Many people living with aspergillosis—including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), severe asthma with fungal sensitisation (SAFS) and Aspergillus bronchitis—notice that their body temperature behaves differently from what doctors call “normal.”

This is especially common in people who are:

• On long-term steroids

• Tapering steroids

• Living with adrenal insufficiency

• Older adults

• On biologics

• Managing chronic lung disease

This guide explains why your temperature may run lower, why fevers can appear smaller or absent, and how to safely manage this.

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🔶 1. Many aspergillosis patients have a lower baseline temperature

Although “37.0°C” is often quoted, most patients actually sit anywhere between 35.5–36.5°C.
Reasons include:

✔ Long-term steroids

Prednisolone, methylprednisolone, hydrocortisone, and even high-dose inhaled steroids can blunt the immune response and lower your resting temperature.

✔ Adrenal insufficiency

If your adrenal glands are suppressed, your body’s ability to raise temperature is reduced.
You may get no fever at all, even with infections.

✔ Chronic lung disease

Living with ABPA, CPA or bronchiectasis can change how your body regulates heat.

✔ Biologic treatments

Some biologics influence inflammatory signalling and may soften fever responses.

✔ Age

Older adults naturally have:

• Lower metabolism

• Lower baseline temperature

• Reduced ability to generate fever (“immune senescence”)

Many older aspergillosis patients sit around 35.7–36.2°C when completely well.

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🔶 2. Fever is a rise from your normal — not a single number

For someone with a naturally low temperature, a fever may look very different.

A useful rule:

A fever = a rise of 1°C above your personal baseline,
even if the thermometer is below 38°C.

Example

• Your baseline = 35.8°C

• Your fever may begin at 36.8–37.0°C

You may feel shivery, hot, exhausted or “flu-ish” long before hitting 38°C.

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🔶 3. Why fevers are often “muted” in aspergillosis

✔ Steroids

Reduce the body’s ability to trigger a strong fever.

✔ Adrenal insufficiency

Greatly reduces your ability to raise temperature; infections may show as fatigue, dizziness, nausea or sudden weakness instead.

✔ Age

Older adults may have:

• No fever

• A tiny rise

• Confusion or breathlessness as the only sign of infection

✔ Chronic disease

Your temperature regulation system may simply behave differently because of long-term inflammation.

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🔶 4. What YOU can do to manage this safely

✔ Know your personal baseline

Measure your temperature twice daily for 5–7 days when well.
Record the average — this is your true normal.

✔ Treat a 1°C rise as your own fever

Don’t wait for the thermometer to reach 38°C.

✔ Watch symptoms more than the number

Seek medical advice if you notice:

• Feeling feverish or shivery

• Breathing worsening

• New chest or flank pain

• Sudden exhaustion

• Increased heart rate

• Confusion, dizziness or “not right”

• New cough or change in sputum

These can indicate infection even without a high temperature.

✔ Keep a symptom + temperature chart

Especially if you:

• Are on steroids

• Have adrenal insufficiency

• Are tapering

• Are on biologics

• Have recurrent infections

Even simple notes help clinicians hugely.

✔ Tell every clinician your temperature baseline

Not all doctors will know your usual pattern, so tell them:

“My normal temperature is around X°C.
I don’t get high fevers because of chronic illness/steroids/adrenal suppression.
A small rise is significant for me.”

This is important in GP appointments, A&E, respiratory clinics and hospital admissions.

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🔶 5. Extra precautions if you have adrenal insufficiency

People with steroid-induced adrenal suppression must be especially careful:

• A small temperature rise + feeling unwell may mean you need stress-dose steroids

• Vomiting, dizziness, intense fatigue or confusion are warning signs

• Always follow your adrenal emergency plan

• Always carry your Steroid Emergency Card and hydrocortisone emergency injection if prescribed

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🔶 6. Do doctors understand this?

Most clinicians understand the general rules:

• Older adults often do not mount high fevers

• Steroids blunt fever

• Adrenal insufficiency changes the febrile response

• Infection may present atypically

However, few clinicians know your personal baseline unless you tell them.

Sharing your own numbers helps them interpret your symptoms safely and accurately.

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🟩 Summary for Aspergillosis Patients

• Many people with aspergillosis have a naturally lower temperature.

• Steroids, adrenal insufficiency and age can all reduce your ability to produce a fever.

• A rise of 1°C above YOUR normal may be your fever.

• Focus on overall symptoms, not just the thermometer.

• Tell every clinician your baseline temperature.

• Take extra care if you have adrenal insufficiency.

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