🏥 Surgery in Patients with ABPA or CPA: Can It Worsen Symptoms, and Should It Proceed?

Patients with Aspergillus-related lung diseases, such as Allergic Bronchopulmonary Aspergillosis (ABPA) and Chronic Pulmonary Aspergillosis (CPA), sometimes report worsened symptoms after undergoing surgery under general anaesthetic. While this is a recognised clinical pattern, it does not mean surgery should be avoided. Instead, it requires preparation and close perioperative management to reduce risk.

🔍 Can Surgery Worsen Aspergillosis Symptoms?

Yes — and here’s why:

✳️ 1. Airway Irritation from Intubation

• Endotracheal tubes can irritate airways already inflamed by ABPA or structurally altered by CPA.

• Mechanical ventilation can impair mucus clearance and exacerbate cough or infection.

✳️ 2. Postoperative Immunosuppression

• Surgery temporarily suppresses immune function.

• Perioperative corticosteroids or stress-induced immune suppression can permit fungal flare-ups or reactivation.

✳️ 3. Impaired Mucus Clearance

• Pain, immobility, and sedation reduce the patient’s ability to cough and clear secretions.

• In CPA or ABPA, this can lead to plugging, fungal regrowth, or secondary bacterial infection.

✳️ 4. Drug Interactions

• Azole antifungals (e.g. itraconazole, posaconazole) interact with many anaesthetics, opioids, and steroids.

• These interactions can alter drug levels, reduce antifungal efficacy, or increase toxicity risk.

✳️ 5. Stress and Inflammation

• Surgical stress may worsen the inflammatory or allergic component of ABPA.

• CPA-related cavities may bleed or become re-infected post-op.

✅ Should Surgery Still Go Ahead?

Yes — surgery can and often should proceed when it is medically indicated.

Delaying needed procedures (e.g. for cancer, fractures, or pain relief) can lead to worse outcomes than the potential risks related to aspergillosis.

🛡️ Recommended Precautions

🔷 Pre-Operative Planning

• Ensure all care teams are aware of the diagnosis.

• Review lung imaging, baseline oxygenation, and current antifungal/steroid regimens.

• Arrange for pre-op airway clearance if sputum is a concern.

🔷 Antifungal Management

• Continue antifungal therapy through the perioperative period.

• Use IV formulations if oral administration isn’t possible.

• Check for drug interactions with anaesthetic or post-op medications.

🔷 Steroid Cover (ABPA and CPA on steroids)

• Patients on chronic steroids may need perioperative hydrocortisone supplementation (adrenal cover).

• Apply “sick day rules” or use the patient’s adrenal insufficiency plan, if applicable.

🔷 Post-Op Monitoring

Watch for:

• Worsening cough, breathlessness, or sputum

• Fever or signs of secondary infection

• Raised IgE (in ABPA) or haemoptysis (in CPA)

• Any signs of antifungal failure or drug toxicity

⚠️ When Might Surgery Be Delayed?

Consider postponing non-urgent surgery if:

• There is active haemoptysis

• The patient has uncontrolled inflammation or fungal burden

• A recent scan shows expanding cavities or new infiltrates

• Antifungal resistance is suspected or not yet managed

💬 Key Message for Patients

“Having ABPA or CPA doesn’t mean you can’t have surgery — but we do need to take extra care around your airways, your antifungal treatment, and your recovery. With the right team and planning, we can safely support you through your procedure.”