Aerosolized Antifungals for the Treatment of Pulmonary Fungal Diseases

Inhaled antifungals achieve high lung concentrations with minimal systemic adverse events. Despite being available for over five decades, data supporting their use outside the mold-active prophylaxis setting are lacking. Herein, we review the recent evidence on inhaled antifungals in treating pulmonary aspergillosis (allergic, chronic, and invasive) and mucormycosis.

Several antifungals have recently been evaluated, including repurposed and newer inhaled agents (opelconazole). Inhaled amphotericin B deoxycholate (in pulmonary mucormycosis) and liposomal formulation (in invasive aspergillosis) were safely used in two recent randomized trials. However, both these small trials failed to demonstrate added benefit with adjunctive inhaled amphotericin. In allergic bronchopulmonary aspergillosis, nebulized amphotericin B may prolong the time-to-exacerbation when used in patients experiencing frequent exacerbations.

The last decade has witnessed considerable progress in inhaled antifungals. Ongoing trials will likely offer hope for managing allergic and invasive pulmonary mycoses in the future.