Aspergillus Bronchitis

Aspergillus bronchitis is a long-term infection of the larger airways (bronchi) caused by Aspergillus mould. It is most often seen in people who already have damaged or widened airways, particularly bronchiectasis or cystic fibrosis.

It can cause persistent cough, sputum, breathlessness and repeated chest symptoms. It is different from an allergic condition such as ABPA, and from chronic pulmonary aspergillosis (CPA), which affects the lung tissue rather than mainly the airways.

Key points

• Aspergillus bronchitis is a chronic infection affecting the larger airways.
• It is most often associated with bronchiectasis, cystic fibrosis or other long-term airway damage.
• It is not the same as ABPA, which is an allergic reaction to Aspergillus.
• A single positive sputum result does not always mean that treatment is needed.
• Diagnosis depends on symptoms, repeated test results, scans and excluding other causes.
• Treatment may include antifungal medicine, airway clearance and management of the underlying lung condition.

What is Aspergillus bronchitis?

People breathe in Aspergillus spores every day. In most people, the lungs and immune system remove them without causing illness.

When the airways are already damaged or do not clear mucus well, Aspergillus can sometimes persist in the sputum and contribute to ongoing airway symptoms. This is called Aspergillus bronchitis.

The term is used by specialist teams for a pattern of persistent symptoms and repeated positive samples. It is not diagnosed from one sputum sample alone.

How does it differ from other Aspergillus-related conditions?

• Colonisation means Aspergillus has been found in a sample but may not be causing illness.
• Aspergillus bronchitis means the fungus is thought to be contributing to persistent airway symptoms or inflammation.
• ABPA is an allergic immune reaction to Aspergillus, usually associated with asthma or cystic fibrosis.
• CPA is a longer-term infection affecting the lung tissue, often with cavities or nodules on scans.
• Invasive aspergillosis is a serious infection that usually affects people with major immune suppression.

More than one lung condition can be present at the same time. This is one reason that specialist assessment is sometimes needed.

Who is most likely to be affected?

Aspergillus bronchitis is most often considered in people with long-term airway disease, including:

• Bronchiectasis
• Cystic fibrosis
• Chronic mucus production or difficulty clearing sputum
• Some forms of severe COPD or chronic airway inflammation

It is not contagious and cannot be passed from person to person.

Symptoms

Symptoms often overlap with bronchiectasis, asthma, COPD and bacterial chest infections. They may include:

• Persistent or worsening cough
• More sputum, or thicker and stickier sputum
• Breathlessness or wheeze
• Repeated chest symptoms that do not improve as expected with antibiotics
• Increasing difficulty clearing mucus
• Fatigue or feeling generally unwell during flare-ups

These symptoms do not prove Aspergillus bronchitis. They are a reason to discuss sputum results and ongoing symptoms with your respiratory team.

How is it diagnosed?

Diagnosis is based on the whole picture, rather than any one test. Doctors may consider:

• Persistent airway symptoms, especially when they have not improved as expected
• Repeated detection of Aspergillus in sputum culture or PCR testing
• Blood tests, including Aspergillus IgG antibodies where appropriate
• CT scans to assess bronchiectasis, mucus plugging and other changes in the lungs
• Whether ABPA, CPA, bacterial infection or another cause better explains the symptoms

A bronchoscopy is occasionally needed, but not for everyone. It may help when sputum cannot be produced or when the diagnosis remains unclear.

Treatment

Treatment is individual. Not everyone with a positive sputum sample needs an antifungal medicine. The aim is to improve symptoms, reduce the fungal burden where relevant and protect the airways.

Antifungal medicines

When treatment is appropriate, this may include an oral antifungal such as itraconazole. Other medicines, including voriconazole or posaconazole, may be considered when needed.

Antifungals can interact with other medicines and may affect the liver. Your team may arrange blood tests, drug-level monitoring and a review of all your current medicines. The length of treatment and whether it is helping should be reviewed with you regularly.

Airway clearance

Clearing mucus is an important part of care for many people with Aspergillus bronchitis and bronchiectasis. A respiratory physiotherapist can help identify techniques that suit you, such as breathing techniques, devices or nebulised treatment where appropriate.

Managing the underlying lung condition

Good bronchiectasis, asthma or COPD care remains essential. This may include inhaler review, vaccination, regular sputum testing, treatment of bacterial infections and support with airway clearance.

When should I speak to my healthcare team?

Contact your GP, respiratory team or specialist nurse if you have persistent or worsening cough, increasing sputum, repeated chest symptoms, or a sputum result showing Aspergillus that you do not understand.

Seek urgent medical advice for severe breathlessness, significant or repeated coughing up of blood, chest pain, or a rapid deterioration in how you feel.

Related information

Visit the Aspergillus Bronchitis Hub

Learn about ABPA
Learn about chronic pulmonary aspergillosis (CPA)
Learn about treatment for aspergillosis
Browse the Aspergillosis Knowledge Hub

References

• European Respiratory Society clinical practice guideline for the management of adult bronchiectasis
• Chotirmall SH, Al-Alawi M, Mirkovic B, et al. Aspergillus-associated airway disease, inflammation, and the innate immune response. BioMed Research International. 2013;2013:723129.

Last reviewed: September 2026