If you’ve been diagnosed with bronchiectasis, COPD, or other chronic lung problems, and keep getting infections or mucus that tests positive for Aspergillus, you might be told you have Aspergillus bronchitis. But what does that mean? And how is it different from ABPA (Allergic Bronchopulmonary Aspergillosis)?
This guide explains what Aspergillus bronchitis is, how it’s diagnosed, how common it is, and how it differs from ABPA.
🌬️ What Is Aspergillus Bronchitis?
Aspergillus bronchitis is a chronic fungal infection of the airways caused by Aspergillus fumigatus. It happens in people with damaged or scarred airways, such as:
-
Bronchiectasis
-
COPD
-
Cystic fibrosis
-
Occasionally asthma (if structural damage exists)
It’s a low-grade infection, not an allergy and not an invasive disease. The fungus lives in the mucus lining the airways, causing persistent inflammation, infection, and symptoms.
🔍 What Are the Symptoms?
| Common symptoms | What to know |
|---|---|
| Persistent cough | Often brings up sticky or brown mucus |
| Worsening breathlessness | Not always explained by asthma or infection alone |
| Fatigue or low energy | Common in chronic fungal infections |
| Frequent infections | May keep returning despite antibiotics |
| Wheeze | Sometimes, especially in asthma or ABPA overlap |
| Weight loss or low-grade fever | Possible in long-standing infection |
đź“Š How Common Is It?
Aspergillus bronchitis is underdiagnosed but increasingly recognised — especially in patients referred to specialist centres.
Estimated frequency in different conditions:
| Underlying condition | Estimated rate of Aspergillus bronchitis |
|---|---|
| Bronchiectasis | ~5–15%, higher in referral centres |
| COPD | ~1–5%, especially with steroid use |
| Cystic fibrosis | 5–10% (non-allergic cases) |
| Asthma (alone) | Rare unless bronchiectasis is also present |
It may be mistaken for a flare-up or chronic bacterial infection. Many people are told it’s “just colonisation” — but if symptoms persist and Aspergillus keeps growing in sputum, Aspergillus bronchitis should be considered.
🧪 How Is It Diagnosed?
There’s no single test. Diagnosis is based on clinical features plus evidence of fungal growth and a non-allergic immune pattern.
| Test | What it shows |
|---|---|
| Sputum culture / PCR | Repeated detection of Aspergillus |
| Aspergillus IgG (blood) | Often raised, shows chronic exposure |
| Aspergillus IgE & eosinophils | Usually normal — helps exclude ABPA |
| CT scan | Shows bronchiectasis, mucus plugging, but no cavitation |
| Response to antifungals | Clinical improvement supports diagnosis |
🔄 How Is It Different from ABPA?
ABPA is an allergic reaction to Aspergillus that mainly affects people with asthma or cystic fibrosis.
Aspergillus bronchitis, on the other hand, is a fungal infection in damaged airways, not an allergy.
| Feature | Aspergillus Bronchitis | ABPA |
|---|---|---|
| Type of disease | Chronic fungal infection | Allergic lung disease |
| Immune markers | High IgG, normal IgE | High IgE and eosinophils |
| Sputum | Repeated growth of Aspergillus | May or may not grow |
| CT findings | Bronchiectasis, mucus | Central bronchiectasis, mucus plugs |
| Treatment | Antifungals only | Steroids ± antifungals |
| Typical patient | Bronchiectasis, COPD | Asthma (often severe), sometimes CF |
Some patients can have both conditions at once, especially those with asthma and bronchiectasis — so testing is important.
đź’Š Treatment Options
| Treatment | Purpose |
|---|---|
| Oral antifungals (itraconazole, voriconazole) | Main treatment — often for several months |
| Inhaled antifungals (e.g. nebulised amphotericin) | Alternative if oral drugs not tolerated |
| Airway clearance physiotherapy | Helps remove mucus and fungal load |
| Regular sputum testing | To monitor treatment response |
| Steroids | Not used unless there’s overlapping ABPA or asthma |
🧠Summary
| Question | Answer |
|---|---|
| Is it an infection? | ✅ Yes — fungal infection in the airways |
| Is it an allergy? | ❌ No — that’s ABPA |
| Can it coexist with ABPA? | âś… Yes, in some cases |
| How is it diagnosed? | Repeated Aspergillus in sputum + high IgG + symptoms |
| How is it treated? | Antifungal medication (oral or nebulised) |
| Will it go away? | Often improves with treatment, but monitoring is essential |
đź’¬ What to Ask Your Doctor
-
Could my symptoms be from Aspergillus bronchitis?
-
Have I had sputum cultures and Aspergillus blood tests (IgG, IgE)?
-
Would antifungal treatment help me?
-
Should I be referred to a specialist centre (e.g. for CPA, ABPA, bronchiectasis)?
-
Am I on the best airway clearance and physiotherapy plan?
Latest News posts
News archive