Allergic bronchopulmonary aspergillosis (ABPA) is an allergic lung condition caused by an exaggerated immune response to Aspergillus mould. It most often affects people with asthma, bronchiectasis or cystic fibrosis. It is not the same as an invasive fungal infection.
People with ABPA may experience worsening asthma, cough, wheeze, breathlessness, fatigue and thick mucus or mucus plugs. Symptoms can fluctuate, with quieter periods and flare-ups.
Patient-centred information from the National Aspergillosis Centre. This guide combines specialist clinical knowledge with the questions, experiences and practical concerns raised by people living with ABPA and their carers.
Key points
- ABPA is an allergic reaction to Aspergillus in the airways.
- It is most commonly associated with asthma, bronchiectasis or cystic fibrosis.
- Diagnosis depends on several pieces of evidence; no single test gives the whole answer.
- Treatment is individual and may include anti-inflammatory treatment, antifungal medicine, asthma care and monitoring.
- Regular follow-up helps identify flare-ups, treatment side effects and lung changes early.
What happens in ABPA?
Aspergillus spores are common in the air and most people breathe them in without harm. In ABPA, the immune system reacts too strongly in the airways. This can cause inflammation, swelling and excess mucus. Over time, repeated inflammation can contribute to bronchiectasis or other lung changes.
Read: What is aspergillosis? →
Symptoms of ABPA
Symptoms vary between people and can overlap with asthma or bronchiectasis. They may include:
- worsening cough, wheeze, chest tightness or breathlessness;
- thick sputum, sometimes brown, or mucus plugs;
- fatigue, feverishness or generally feeling unwell;
- recurrent chest symptoms or asthma flare-ups; and
- coughing up blood in some cases.
Contact your clinical team if symptoms are new, worsening or different from your usual pattern. Seek urgent medical help for significant or repeated coughing up of blood, rapidly worsening breathlessness or severe illness.
How is ABPA diagnosed?
ABPA can be difficult to recognise because many symptoms are shared with asthma, bronchiectasis and other lung conditions. Clinicians consider the whole picture: symptoms and medical history, scans, blood tests and sometimes sputum results.
Current international guidance uses evidence of sensitisation to Aspergillus, total IgE and additional supporting evidence such as Aspergillus-specific IgG, eosinophils or characteristic imaging. These results must be interpreted together by the clinical team; a result above or below one threshold does not diagnose ABPA by itself.
Treatment and monitoring
The aim is to control inflammation, improve symptoms, prevent further lung damage and reduce the risk of flare-ups. Treatment depends on your symptoms, tests, scan findings, other lung conditions and previous response to treatment.
Depending on the individual, a plan may include asthma treatment, corticosteroids or other anti-inflammatory treatment, antifungal medicine, airway-clearance support and regular monitoring. Biologic medicines may be considered for selected people, particularly where asthma or allergic inflammation remains difficult to control. Decisions about treatment and any changes to prescribed medicine should be made with your clinical team.
Monitoring may include symptoms, total IgE and other blood tests, scans, lung function, sputum tests and drug-safety or drug-level checks where relevant.
Read more about treatment and management →
Living with ABPA
ABPA can bring practical as well as medical challenges: fatigue, uncertainty, treatment burden, anxiety about flare-ups and the work of managing asthma or bronchiectasis alongside it. Many people find that pacing, airway clearance where advised, keeping notes for appointments and support from others make a real difference.
Further ABPA information
- Asthma and aspergillosis
- Which type of aspergillosis do I have?
- Search the Knowledge Hub for more ABPA information
Common questions
Is ABPA contagious?
No. ABPA is not passed from person to person.
Is ABPA the same as a fungal infection?
No. ABPA is mainly an allergic immune response. It is different from chronic or invasive forms of aspergillosis, although antifungal medicine may be part of treatment for some people.
Can ABPA come back after treatment?
Some people have flare-ups or need treatment changes over time. This is why regular review and monitoring are important.
Last reviewed: September 2026
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