The chronic forms of aspergillosis (i.e. those suffered by people with a normal immune system) can last many years, so maintenance is an important issue. All of the chronic forms are the result of the fungus gaining a foothold in part of the body and growing slowly, all the while irritating the surface of the delicate tissues they come into contact with; this can cause changes to the tissues concerned.
Most of these types of aspergillosis affect the lungs and sinuses. As far as the lungs are concerned, the delicate tissues irritated by the fungus are important to us to allow us to breathe. These tissues must be flexible in order to stretch as we breathe in, and thin in order to allow efficient exchange of gases to and from the blood supply, which runs just below the membranes.
Irritation causes these tissues to inflame and then to thicken and scar – a process which makes the tissues thick and inflexible.
Doctors try to manage this process firstly by diagnosing as early as possible – something that has been difficult in the past but is starting to get easier with new technology becoming available.
The next most important thing is to reduce or prevent inflammation, so steroids are prescribed. The dose is often varied by the doctor according to symptoms (N.B. NOT something to attempt under any circumstances without your doctor’s agreement) in an attempt to minimise the dose. Steroids have many side effects and minimising the dose also minimises those side effects.
Antifungals such as itraconazole, voriconazole or posaconazole are also often used as, although they cannot eradicate the infection, they do reduce symptoms quite markedly in many cases. The dose of the antifungal is also minimised to prevent side effects but sometimes also to minimise cost, as antifungals can be very expensive.
Some patients will find themselves on antibiotics from time to time as bacterial infections can be a secondary form of infection in chronic aspergillosis.