.77 7
recommend corticosteroids for productions
[100-200] [1-14]
all ABAP exacerbations, and SOB 40
Amphotercin 2 (4%) 2 5.5 2
the addition of itraconazole for New/increased 18
(nebulized) [4-7]
poor corticosteroid responders pulmonary infiltrates
or corticosteroid-dependent Fatigue 16 Azathioprine 1 (2%) 250 5 1 Conclusions
patients. Decreasing PFT’s 14 1) Novel treatment regimens
utilized at TCH include
itraconazole, voriconazole,
Primary Outcomes Therapeutic Outcomes nebulized amphotercin, and
azathioprine.
1) Characterization of 2) Therapeutic outcomes
standard and novel ABPA associated with both treatment
treatment regimens regimens led to improvement in
Study Objectives 2) Describe therapeutic FEV1, a decrease in serum IgE,
outcomes of these and complete resolution of
• To describe both standard and treatment regimens symptoms.
novel treatment regimens for a) FEV1 3) Therapy was generally well
ABPA in patients with CF at tolerated with only 14% of
TCH. b) IgE
c) Changes in symptoms Range Range patients experiencing ADEs.
• Evaluate the therapeutic 3-4208 3-5966
outcomes associated with 4) Additional studies are warranted
d) Adverse drug events SD ±23
standard and novel treatment to further define the role of these
(ADE)
regimens. novel therapies.