Study of the effectiveness of voriconazole in the treatment of Aspergillus fumigatus associated asthma

INTERVENTION: 12 month randomised double‐blind placebo‐controlled parallel group trial to receive either placebo or voriconazole 200 mg twice daily orally for 12 weeks. CONDITION: Asthma ; Respiratory ; Asthma PRIMARY OUTCOME: The number of severe exacerbations over the 12 months of the study. SECONDARY OUTCOME: 1. The percentage of patients whose sputum is no longer AF positive after three months of treatment with voriconazole and at the end of the study; 2. The change in the sputum eosinophil count (measured as area under the curve) in the voriconazole versus the placebo group after three months of treatment and at the end of the study; 3. The change in the total sputum neutrophil count (measured as area under the curve) in the voriconazole versus the placebo group after three months of treatment and at the end of the study; 4. The change in forced expiratory volume in one second (FEV1) between the treatment and placebo group after treatment and at the end of the study; 5. The number of courses of antibiotics between the treatment and placebo groups; 6. The improvement in Juniper Asthma Control Questionnaire (JACQ) score at the end of the treatment and at the end of the study INCLUSION CRITERIA: 1. Symptoms consistent with a diagnosis of asthma 2. A clinical phenotype consistent with AF associated asthma in the opinion of at least two consultant members of the study team 3. Evidence of immune sensitisation to AF (either positive AF IgE, positive SPT to AF or positive AF IgG) 4. A raised peripheral blood eosinophil count or sputum eosinophil count of more than 10% on at least one occasion in the last two years 5. AF in sputum on two occasions within the six months prior to entry into the study 6. At least two severe exacerbations in the previous 12 months (defined as a requirement for a course of high dose oral steroids for treatment of their asthma) 7. Aged above 18 years, both male and female