🫁 Understanding ABPA, Bronchiectasis & Lung Cavities

A Patient’s Guide to What Happens in the Lungs – and What You Can Do About It

🌿 What is ABPA?

Allergic Bronchopulmonary Aspergillosis (ABPA) is a condition where the lungs react strongly to a common fungus called Aspergillus. This overreaction causes inflammation in the airways, making it harder to clear mucus and increasing the risk of flare-ups.

Many people with asthma or cystic fibrosis are more likely to develop ABPA, but it can affect others too.

🌀 What Happens to the Lungs?

Over time, repeated inflammation and mucus build-up can affect the structure of the airways. Here’s what can happen:

1. Bronchiectasis

• The airways (bronchi) become widened and thickened.

• This makes it harder to clear mucus, which can lead to more infections.

• In ABPA, this usually affects the central parts of the lungs.

🔸 Bronchiectasis is not the same as a lung cavity. It’s a change in the shape of the airways, not a hole in the lung.

2. Lung Cavities (Less Common)

• These are air-filled spaces that form when a small area of lung tissue is damaged or infected.

• Cavities are less common in ABPA but can happen after repeated inflammation or infection.

• They may look worrying on a scan, but often they are just monitored and don’t cause major issues unless they become infected.

🩺 What About Lung Function?

ABPA and bronchiectasis can affect lung function, especially if not caught early.

• Spirometry tests may show lower results if the airways are blocked or inflamed.

• Some people improve after treatment; others may see a gradual decline.

• Most patients still breathe well at rest, and many stay active with proper care.

🌬️ Will Cavities Leak Air?

This is a common worry. The answer is: usually not.

• Most cavities in ABPA are not at risk of bursting or leaking.

• Sudden breathlessness or chest pain should always be checked, but leaks (pneumothorax) are rare in ABPA.

📉 Does Everyone Get Cavities?

Not at all.

• Around 50–90% of ABPA patients get some bronchiectasis.

• Only a minority go on to develop true cavities.

• Early treatment and regular check-ups help reduce the risk of further lung changes.

🧪 What About Oxygen Levels?

Many people with ABPA — even with bronchiectasis — still have normal oxygen levels (SpO₂):

• Most rest between 95–98%

• During a flare or infection, it might dip a little

• If oxygen drops below 92%, your team may check more closely

🧘 What Can I Do to Stay Well?

• 🩺 Stick to your treatment plan – antifungals, inhalers, or steroids if prescribed

• 💨 Clear mucus regularly – ask about airway clearance techniques

• 🧼 Avoid damp, mouldy environments

• 🍎 Stay active and eat well

• 📆 Attend check-ups and lung function tests

• 🚭 Avoid smoking or vaping (these can worsen damage)

💬 A Final Word

Having ABPA and some lung changes doesn’t mean life has to stop. Many people continue to live active, fulfilling lives. Even with bronchiectasis or small cavities, the focus is on prevention, staying stable, and getting support when needed.