Mahsa Manafi Varkiani - Innovative Medical Research Center, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
Majid Mirsadraee - Department of Internal Medicine, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
Zahra Anhaee Nasseri - Innovative Medical Research Center, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
Mohammadreza Khakzad - Innovative Medical Research Center, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
Shadi Ghaffari - Department of Physiology, Faculty of Biology, Islamic Azad University, Damghan Branch, Damghan, Iran
Tayebeh Rabbani Nia - Innovative Medical Research Center, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran

Background and Purpose: Considering the possible role of fungal sensitization in the treatment of resistant asthma, which may lead to the remodeling of bronchial structure, we theorized that itraconazole could result in better control of asthma. In this regard, this study aimed to compare the effects of itraconazole and prednisolone (routinely prescribed) on clinical, structural, and biomarker findings of the remodeling of asthma.Materials and Methods: This double-blind controlled randomized clinical trial was performed on ۷۰ adult patients suffering from severe persistent asthma. The intervention group received ۲۰۰ mg of itraconazole per day, and the control group received ۱۰ mg of prednisolone per day, for ۳۲ weeks, in addition to the classic treatment of asthma. The subjects were randomly divided into two groups, and assigned by sealed envelope. Blinding was performed by repacking the drug in a similar container. Primary outcomes were asthma control test score, fibroblast growth factor ۲, and wall area percentage on RB۱ bronchus measured by computed tomography. The outcomes were compared in subjects classified as allergic, eosinophilic, T۲ low asthma, and four types of inflammatory cell classification in sputum.Results: Seventy subjects finished the ۳۲-week trial (۳۵ subjects in each group). Baseline data did not show significant differences between groups. A comparison of asthma variants showed significantly more severe cough and dyspnea in the allergic variant and higher spirometry results in T۲-low asthma. Sputum cytology revealed a mixed pattern as the most frequent type (۴۷%). After the trial, two groups improved in many parameters; however, FGF-۲ improved more significantly by itraconazole (۴.۶۶±۱۶.۹۲ decreased to ۱.۱۴±۲.۹۸), and FEV۱/FVC was significantly higher in the itraconazole group,compared to the control group. These results did not change in terms of asthma variants and sputum classification.Conclusion: Itraconazole was superior to prednisolone in the treatment of many clinical and spirometry aspects in severe persistent asthma.

Asthma, Bronchial wall thickness, Fibroblast growth factor ۲, itraconazole, Prednisolone, Remodeling