🌬️ Living with Asthma and Aspergillosis: Understanding the Overlap, the Immune System, and the Right Treatment

If you live with asthma and have been told you also have aspergillosis, such as ABPA (Allergic Bronchopulmonary Aspergillosis) or SAFS (Severe Asthma with Fungal Sensitisation), your situation is more complex than most people realise.

This guide explains:

• The different types of asthma

• How aspergillosis complicates asthma

• The role of eosinophils, IgE, and the immune system

• Why some people don’t have “typical” symptoms (like wheeze)

• What treatments are available — and how to personalise your care

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🧠 Asthma Isn’t One Disease

Asthma is a condition where the airways (breathing tubes) become:

• Inflamed (swollen and irritated)

• Overreactive to certain triggers (allergens, cold air, infection, etc.)

• Narrowed and often filled with mucus, making breathing difficult

But not everyone with asthma has the same cause, symptoms, or treatment response. Asthma actually includes many subtypes — and understanding your type is key to getting the right care.

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🧬 Common Asthma Types in Aspergillosis

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🫢 New Section: What Is “Silent Asthma”?

“Silent asthma” is not an official medical term, but it’s used to describe:

• Asthma without the classic wheeze (often just cough or tightness)

• Or where asthma attacks happen suddenly, without clear warning

This is important because:

• People may not realise they have asthma

• Diagnosis may be delayed or missed

• Flare-ups can be severe or even life-threatening

• It may occur in people with fungal asthma, ABPA, or airway damage

Silent asthma is especially relevant in:

• Older adults

• People with ABPA or SAFS

• People with cough-variant asthma

• Anyone whose asthma doesn’t “sound” typical

🧪 Tests like FeNO, spirometry, and blood eosinophil counts are vital for confirming what’s really happening inside the lungs — even if symptoms are subtle.

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🔬 Why ABPA Adds Complexity

If you have ABPA, the asthma symptoms are made worse by:

• A hypersensitive immune reaction to Aspergillus fumigatus

• Mucus plugging and blocked airways

• Lung damage (bronchiectasis) that doesn’t improve with inhalers alone

• A mix of allergic and eosinophilic inflammation

Key signs include:

• Extremely high IgE levels

• Raised eosinophils

• Positive blood tests for Aspergillus

• Lung CT scan changes

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💊 Treatment Options Based on Asthma Type

Each treatment is tailored based on whether your asthma is driven by:

• IgE (allergy)

• Eosinophils (inflammation)

• Fungal exposure or colonisation

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📍 What to Discuss with Your Healthcare Team

If you:

• Have asthma that isn’t well controlled

• Need frequent steroids

• Have a chronic cough, thick mucus, or lung damage

• Have high IgE or eosinophils

• Or don’t wheeze, but still get breathless or fatigued…

… it’s important to ask your doctor:

• Could I have ABPA or SAFS?

• Is there a fungal or eosinophilic component to my asthma?

• Should I be tested for Aspergillus allergy or IgE?

• Am I a candidate for biologics or antifungals?

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✅ Final Takeaway

Asthma with aspergillosis is more than just “bad asthma” — it’s a complex condition involving allergy, inflammation, fungal exposure, and in some cases, permanent airway changes. Some patients don’t experience wheeze — this is called “silent asthma,” and it deserves just as much attention.

You don’t have to manage this alone — and there are now targeted treatments that can help reduce symptoms, prevent damage, and improve quality of life.

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