GAtherton

​Survey of current national and international guidance to reduce risk of exposure to Aspergillus spp. in healthcare settings

​The article reviews existing guidelines aimed at minimizing the risk of Aspergillus exposure in hospitals and clinics throughout the world. Aspergillus is a common mold that can cause serious infections, especially in individuals with weakened immune systems or chronic lung conditions.​

Key Points for Patients:

• Vulnerable Groups: Patients with compromised immune systems (such as those undergoing chemotherapy or organ transplants) and individuals with chronic lung diseases are at higher risk of Aspergillus infections.​

• Preventive Measures in Healthcare Settings: The article emphasizes the importance of infection control practices in hospitals to protect at-risk patients. These measures include maintaining proper ventilation systems, using HEPA filters, and implementing protective protocols during construction or renovation activities within healthcare facilities.​

• Need for Consistent Guidelines: The review highlights that while various national and international guidelines exist, there is a need for more consistent and comprehensive recommendations to effectively reduce Aspergillus exposure in healthcare environments.​

What This Means for You:

• Stay Informed: If you are at risk, be aware of the infection control practices in place at your healthcare facility.​

• Advocate for Safety: Don't hesitate to ask healthcare providers about the measures they take to prevent mold exposure, especially during hospital stays or treatments.​

• Personal Precautions: Follow any advice given by your healthcare team regarding personal protective measures, such as wearing masks or avoiding certain areas during hospital visits.​

For more detailed information, you can access the full article here: ScienceDirect Article

by GAtherton

Seasonal Patterns in Aspergillosis (General Overview for UK)

1. Allergic Bronchopulmonary Aspergillosis (ABPA)

ABPA symptoms — including cough, wheezing, chest tightness, and sputum plugs — often flare in spring and autumn, due to:

• Increased spore counts in the air (Aspergillus spores peak with leaf mold, compost, and decaying plant material)

  • Homes that have poorly controlled humidity tend to grow moulds more in Autumn/Winter

• Coinciding with other allergies and asthma triggers

• Damp weather and decaying vegetation can promote indoor mold growth

Patients often report flares in April–May and September–October, sometimes needing steroids or antifungals adjusted.

2. Chronic Pulmonary Aspergillosis (CPA)

CPA may show less dramatic seasonality, but symptoms (fatigue, cough, haemoptysis) can worsen in:

• Winter – due to:

  • Increased viral infections (influenza, RSV, etc.)

  • Cold air worsening underlying lung disease (COPD, bronchiectasis)

  • Indoor heating leading to drier air and more airborne spores

    • Homes that have poorly controlled humidity tend to grow moulds more in Autumn/Winter

• Reduced sunlight/vitamin D may also affect immunity

3. Invasive Aspergillosis (IA)

Invasive disease tends to be more linked to hospital exposure, immunosuppression, and construction/dust, rather than season. However:

• Some studies have linked higher hospital-acquired IA rates to building works in warmer months, when air filtration is challenged.

Summary Statement You Could Use:

“While aspergillosis can cause symptoms year-round, many patients with ABPA or chronic forms report worsening symptoms in spring and autumn, likely due to increased mold exposure, humidity changes, and seasonal allergens. Winter can also pose challenges for those with weakened lungs or immune systems.”

by GAtherton

When Breath Becomes Panic: Coping with Breathing-Related Fear in Aspergillosis

For many people living with aspergillosis—whether it's ABPA, CPA, or another form—there’s a quiet fear that goes beyond the coughing, mucus, or fatigue. It’s the fear of simply not being able to breathe.

And when that fear takes hold, it can become a panic attack, made worse by breathlessness itself. It’s a vicious cycle: the harder it is to breathe, the more fear takes over… and the more fear takes over, the harder it becomes to breathe.

For some, these episodes can be so intense that they involve loss of bladder or bowel control, trembling, dizziness, or a terrifying feeling of doom. These are real physical symptoms. They’re not “just in your head.” They’re a nervous system in overdrive, reacting to what feels like a life-or-death moment.

You are not alone in this.

What Is a Breathing Panic?

A breathing panic (or panic attack triggered by breathlessness) is when a person’s body and mind go into full emergency mode — often without warning — because they feel they’re not getting enough air.

In aspergillosis, this can happen:

• During a flare-up or infection

• After exertion or exposure to allergens

• At night, when mucus blocks airways

• During coughing fits

• When feeling isolated, scared, or overwhelmed

The body releases adrenaline, heart rate speeds up, muscles tighten, and breathing becomes shallow or frantic. The brain believes it’s under threat. And sometimes, that intense physical response can lead to involuntary bladder or bowel release, shaking, chest pain, or feeling faint.

“I Thought I Was Dying” — You're Not Alone

Many patients describe these episodes as terrifying. Some feel embarrassed or afraid to tell others about what really happened — especially if they lost control of bodily functions. But this is not weakness or failure. It is the body doing its best to survive a perceived emergency.

There is no shame in what your body does when it’s frightened.

How to Cope During a Breathing Panic

Here are some tools used by people living with lung conditions to manage and reduce panic when it strikes:

1. Focus on the Out-Breath

When panicking, many people gasp for air. But exhaling fully is key. Try:

• Pursing your lips like blowing out a candle

• Slowly exhaling for longer than you inhale

• Counting the exhale to 4 or 5 if you can

2. Ground Your Senses

To bring your mind back into your body:

• Look around and name 5 things you see

• Touch 4 things and describe their texture

• Listen for 3 sounds

• Smell 2 things

• Say 1 thing out loud that you’re grateful for

3. Position Your Body

Sit upright or lean forward slightly. A position known as “tripod breathing” — resting forearms on a table or knees — can help open the lungs.

4. Cool Air on the Face

A small fan blowing gently on your face can help signal to the brain that it’s safe to slow down.

Preventing Future Panic Episodes

You can’t always avoid breathlessness, but you can build confidence in managing it:

- Respiratory Physiotherapy

Ask your GP or consultant to refer you to a respiratory physio. They can teach breathing control techniques that may reduce the risk of panic and improve mucus clearance.

- Psychological Support

Breathing panic has a huge emotional impact. You may benefit from talking therapies like:

• CBT (Cognitive Behavioural Therapy) tailored to breathlessness

• ACT (Acceptance & Commitment Therapy) for chronic illness

• Trauma-informed therapy if panic stems from medical trauma

In many parts of the UK, IAPT services offer free NHS therapy — you can even self-refer online.

- Pelvic Floor Support

If you’ve experienced bladder or bowel accidents during panic, there is help available. Continence nurses and pelvic health physios can offer discreet support, exercises, and advice to rebuild control and confidence.

You Deserve Support, Not Silence

Panic is not a failure. It’s your body’s alarm bell — but you don’t have to live in fear of it. With the right tools, support, and compassion (for yourself as well as from others), you can take steps to feel safer in your body again.

If you’ve been through this, speak to your respiratory team. They need to know. If you’ve felt alone, reach out to a support group — like the Aspergillosis Support UK group — where others truly understand.

You’re not alone. And you are stronger than your worst moments.

by GAtherton

Understanding Drug Interactions with Antifungal Medications

Information for patients and carers receiving treatment for aspergillosis

Why drug interactions matter

Many antifungal medications used to treat aspergillosis can affect — or be affected by — other medicines you may be taking. These drug interactions can change how well a medication works, increase side effects, or cause unexpected reactions.

Knowing what to watch for and sharing your full medication list with your healthcare team can help keep you safe.

Antifungal medicines that interact with other drugs

Common antifungals:

• Voriconazole
• Posaconazole
• Itraconazole
• Isavuconazole

These drugs are processed through the liver and can interfere with enzymes (like CYP3A4) that control how other medications are broken down.

Examples of drugs that may interact

Heart medications

• Statins (e.g. simvastatin) — can build up and cause muscle damage
• Calcium channel blockers (e.g. amlodipine) — may cause low blood pressure
• Warfarin and other anticoagulants — may require closer INR monitoring

Mental health medications

• SSRIs (e.g. sertraline, fluoxetine) — can increase side effects
• Benzodiazepines (e.g. diazepam) — may be stronger or last longer

Steroids

• Prednisolone — levels may increase with antifungals, increasing risk of side effects

Immunosuppressants

• Tacrolimus, cyclosporine — antifungals can raise their levels significantly

Other

• Oral contraceptives — effectiveness may be reduced (use backup contraception)
• Some diabetes medications — risk of low or high blood sugar
• Antacids or proton pump inhibitors — can reduce absorption of antifungals

What you can do

• Make sure your drug list is kept up to date and brought to every clinic visit or hospital appointment
• You can ask your pharmacist or look up your medicines in the British National Formulary (BNF) or NHS Medicines A-Z to find out more about possible interactions. The Fungal Infection Trust also maintains a list specifically for antifungal medication
• Always give your care team a full, up-to-date medication list, including over-the-counter medicines, supplements, and herbal remedies
• Don’t stop or start any medicines without checking first
• Let your GP and pharmacist know you're taking antifungal treatment
• Ask your team if your medication needs to be monitored more closely (e.g. blood levels)

Signs of a potential drug interaction

• Unexplained dizziness, fainting, or fast heart rate
• New or worsening side effects
• Signs of toxicity (nausea, confusion, muscle pain, tremors)
• Bleeding or bruising more easily

If you notice anything unusual, contact your healthcare team or pharmacist.

by GAtherton

When to Speak Up About Side Effects

For patients and carers managing aspergillosis treatment

Why this matters

Treatment for aspergillosis is often long-term and involves medications that can affect people in different ways. It's important to know that you don’t have to suffer in silence. Recognising side effects early and reporting them can help you stay well and improve your quality of life.

Medications commonly used in aspergillosis

Antifungals
Voriconazole, Posaconazole, Itraconazole, Isavuconazole

Steroids
Prednisolone (oral), Inhaled corticosteroids

Biologic therapies
Omalizumab (anti-IgE), Mepolizumab/Benralizumab (anti-IL-5), Dupilumab (anti-IL-4/IL-13)

What to watch for

Note: These side effects range from common to rare. Most people do not experience all of them, but it's important to be aware of what might occur. If you’re unsure whether a symptom is related to your medication, always ask.

Cardiac side effects (uncommon to rare, but important to report)

• Palpitations (racing or irregular heartbeat)
• Dizziness or fainting
• Swelling in the legs or ankles
• Chest pain or tightness
• Changes in blood pressure or heart rhythm (QT prolongation) (can occur with antifungals or steroids)
• Palpitations (racing or irregular heartbeat)
• Dizziness or fainting
• Swelling in the legs or ankles
• Chest pain or tightness
• Changes in blood pressure or heart rhythm (QT prolongation)

Let your healthcare team know if you have a history of heart conditions, or experience any of these symptoms during treatment.

Antifungal side effects (common to occasional)

• Skin rash, burning, or sun sensitivity, even indoors (through windows or from reflected light)
• Visual changes (blurred vision, colour distortion, photophobia)
• Liver enzyme abnormalities (can show up on blood tests)
• Nausea, abdominal discomfort, or taste changes
• Hallucinations, anxiety, or confusion (rare but serious — seek help immediately)

Steroid side effects (common with long-term use)

• Mood swings, anxiety, or irritability
• Insomnia or restlessness
• Increased appetite or weight gain
• High blood sugar, especially if diabetic
• Bone thinning (osteoporosis) over time
• Skin thinning, easy bruising, or delayed healing
• Eye pressure/glaucoma or cataracts (with long-term use)

Biologic side effects (generally well-tolerated; uncommon side effects listed below)

• Localised reactions at the injection site (pain, swelling, redness)
• Headache, fatigue, or low-grade fever
• Worsening eye symptoms, especially with dupilumab (e.g. dry eyes, redness)
• Rare: allergic reactions or increased infection risk (let your team know if you’re feeling unwell after a dose)

When to get in touch

You should contact your care team if:

• A side effect is persistent, worsening, or interfering with your daily life
• You notice any mental health changes (anxiety, low mood, agitation)
• You feel dizzy, unwell, or unable to tolerate food or fluids
• There are signs of infection (e.g. fever, cough, chills, pain)
• You are unsure whether what you’re feeling is a side effect or something else

You're not being a nuisance

Asking questions or raising concerns is part of staying safe. Medications can usually be adjusted, paused, or switched — but your team needs to know how you’re feeling to make those decisions. You are an expert in your own experience.

Tip: Keep a side effect diary

• Note any changes in sleep, mood, appetite, skin, or digestion
• Bring this with you to appointments
• If helpful, ask a family member or friend to help observe changes

by GAtherton

Voriconazole and Sun Sensitivity

People taking voriconazole need to be very cautious in the sun because this antifungal can cause photosensitivity reactions—meaning the skin becomes more sensitive to sunlight, even through glass or on cloudy days. This can lead to severe sunburn, skin blistering, and long-term damage, including premalignant and malignant skin changes (like squamous cell carcinoma), especially with prolonged use.

Here’s what people on voriconazole should do to protect themselves:

Sun Safety Tips for Voriconazole Users

1. Avoid direct and reflected sunlight:

   • Try to stay indoors between 10 a.m. and 4 p.m., when UV rays are strongest.

   • Choose shaded routes or walk on the shady side of the street.

   • Avoid indirect or reflected sunlight (e.g. off windows, water, sand, snow)

2. Wear protective clothing:

   • Long-sleeved tops, trousers, and wide-brimmed hats are essential.

   • Consider UV-protective clothing (many brands offer this specifically).

   • Use UV-protective sunglasses to shield your eyes.

3. Use high-factor sunscreen:

   • Broad-spectrum SPF 50+ sunscreen is best.

   • Apply generously to all exposed skin, including hands, ears, and neck.

   • Reapply every 2 hours, and after sweating or washing.

4. Avoid sunbeds and tanning lamps:

   • Artificial UV exposure can also cause damage.

5. Check windows:

   • UV-A rays can penetrate glass, so use UV-filtering films on car and home windows if needed.

6. Regular skin checks:

   • Long-term voriconazole use has been linked to skin cancer, especially in immunocompromised individuals.

   • See a dermatologist regularly, and report any new or changing skin lesions.

Signs of Photosensitivity to Watch For:

• Red, itchy, or painful rash in sun-exposed areas

• Skin blistering or peeling

• New moles or spots, or changes to existing ones

If you're on long-term voriconazole and sun exposure is unavoidable, it might be worth discussing alternative antifungal treatments with your doctor, especially if skin damage begins to occur.

Here’s a mix of recommended sunscreens and UV-protective gear that people on voriconazole (especially those with prolonged use or immunosuppression) often find effective. These are high-protection, broad-spectrum, and suitable for sensitive or compromised skin.

Top Sunscreens for Voriconazole Users

Available in the UK

1. La Roche-Posay Anthelios UVMune 400 Invisible Fluid SPF 50+

   • Extremely high UVA/UVB protection.

   • Lightweight, non-greasy, great for sensitive skin.

   • Popular among transplant and cancer patients for sun protection.

2. Altruist Dermatologist Sunscreen SPF 50/50+

   • Developed by a UK dermatologist.

   • Broad-spectrum, affordable, fragrance-free.

   • Available in bulk (good for daily use on large areas).

3. Ultrasun Extreme SPF 50+

   • Long-lasting protection, water-resistant.

   • Ideal for extreme sun sensitivity.

   • One application can last several hours if you’re not sweating heavily.

4. Eucerin Sun Fluid Pigment Control SPF 50+

   • High UVA/UVB and HEVIS (visible light) protection.

   • Helps prevent hyperpigmentation from sun damage.

5. Heliocare 360° Mineral Tolerance Fluid SPF 50+

   • 100% mineral filters (ideal for highly sensitive or reactive skin).

   • Broad-spectrum including infrared and visible light.

   • Often recommended by dermatologists for patients with photosensitive conditions.

UV-Protective Clothing

Look for clothes labelled UPF 50+ (Ultraviolet Protection Factor), which blocks 98% of UV rays. Here are some trusted brands:

Available in the UK or for international shipping:

1. Solbari (Australia/UK)

   • Offers UPF 50+ certified clothing, including hats, long-sleeve tops, trousers, and gloves.

   • Specifically designed for people with photosensitivity and skin cancer risks.

2. Coolibar (US-based, ships to UK)

   • One of the gold-standard brands for UV-protective clothing.

   • Comfortable, stylish, and medically recommended for sun-sensitive conditions.

3. Uniqlo Airism Long Sleeve Tops

   • While not marketed as UV-protective, many of their Airism or UV-cut ranges have built-in UV filters.

   • Great for layering or casual use.

4. Decathlon UV Protection Range

   • Affordable UPF clothing, especially good for outdoor walking and travel.

   • Includes UV-protective hats, neck gaiters, and swimwear.

UV-Protective Sunglasses

Make sure they:

• Are labelled UV400 or 100% UVA & UVB protection

• Preferably have wraparound lenses to protect the sides

• Brands: Ray-Ban, Oakley, M&S UV-protection glasses, or Fitovers if you already wear prescription glasses.

by GAtherton

What are all the diseases that link to higher risk of aspergillosis?

by GAtherton

Taking itraconazole for the first time?

Checklist for Taking Itraconazole the First Time

1. Know Your Form: Capsule vs Liquid

• Capsules:

  • Must be taken with a full meal (ideally high-fat) to help absorption

  • Avoid taking with antacids, PPIs, or H2 blockers (like omeprazole, ranitidine)

• Liquid (solution):

  • Must be taken on an empty stomach

  • Better absorption than capsules—but tastes unpleasant to some

Make sure you know which form you're on and follow the correct instructions. If unsure, ask your pharmacist.

2. Stick to a Routine

• Take it at the same time every day

• Don’t skip doses

• If you miss one and it's within a few hours—take it. If it’s close to the next dose, skip it—don’t double up.

3. Food and Drug Interactions

• Avoid grapefruit juice – it can increase side effects

• Avoid alcohol – adds to liver strain

• Tell your doctor/pharmacist if you take:

  • Statins

  • Calcium channel blockers

  • Steroids

  • Blood thinners (e.g., warfarin)

  • Drugs that reduce stomach acid

4. Baseline & Follow-Up Tests

• Before or soon after starting, you should have:

  • Liver function tests (LFTs)

  • Kidney function tests

  • Itraconazole blood levels (usually after 1–2 weeks if long-term treatment)

  • ECG if there's any heart history (due to rare risk of heart problems)

Ask your doctor to schedule a check-up in 2–4 weeks to make sure the drug level is therapeutic and safe.

5. Watch for Side Effects

Common but usually mild:

• Nausea

• Diarrhea

• Headache

• Rash

More serious (call your doctor if these occur):

• Upper right abdominal pain, yellowing of the eyes/skin ( possible liver injury)

• Shortness of breath, ankle swelling ( possible heart effects)

• Tingling or numbness ( rare nerve effects)

• Fatigue, dizziness, or mood changes

6. Stay Hydrated and Track Symptoms

• Keep a daily symptom diary (breathlessness, fatigue, cough, rash, mood, etc.)

• Stay hydrated, eat well, and let your team know if anything feels “off”

Want a Tip?

You can ask for a medication review a couple weeks after starting—especially if you're on other long-term meds. That’s often when interactions or early side effects show up.

Keep your prescribing doctor informed of any new symptoms, and don't forget your pharmacist is a great source of good advice about any drug you are taking and how they may interact with each other.

by GAtherton