Aspergillosis, encompassing allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA), has an 80% mortality rate over five years unless treated. Azoles are hepatotoxic and require regular monitoring to prevent drug-induced liver injury (DILI). Our service review aimed to evaluate diagnosis and treatment safety. 

We retrospectively analysed patients managed by the fungal respiratory team at the Royal Sussex County Hospital, Brighton from 1st July 2021 to 30th June 2022. For ABPA patients, we applied the revised diagnostic criteria (Asano K et al. J Allergy Clin Immunol. 2021 Apr;147(4)). Patients on azole treatment were reviewed to ascertain whether pretreatment tests and effective monitoring were carried out, as per local guidelines.

28 patients were managed by the service. 19 patients diagnosed with ABPA, 5 with CPA and 4 with other conditions. Of the 19 ABPA patients, 94.7% (18/19) met the revised diagnostic criteria. 60.7% of patients (17/28) had been on azole treatment, most commonly itraconazole. Median time on treatment was 8 months. All patients had baseline LFTs, and all, except one, had a pre-treatment ECG. Regarding monitoring, 75% of patients had LFTs checked in an appropriate period. Of the remaining 25% of patients, the median time to LFTs was five weeks. 80% of patients had regular LFTs monitoring. One patient stopped treatment due to DILI. Just 42.9% of patients had an azole therapeutic level sent within an appropriate time frame. For the remainder of patients, the median time to therapeutic level was 8 weeks. No patients died in this period.

Our service review shows adequate accuracy in diagnosing ABPA but improvement is needed for monitoring to prevent patient harm.