A Study of Itraconazole and Posaconazole for Chronic Pulmonary Aspergillosis

Inclusion Criteria: * One or more clinical symptoms (persistent cough, recurrent haemoptysis, weight loss, malaise, fever, dyspnoea) for ≥3 months * Slowly progressive or persistent radiological findings on CT thorax including one or more cavities with or without a fungal ball, fibrosis, pericavitary infiltrates, consolidation, nodules, or pleural thickening * Serum A. fumigatus-IgG ≥27 milligrams of antibody/litre (mgA/L), or growth of Aspergillus in respiratory secretions (twice in sputum or once in bronchoalveolar lavage fluid \[BALF\]) or serum galactomannan index (GMI) ≥1.7 or BALF GMI ≥2.6. * Exclusion of other pulmonary disorders with similar presentation (active pulmonary TB, malignancy, other infections) Exclusion Criteria: * Failure or refusal to provide written informed consent * Patients on immunosuppressive drugs, receiving prednisolone (or equivalent) ≥10 mg/day for ≥3 weeks, or known HIV infection * Intake of antifungal triazoles for ≥3 weeks in the preceding 3 months (prior azole therapy) * Active pulmonary infection due to Mycobacterium tuberculosis or non-tuberculous mycobacteria * Other forms of pulmonary aspergillosis (subacute or acute invasive aspergillosis) * Pregnancy or lactation * Significant hepatic dysfunction (ALT/AST ≥3× upper limit of normal at baseline) * Known hypersensitivity to azole antifungals