GAtherton

Infographic comparing symptoms of ABPA and long-term steroid side effects, including fatigue, mood changes, weakness and overlapping symptoms.

ABPA or Steroid Side Effects? Understanding Symptoms During Long-Term Treatment

Infographic comparing symptoms of ABPA and long-term steroid side effects, including fatigue, mood changes, weakness and overlapping symptoms.
Many symptoms such as fatigue, weakness, and low mood can be caused by both ABPA and long-term steroid treatment, making it difficult to tell the difference without clinical review.

Last reviewed: April 2026

Many people living with Allergic Bronchopulmonary Aspergillosis (ABPA) who take long-term steroids find it difficult to tell whether their symptoms are caused by the condition or the treatment.

Symptoms in ABPA can come from both the condition and long-term steroid treatment. Fatigue, weakness, mood changes, and general unwellness are common to both, making it difficult to identify a single cause without clinical review.

This is especially true for people taking corticosteroids such as methylprednisolone or prednisolone.

Infographic comparing symptoms of ABPA and long-term steroid side effects including fatigue, mood changes and weakness
Many symptoms such as fatigue, weakness, and low mood can be caused by both ABPA and long-term steroid treatment, making it difficult to tell the difference without clinical review.

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Key Points

  • ABPA and steroid treatment can cause overlapping symptoms.
  • Fatigue, low mood, and general unwellness can come from either the condition or medication.
  • Long-term corticosteroid use can cause additional side effects.
  • It is common to feel unsure what is causing symptoms.
  • Ongoing or worsening symptoms should be discussed with your healthcare team.

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Why is it hard to tell the difference?

ABPA is an immune-driven lung condition that causes inflammation. Treatment often includes corticosteroids such as methylprednisolone or prednisolone, which reduce inflammation but can also affect many systems in the body.

This means that:

  • The disease itself can cause symptoms
  • The treatment can also cause symptoms

As a result, people often experience a combination of both.

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Symptoms caused by ABPA

ABPA commonly affects the lungs but can also cause more general symptoms.

  • Fatigue and low energy
  • Breathlessness
  • Cough and mucus production
  • Chest tightness
  • General feeling of being unwell

Fatigue can be particularly prominent, especially during flare-ups.

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Side effects of long-term steroids

Corticosteroids such as methylprednisolone are highly effective treatments, but long-term use can lead to a range of side effects.

  • Fatigue and weakness (including muscle loss)
  • Mood changes (anxiety, low mood, irritability)
  • Easy bruising (skin becomes thinner)
  • Stomach irritation or pain
  • Dizziness or feeling unwell
  • Sweating
  • Bone or joint discomfort

Learn more about treatment approaches in aspergillosis treatment options.

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Where symptoms overlap

Some symptoms can be caused by both ABPA and steroid treatment, making them difficult to interpret.

Symptom Possible cause
Fatigue ABPA inflammation or steroid effects
Low mood / anxiety Medication effects or impact of chronic illness
Weakness Muscle loss from steroids or reduced activity
General unwell feeling Both

This overlap is one of the most challenging aspects of long-term management.

🔎 Not sure what’s causing your symptoms?
Many people with ABPA feel exactly the same—this overlap is one of the most common challenges during long-term treatment.

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Understanding specific symptoms

Some symptoms are more commonly linked to treatment effects:

  • Easy bruising – often related to steroid use
  • Heel or ankle pain – may relate to tendon or joint effects
  • Stomach pain – can be linked to steroid irritation

Other symptoms, such as fatigue, dizziness, and nausea, may have multiple possible causes.

Because of this, it is often not possible to attribute symptoms to a single cause without clinical review.

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When to seek medical advice

You should contact your healthcare team if you experience:

  • Persistent or worsening fatigue
  • New dizziness or nausea
  • Ongoing stomach pain
  • Increasing weakness
  • Mood changes affecting daily life

These symptoms do not necessarily indicate a serious problem, but they may mean that treatment or support needs to be reviewed.

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Summary

In ABPA, symptoms such as fatigue, weakness, and low mood can arise from both the condition and its treatment. Long-term steroid use can add additional effects, making it difficult to distinguish between causes.

If symptoms are persistent or worsening, it is important to discuss them with your healthcare team so that appropriate adjustments or support can be considered.

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Further Reading

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Author & Review

Prepared for aspergillosis.org to support patient understanding. Content reflects current clinical knowledge and patient-reported experience.

Disclaimer

This information is for general education only and does not replace advice from your healthcare team.

by GAtherton

Infographic showing causes of weight loss and weakness in aspergillosis including inflammation, reduced appetite, medication effects and muscle loss, with stages of recovery.

Weight Loss and Weakness in Aspergillosis: Why It Happens, How It Feels, and What Helps Recovery

Infographic showing causes of weight loss and weakness in aspergillosis including inflammation, reduced appetite, medication effects and muscle loss, with stages of recovery.
Weight loss and weakness in aspergillosis are usually caused by a combination of inflammation, increased energy use, reduced appetite, and muscle loss. Recovery is often gradual and happens in stages.

Last reviewed: April 2026

Unexpected weight loss and severe weakness are among the most worrying symptoms people report after being diagnosed with aspergillosis. Many describe feeling unlike themselves—physically drained, thinner than they have ever been, and struggling with everyday activities.

This article explains why this happens, what is going on in the body, and what recovery typically looks like.

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Key Points

  • Weight loss and fatigue are common in aspergillosis, particularly early in the illness or during flare-ups.
  • They are usually caused by a combination of inflammation, increased energy use, reduced appetite, and muscle loss.
  • Medication side effects can contribute but are rarely the main cause.
  • Many people improve over time, but recovery is usually gradual and can take weeks to months.
  • Stabilising weight is often the first important step before regaining strength.

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Contents

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Why does aspergillosis cause weight loss?

Weight loss in aspergillosis is rarely due to a single cause. Instead, it is usually the result of several overlapping processes.

1. Increased energy use (hypermetabolism)

When the body is dealing with infection or inflammation, it requires more energy. This is sometimes described as a hypermetabolic state.

  • The immune system is active and consumes energy
  • The body produces inflammatory signals
  • Breathing effort may increase

This means you may be burning more calories than usual—even at rest.

2. Reduced appetite

Many people notice they are eating less, sometimes without realising it. This may be due to:

  • Feeling unwell or fatigued
  • Shortness of breath when eating
  • Changes in appetite driven by inflammation

3. Medication effects

Some treatments can affect appetite or digestion. For example:

  • Antifungal medications such as itraconazole or voriconazole may cause nausea or taste changes
  • Steroids may increase appetite but can also contribute to muscle weakness over time

Medication effects vary widely and are usually only part of the overall picture.

4. Muscle breakdown

During illness, the body may break down muscle to meet energy needs. This can happen quickly, especially if activity levels fall.

This leads to:

  • Loss of strength
  • Reduced stamina
  • A feeling of being “weak” rather than just lighter

5. Underlying lung disease

Many people with aspergillosis also have conditions such as bronchiectasis, asthma, or chronic obstructive pulmonary disease (COPD). These can increase the effort required for breathing and contribute to ongoing energy use.

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What is happening inside the body?

Several biological processes contribute to weight loss and fatigue:

  • Inflammatory signalling: The immune system releases chemical signals that affect metabolism and appetite
  • Catabolism: The body breaks down tissues (including muscle) to release energy
  • Energy imbalance: More energy is used than consumed

This combination can make weight loss feel rapid and difficult to control.

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Which types of aspergillosis are affected?

These symptoms are most commonly seen in:

However, not everyone experiences weight loss, and severity varies.

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Why does it feel so severe?

Many people describe this stage as one of the most difficult parts of their illness. This is because several factors are happening at once:

  • Physical energy is reduced
  • Muscle strength has declined
  • The body is under ongoing stress
  • Recovery has not yet begun

This can make everyday activities—such as walking, cooking, or even eating—feel unusually difficult.

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Does it get better?

In many cases, yes—there is gradual improvement over time, especially once treatment begins to control the condition.

Recovery often follows a pattern:

  • Initial phase: weight loss and severe fatigue
  • Stabilisation: weight loss slows or stops
  • Recovery: gradual return of strength and energy

This process is usually slow and uneven, with good and bad days.

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What can help day to day?

1. Focus on maintaining nutrition

  • Eat small amounts regularly rather than large meals
  • Choose foods that are easy to prepare and eat
  • Include protein to support muscle maintenance

2. Pace activity carefully

  • Gentle movement can help maintain strength
  • Avoid pushing too hard, as this can worsen fatigue
  • Increase activity gradually as energy improves

3. Look at trends over time

It can be helpful to focus on gradual changes such as:

  • Weight stabilising
  • Small improvements in energy

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Nutrition and rebuilding strength

Recovery often happens in stages:

  • Stage 1: Stabilising weight
  • Stage 2: Gradually increasing intake
  • Stage 3: Rebuilding muscle and strength

Regaining muscle mass takes time and usually follows once the underlying condition is better controlled.

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When to seek medical advice

You should contact your healthcare team if you experience:

  • Continued or rapid weight loss
  • Increasing weakness
  • Difficulty eating or swallowing
  • New or worsening symptoms

This may indicate the need for additional support or adjustment of treatment.

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Common questions

Is weight loss just due to poor appetite?

No. Reduced appetite is only one factor. Increased energy use and muscle loss are also important contributors.

Are medications the main cause?

Medications can contribute, but they are rarely the main reason for weight loss.

Will I regain my strength?

Many people do regain strength over time, although recovery is usually gradual.

Why does recovery take so long?

The body needs time to reduce inflammation, restore energy balance, and rebuild muscle.

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Summary

Weight loss and weakness in aspergillosis are common and can feel severe, particularly early in the illness. They are usually caused by a combination of increased energy use, reduced appetite, muscle loss, and underlying lung disease.

Although recovery can take time, many people improve gradually as treatment takes effect.

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Further Reading

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Author & Review

Prepared for aspergillosis.org to support patient understanding. Content reflects current clinical knowledge and patient-reported experience.

Disclaimer

This page is for general information only and does not replace advice from your healthcare team.

by GAtherton

Infographic summarising weekly aspergillosis research including ABPA biologics, antifungal resistance, occupational exposure and invasive aspergillosis studies (April 2026)

Weekly Aspergillosis Research Update: Week ending 27 April 2026

Highlights this week

  • Occupational aspergillosis: workplace exposure to Aspergillus highlighted in a national study.
  • ABPA and biologics: early evidence for tezepelumab in allergic bronchopulmonary aspergillosis.
  • Mucus plugging: important mechanism in ABPA, bronchiectasis and chronic lung disease.
  • Invasive disease: new analysis of antifungal treatment strategies.
  • Resistance: ongoing global surveillance of antifungal susceptibility.

Occupational non-invasive aspergillosis

A French national multicentre study reviewed occupational cases of non-invasive aspergillosis over more than 20 years.

Why it matters: workplace exposure (dust, compost, damp buildings, waste handling) may contribute to disease in some patients and should be considered in clinical history-taking.

Reference: Michel A et al.

PMID: 42033338

Tezepelumab in allergic bronchopulmonary aspergillosis

A small 4-patient case series explored the use of tezepelumab in allergic bronchopulmonary aspergillosis (ABPA) with severe asthma.

Why it matters: adds to growing interest in biologics for ABPA, particularly where steroid burden is high. Evidence remains early and limited.

Reference: Sanz-Sanjosé B et al.

PMID: 42017435

Mucus plugging in chronic lung disease

A narrative review examined mucus plugging in chronic obstructive lung diseases and bronchiectasis, including ABPA.

Why it matters: mucus plugs can block airways, worsen breathlessness, and contribute to infection risk and scan abnormalities.

Reference: Schou C et al.

PMCID: PMC13103984

Invasive aspergillosis treatment

A systematic review and network meta-analysis compared antifungal treatment regimens for invasive aspergillosis.

Why it matters: invasive aspergillosis remains a high-mortality infection; early diagnosis and optimal antifungal therapy are critical. Triazoles and other antifungals remain central to management. :contentReference[oaicite:0]{index=0}

Reference: Gu Q et al.

PMID: 42012594

Natural killer cells and resistant Aspergillus

A laboratory study demonstrated antifungal activity of human natural killer cells against azole-resistant Aspergillus fumigatus.

Why it matters: improves understanding of immune defence mechanisms and may inform future therapies.

Reference: Namie H et al.

PMID: 42012259

Antifungal susceptibility surveillance

A multicentre Taiwan study examined susceptibility patterns of clinical Aspergillus isolates (2021–2023).

Why it matters: resistance patterns vary geographically, influencing antifungal treatment choices.

Reference: Hsieh M et al.

PMID: 42012212

Invasive aspergillosis in severe viral illness

A study explored invasive pulmonary aspergillosis complicating severe fever with thrombocytopenia syndrome.

Why it matters: reinforces the link between severe illness, immune disruption, and risk of invasive aspergillosis.

Reference: Du Q et al.

PMID: 42032512

Lower-priority or indirect papers

Veterinary study (canine nasal aspergillosis)

Primarily a veterinary oncology study with limited relevance to human disease.

Reference:

PMID: 42007656

Canakinumab pharmacovigilance

Focuses on drug safety rather than aspergillosis.

Reference:

PMID: 41998856

Overall message

This week’s research highlights the wide scope of aspergillosis—from environmental and occupational exposure to allergic disease, invasive infection, antifungal resistance, and immune responses. The most relevant developments for patients remain ABPA biologics, mucus plugging, and antifungal resistance trends.

Patient note

This summary is for general information only and does not replace medical advice. Always discuss treatment decisions with your specialist team.

by GAtherton

Infographic showing how damp homes and poor ventilation lead to mould, microbes and respiratory health problems

Damp Homes, Indoor Air and Health: What a Recent Evidence Review Tells Us

Infographic showing how damp homes and poor ventilation lead to mould, microbes and respiratory health problems
How dampness and poor ventilation can increase mould and affect the air we breathe indoors.

Summary: A recent rapid review by researchers from the Health and Safety Executive examined evidence on microbiological hazards in buildings, including moulds, bacteria and viruses. The review highlights that dampness, poor ventilation and building design can all affect indoor air quality and respiratory health.

Key points

  • People spend much of their time indoors, so indoor air quality can strongly affect health.
  • Damp indoor conditions increase the risk of mould growth and musty odours.
  • Common indoor moulds include Aspergillus, Penicillium and Cladosporium.
  • Dampness and visible or hidden mould are linked with asthma, rhinitis, wheeze and other respiratory symptoms.
  • Ventilation is one of the most important ways to reduce moisture and dilute airborne contaminants.
  • Improving energy efficiency is important, but very airtight homes still need adequate ventilation.

Contents

Why indoor air matters

Most of us spend a large amount of time indoors — at home, at work, or in public buildings. The air inside buildings can contain particles from many sources, including dust, mould spores, bacteria, viruses, cooking, cleaning products, pets and outdoor air entering the home.

The recent review, Exposure Risks from Microbiological Hazards in Buildings and Their Control — A Rapid Review of the Evidence, looked at evidence for harmful microorganisms in indoor air and on surfaces, and how building design, ventilation and moisture affect exposure.

What the review found

The review found strong evidence that microorganisms can be present in indoor air and on surfaces. These include fungi, bacteria and viruses. The evidence was strongest for the role of dampness and poor ventilation in increasing the risk of indoor mould growth and respiratory health effects.

The review’s main conclusions included:

  • Airborne allergenic fungi are well documented in indoor air.
  • Damp conditions increase mould growth and mouldy odours indoors.
  • Dampness and mould are associated with respiratory ill health, including asthma, rhinitis and wheezing.
  • Penicillium, Aspergillus and Cladosporium are commonly detected in damp buildings.
  • Infectious viruses and bacteria can also be detected in indoor air and on surfaces.
  • Ventilation is a key control measure for reducing moisture and diluting airborne contaminants.

Damp, mould and lung health

Dampness is one of the most important drivers of indoor mould growth. Moisture can come from leaks, condensation, flooding, poor insulation, inadequate heating, drying clothes indoors, cooking, showering, or poor ventilation.

When dampness persists, mould can colonise indoor materials such as plasterboard, wallpaper, wood, carpets, soft furnishings and settled dust. Mould may be visible, but it can also grow in hidden areas such as behind furniture, inside wall cavities, behind wallpaper, under flooring, or around poorly ventilated cold surfaces.

Exposure to damp and mould has been linked with:

  • Wheezing
  • Asthma symptoms or asthma worsening
  • Rhinitis and nasal symptoms
  • Cough
  • Respiratory infections
  • Worsening symptoms in people with existing lung disease

Importantly, the review notes that the relationship between indoor microorganisms and health is complex. Risk depends on the type of organism, the level of exposure, the building conditions and the susceptibility of the person exposed.

Aspergillus and aspergillosis

Aspergillus is a common mould found in the environment. Most people inhale Aspergillus spores every day without becoming ill. However, some people are more vulnerable, including those with asthma, bronchiectasis, chronic lung disease, weakened immune systems, or previous lung damage.

In susceptible people, exposure to Aspergillus may contribute to conditions such as allergic bronchopulmonary aspergillosis (ABPA), severe asthma with fungal sensitisation (SAFS), aspergillus bronchitis, or chronic pulmonary aspergillosis (CPA). The home environment is not the only source of exposure, but damp indoor spaces may increase the amount of fungal material a person breathes in.

This does not mean that every damp home causes aspergillosis, or that every person exposed to mould will become ill. It does mean that reducing dampness, improving ventilation and addressing visible or hidden mould are sensible steps for respiratory health.

Ventilation and building design

One of the strongest messages from the review is that ventilation is central to controlling indoor microbiological risk. Ventilation helps by:

  • Removing moisture from indoor air
  • Reducing condensation
  • Diluting airborne mould spores and other particles
  • Reducing the build-up of infectious aerosols
  • Improving overall indoor air quality

The review also highlights an important modern problem. Homes are increasingly designed or retrofitted to be more airtight and energy efficient. This can improve warmth and reduce energy use, but if ventilation is inadequate, moisture and airborne contaminants may accumulate indoors.

In other words, insulation and energy efficiency are important, but they need to be balanced with effective ventilation and moisture control.

What can help reduce risk?

The review does not suggest that one single action solves all indoor air problems. Instead, it supports a combined approach.

1. Reduce moisture

  • Repair leaks promptly.
  • Check roofs, gutters, pipes and window seals.
  • Use extractor fans in kitchens and bathrooms where available.
  • Avoid drying clothes indoors where possible, or ventilate well if you do.
  • Reduce condensation on windows and cold walls.

2. Improve ventilation

  • Use trickle vents if fitted.
  • Open windows when safe and practical.
  • Use mechanical ventilation systems correctly.
  • Keep air bricks and vents clear.
  • Make sure extractor fans are working effectively.

3. Deal with mould safely

  • Small areas of surface mould may be cleaned carefully using appropriate household methods.
  • Large, persistent or recurring mould usually needs the underlying damp problem fixed.
  • People with significant lung disease, immune suppression or severe symptoms should avoid heavy mould disturbance and seek advice.

4. Reduce dust reservoirs

  • Regular cleaning can reduce settled dust and spores.
  • HEPA-filter vacuum cleaners may be helpful for some households.
  • Hard flooring may be easier to keep dust-free than carpets in high-risk situations.

5. Consider air filtration where appropriate

Portable high-efficiency particulate air (HEPA) filters may help reduce airborne particles in some settings. They are not a substitute for fixing damp or improving ventilation, but they may be a useful additional measure for some people.

Help us understand damp homes and health

The evidence linking damp homes, mould and respiratory health is strong, but there are still important unanswered questions. We need to better understand how different homes, building types, ventilation patterns and damp conditions affect people’s health in real life.

The National Aspergillosis Centre is running a UK citizen science study looking at damp homes and health.

We are inviting people to register their interest in taking part.

The study is open to people with and without lung conditions, and to people living in homes with or without damp or mould. This comparison is important because it helps researchers understand which factors are most strongly linked with health outcomes.

Register your interest in the damp homes and health study

Taking part may involve completing a questionnaire and, at a later stage, providing a dust sample from your home. The information gathered will help improve understanding of indoor environments and respiratory health.

When to seek medical advice

Please seek medical advice if you have:

  • New or worsening breathlessness
  • Chest pain
  • Coughing up blood
  • Persistent fever
  • Repeated chest infections
  • Rapidly worsening asthma symptoms
  • Unexplained weight loss or severe fatigue

If you already have aspergillosis, asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), immune suppression, or another lung condition, it is worth discussing any significant damp or mould exposure with your healthcare team.

Common questions

Can mould affect health even if I cannot see it?

Yes. Hidden mould or dampness may still affect indoor air quality. A musty smell, persistent condensation or symptoms that worsen in a particular room may suggest a problem.

Does all mould cause aspergillosis?

No. Mould exposure is common, and most people do not develop aspergillosis. Aspergillosis usually occurs when exposure combines with individual susceptibility, such as asthma, bronchiectasis, immune suppression or existing lung damage.

Is ventilation always good?

Ventilation is usually important for reducing moisture and improving indoor air quality. However, the best approach depends on the building, outdoor conditions and the person’s health. Ventilation should not replace fixing leaks or removing sources of damp.

Can air purifiers solve damp and mould problems?

No. Air purifiers may reduce airborne particles, but they do not remove the source of moisture or mould growth. Damp problems need to be addressed at source.

Summary

This recent evidence review reinforces a practical message: indoor air quality matters. Dampness, poor ventilation and mould growth are not simply cosmetic housing problems — they can affect respiratory health, especially in people with asthma, aspergillosis or other lung conditions.

The most effective approach is to reduce moisture, improve ventilation, remove mould sources where possible and understand how buildings influence exposure. Research such as the UK damp homes and health study will help build better evidence for patients, clinicians, housing providers and policymakers.

References and further reading

Article type: Patient and public information

Last reviewed: April 2026

Based on: Recent evidence review of microbiological hazards in buildings and their control.

by GAtherton

Diagram showing why aspergillosis is often controlled rather than cured, including differences between ABPA and chronic pulmonary aspergillosis (CPA)

Can Aspergillosis Be Cured? Understanding Treatment, Control, and Long-Term Therapy

Last reviewed: April 2026

Key points

  • Aspergillosis is caused by fungi from the Aspergillus group.
  • Most people breathe in Aspergillus spores regularly without becoming ill.
  • In some people, damaged airways, lung cavities, mucus plugs, or immune responses allow the fungus or fungal material to persist.
  • Antifungal treatment may aim to cure, but in many cases the goal is long-term control.
  • Steroids can reduce harmful inflammation in allergic disease, but they can also reduce the body’s ability to clear fungus.

Table of contents

Overview

It is very common for people diagnosed with aspergillosis to feel worried when they read that others have been taking antifungal medication for months or even years.

This can lead to an understandable question:

“Does treatment actually work, or will I have this forever?”

The answer is more nuanced than a simple yes or no. Different forms of aspergillosis behave differently, and treatment goals vary depending on the condition.

Two of the most common conditions are:

Understanding this difference is key to understanding why treatment may continue for a long time.

If you would like a more detailed explanation of how these conditions are diagnosed and managed, see our guides to chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA).

Why breathing in spores does not usually cause disease

Aspergillus spores are present in the environment, including air, soil, compost, dust, and decaying vegetation. Most people breathe in small numbers of these spores regularly without becoming ill.

In healthy lungs, spores are usually cleared by the immune system and by the normal cleaning mechanisms of the airways.

This means:

  • Exposure to Aspergillus is common
  • Most exposure does not lead to disease
  • Aspergillosis usually develops only when there are additional risk factors, such as lung damage, mucus trapping, or altered immune responses

So it is not accurate to think of most patients as being “constantly reinfected”. A better way to think about it is that some lungs provide conditions where Aspergillus, or fungal material, can persist and continue to cause problems.

Why aspergillosis can be hard to clear

Aspergillosis can be difficult to clear for several reasons. These include the structure of the lungs, the biology of the fungus, limitations of drug penetration, and the way the immune system responds.

1. Damaged lung tissue can provide protected spaces

In CPA, Aspergillus often grows in areas of abnormal lung, such as cavities, scarred tissue, or areas affected by bronchiectasis.

These areas can act as protected spaces where the fungus is harder for the immune system and antifungal medicines to reach.

2. Thick mucus can trap fungus and fungal material

In airway diseases such as asthma, bronchiectasis, and ABPA, thick mucus can trap spores, hyphae, and fungal fragments.

This trapped material can continue to stimulate inflammation even when the fungus is not invading lung tissue.

3. Antifungal medicines may suppress rather than sterilise

Antifungal medications can reduce fungal activity and help prevent progression, but they may not always remove every trace of fungus from damaged lung spaces or mucus-filled airways.

For this reason, success is often measured by:

  • Improved symptoms
  • Stabilised weight and energy
  • Fewer flare-ups
  • Stable or improved scans
  • Prevention of further lung damage

Infection and ABPA: different reasons for persistence

Chronic pulmonary aspergillosis: persistence of infection

In chronic pulmonary aspergillosis, the problem is fungal growth in damaged lung tissue.

  • Lung cavities provide spaces where fungus can grow
  • Drug penetration may be limited
  • The immune system may not fully clear infection

Allergic bronchopulmonary aspergillosis: persistence of reaction

In ABPA, the main issue is an exaggerated immune response.

  • Mucus traps fungal material
  • Small amounts can trigger strong reactions
  • Inflammation leads to more mucus

Do steroids influence this?

Yes. Steroids can be helpful but must be used carefully.

In ABPA, they reduce inflammation but may also reduce fungal clearance.

In chronic infection, steroids can increase the risk of persistence or progression.

Monitoring and drug interactions are important during treatment.

Control vs cure: what is the goal?

For many people, the realistic goal is:

  • Stability rather than eradication
  • Reduced symptoms
  • Prevention of progression

 

Diagram showing why aspergillosis is often controlled rather than cured, including differences between ABPA and chronic pulmonary aspergillosis (CPA)
Aspergillosis is often managed as a long-term condition. This diagram shows why complete cure can be difficult and how treatment focuses on control.

Common antifungal treatments

  • Itraconazole
  • Voriconazole
  • Posaconazole

These treatments are selected based on individual factors and require monitoring.

Why don’t I hear many success stories?

People who improve often post less, while those still struggling are more visible in forums.

When to seek medical advice

  • Uncertainty about treatment
  • Side effects
  • Weight loss
  • Worsening symptoms

Common questions

Can aspergillosis be cured?

Sometimes, but often it is managed long-term.

Are people constantly reinfected?

No. Most people clear spores regularly without issue.

Why is ABPA difficult to treat?

Because of ongoing immune reactions and mucus trapping.

Further reading

by GAtherton

Infographic showing ABPA cycle: Aspergillus spores, airway colonisation, immune reaction, inflammation and treatments including steroids and antifungals

ABPA: Allergic Reaction or Fungal Presence in the Lungs?

Infographic showing ABPA cycle: Aspergillus spores, airway colonisation, immune reaction, inflammation and treatments including steroids and antifungals
ABPA involves both an allergic response and the presence of Aspergillus in the airways, which can drive ongoing inflammation.

Allergic Bronchopulmonary Aspergillosis (ABPA) can be confusing. It is often described as an allergic condition, yet patients may also be told there is “fungus in the lungs”.

In reality, both can be true at the same time.

Key points

  • ABPA is primarily an allergic (immune) reaction to Aspergillus
  • The fungus can also persist in the airways (colonisation)
  • Colonisation is not the same as invasive infection
  • Steroids are the standard first-line treatment
  • Antifungals and biologics may be used in selected cases

What is ABPA?

ABPA is a condition where the immune system overreacts to a common environmental fungus, most often Aspergillus fumigatus.

For a full introduction, see our guide to
what is ABPA.

This leads to:

  • airway inflammation
  • increased mucus production
  • worsening asthma symptoms
  • raised Immunoglobulin E (IgE) levels

If you are unfamiliar with IgE, see
our explanation of IgE.

Importantly, ABPA is not an invasive fungal infection. The lungs are reacting to fungal material rather than being invaded by it.

Can the fungus live in the lungs?

Yes—this is an important nuance.

In people with conditions such as:

the structure of the airways can allow Aspergillus to persist in mucus within the airways. This is known as colonisation.

Colonisation means:

  • the fungus is present in airway mucus
  • it may grow at low levels locally
  • it does not invade lung tissue

This is very different from serious invasive fungal infections seen in severely immunocompromised patients.

How ABPA and colonisation interact

ABPA and colonisation are best understood as part of a spectrum of Aspergillus-related lung disease.

They can interact in a cycle:

  1. Aspergillus spores are inhaled
  2. The fungus persists in airway mucus
  3. The immune system reacts strongly (ABPA)
  4. Inflammation leads to more mucus production
  5. This creates an environment where the fungus can persist

This cycle can contribute to:

  • recurrent flare-ups
  • ongoing inflammation
  • persistently raised IgE levels

Standard treatment: steroids

Oral corticosteroids are the traditional first-line treatment for ABPA.

Steroids such as prednisolone are used because they:

  • reduce airway inflammation
  • suppress the allergic immune response
  • improve symptoms such as breathlessness and cough
  • help control flare-ups

Learn more in our guide to
steroids and aspergillosis.

Where do antifungals fit in?

Antifungal medications such as itraconazole are often used as an additional (adjunctive) treatment rather than the primary therapy.

The aim is to:

  • reduce the amount of fungus present in the airways
  • lower the trigger for the immune response
  • sometimes allow a reduction in steroid dose

For more detail, see our
antifungal treatments guide.

Biologic treatments

Biologic therapies such as omalizumab (anti-IgE) are increasingly used in some patients, particularly when:

  • symptoms are difficult to control
  • steroid side effects are significant
  • there is severe asthma alongside ABPA

Read more about
biologics in asthma and ABPA.

Why results and symptoms may not match

Some people with ABPA may feel relatively well but still have:

  • raised IgE levels
  • evidence of fungal presence in the airways

This is because blood tests reflect underlying immune activity, which does not always match how a person feels day to day.

Why treatment is individualised

Although steroids are the standard treatment, management is often tailored to the individual. This is because people may also have:

  • asthma
  • bronchiectasis
  • difficulty tolerating antifungal medications
  • side effects from long-term steroid use

Specialist teams balance these factors when planning treatment.

When to seek medical advice

People with ABPA should seek medical review if they experience:

  • worsening breathlessness
  • increased cough or sputum
  • new or persistent chest symptoms
  • possible medication side effects

Treatment decisions should always be made with a clinician experienced in managing Aspergillus-related lung disease.

Summary

  • ABPA is primarily an allergic condition
  • The fungus can also persist in the airways (colonisation)
  • These processes can drive each other
  • Steroids are the standard first-line treatment
  • Antifungals and biologics may be used in selected cases

Last reviewed: April 2026
Prepared by: National Aspergillosis Centre (patient information resource)

by GAtherton

Fermented foods gut lung axis diagram showing microbiome, lungs, reflux and aspiration risks in chronic lung disease

Fermented Foods & Lung Health: Safety, Infection Risk and Aspergillosis

Last reviewed: April 2026

Many people with lung conditions ask whether foods like kefir, yoghurt or cider vinegar could trigger infections. This article explains what we know — and what we don’t — based on current evidence and patient experience.

 

Fermented foods gut lung axis diagram showing microbiome, lungs, reflux and aspiration risks in chronic lung disease
How fermented foods may influence health: most effects are indirect, via the gut–lung axis, reflux, or aspiration rather than direct lung infection

Can fermented foods cause lung infections?

No. There is no strong evidence that fermented foods cause lung infections such as pneumonia. Any effects on the lungs are more likely indirect, for example through reflux or aspiration rather than direct infection.

Quick answer: fermented foods are generally safe, but individual responses vary.

Key Points

  • Fermented foods contain live microorganisms, usually beneficial bacteria and yeasts
  • For most people, these foods are safe and part of a healthy diet
  • There is no strong evidence linking fermented foods to lung infections
  • Some people with lung disease may be affected by reflux or aspiration
  • If symptoms worsen after certain foods, it is reasonable to avoid them

Table of Contents

What are fermented foods?

Fermented foods are made using microorganisms (such as bacteria or yeast) to transform food. Examples include yoghurt, kefir, sauerkraut, kimchi, cheese and cider vinegar (including those containing the “mother”).

These microorganisms are generally considered non-harmful or beneficial.

Are fermented foods safe?

For most people, including many with chronic lung conditions, fermented foods are considered safe.

They may support gut health, although evidence varies depending on the product and individual.

You can read more in our

diet and aspergillosis guide
.

Can they cause infections?

There is no clear evidence that eating fermented foods causes lung infections such as pneumonia.

Lung infections usually arise from:

  • Microorganisms already present in the airways
  • Inhaled organisms from the environment

This is explored further in our article:

Why antibiotics do not always work
.

Why do concerns arise in lung conditions?

People with aspergillosis, bronchiectasis or chronic lung disease may be more sensitive to changes affecting the lungs.

1. Aspiration

If small amounts of food or liquid enter the airway, this can contribute to infection.

2. Reflux

Reflux can reach the upper airway and may play a role in lung irritation.

3. Lung microbiome

The lungs contain their own microbial environment, which can shift during illness.

4. Coincidence vs causation

An infection occurring after a dietary change does not necessarily mean the food caused it.

Evidence in this area is still developing, and most studies focus on gut health rather than direct lung effects.

Who might need to be more cautious?

  • Frequent lung infections
  • Significant bronchiectasis
  • Swallowing difficulties
  • Severe reflux
  • Weakened immune systems

At specialist centres such as the National Aspergillosis Centre, these factors are considered alongside overall lung health.

Practical considerations

  • Avoid foods that appear to worsen symptoms
  • Introduce new foods gradually
  • Be cautious with unpasteurised products
  • Keep a simple symptom diary

Common questions

Are probiotics the same as fermented foods?

No. Probiotics are specific strains studied for health benefits, while fermented foods vary widely.

Should people with aspergillosis avoid fermented foods?

There is no general recommendation to avoid them. Most people tolerate them well.

Can fermented foods affect the lungs directly?

Not usually. Effects, if present, are more likely indirect.

When to seek medical advice

  • New or worsening breathlessness
  • Persistent cough or sputum changes
  • Fever or infection symptoms
  • Repeated infections

Summary

Fermented foods are generally safe, but individual responses vary. There is no strong evidence linking them to lung infections, but factors such as reflux or aspiration may be relevant in some people.

Balancing general evidence with personal experience is key.

References

Author & Review

This article has been prepared by the National Aspergillosis Centre CARES team for patients and non-specialists.

It is intended for general education and should not replace individual medical advice.

by GAtherton

Help us understand how damp homes affect health

We are supporting a UK research project looking at how damp homes may affect health, including respiratory health and conditions such as aspergillosis.

This study is being led by the National Aspergillosis Centre at Manchester University NHS Foundation Trust, and is being shared through aspergillosis.org to support research into damp homes and health.

We are currently inviting people across the UK to register their interest in taking part.

Registering your interest should take less than one minute and does not commit you to taking part.


Register your interest now

Why this matters

Damp and mould are often linked to health problems, but there is still limited real-world evidence from people’s homes across the UK.

This project aims to help improve understanding of how home environments may affect health by gathering information from people living in a wide range of housing conditions.

Who can register interest?

We would like to hear from people living in the UK, including:

  • people with lung or respiratory conditions
  • people without any known lung or breathing condition
  • people who have experienced damp or mould at home
  • people who have not experienced damp or mould at home
  • members of the general public who would like to contribute to the research

We are keen to hear from people with different health backgrounds and a wide range of home environments.

What is the study about?

This research is exploring how damp homes may affect health. The aim is to improve understanding of the relationship between home environments and health symptoms in real-world settings.

This project is for research purposes only and does not provide medical advice or diagnosis.

What might taking part involve later?

If the study opens, some people who register interest may later be invited to:

  • complete a short questionnaire about their home and health symptoms
  • receive a simple home sampling kit by post
  • collect and return a small household sample, for example dust from the home, for research purposes

The home sampling part is intended to be simple and practical. Full instructions would be provided.

Registering your interest now does not commit you to taking part later.

Important information

  • Registering interest is voluntary.
  • You do not have to take part in the full study later.
  • Your details will only be used to contact you about this project.
  • Your data will be handled in line with UK data protection regulations.
  • You can decide later whether or not to take part.

Frequently asked questions

Am I signing up to take part in the study now?

No. At this stage, you are only registering your interest in hearing more about the study.

Do I need to have a lung condition to register interest?

No. We would like to hear from people with and without lung conditions.

Do I need to have damp or mould in my home?

No. We are interested in hearing from people with a wide range of home environments and experiences.

Will I definitely receive a kit?

Not necessarily. Registering interest helps the research team understand the level of interest and contact people if the study opens.

Will I get personal results about my home or health?

At this stage, no individual results are being promised. More information would be provided if the study proceeds.

What happens after I register interest?

You do not need to do anything further straight away. If the study opens, you may be contacted with more information so you can decide whether you would like to take part.

Register your interest

Ready to help? Complete the form below.

This secure form should take less than one minute to complete.

If the form does not load, you can open it here:

Open the form in a new window

by GAtherton

Infographic showing weekly aspergillosis research update April 2026 including blood mNGS diagnosis, lung immune modulation therapy, and isavuconazole drug modelling

Weekly aspergillosis update – 20 April 2026

This week’s papers point in three useful directions for aspergillosis research: better diagnosis, more precise immune modulation, and improved antifungal pharmacology modelling. The most directly relevant study for day-to-day human aspergillosis care is a new paper on blood metagenomic next-generation sequencing (mNGS) for invasive pulmonary aspergillosis.

1. Blood metagenomic next-generation sequencing for invasive pulmonary aspergillosis

Chen Y, Tang X, Lu S, Guo L, Wang L, Min L, Niu T, Zhou Y.
The diagnostic and prognostic utility of blood metagenomic next-generation sequencing for invasive pulmonary aspergillosis.
Microbiology Spectrum, 17 April 2026.
View on PubMed (PMID: 41995327)

This study addresses one of the hardest clinical problems: distinguishing true invasive pulmonary aspergillosis from colonisation when Aspergillus is detected. A reliable blood-based test could be especially useful where bronchoscopy is not possible or results are unclear.

At present, this should be seen as promising rather than practice-changing, but it is exactly the type of work needed to improve early and accurate diagnosis.

2. Gene delivery of immunomodulatory cytokines to the lung

Makuyana N et al.
Gene delivery of immunomodulatory cytokines to the lung preserves respiratory function during inflammatory challenge.
Science Immunology, 17 April 2026.
View on PubMed (PMID: 41996474)

This preclinical study explores whether delivering immunomodulatory cytokines directly to the lungs can reduce damaging inflammation. The work is linked to influenza-associated pulmonary aspergillosis, where immune-driven lung injury can be severe.

The key idea is that fungal lung disease is not only about infection, but also about how the immune system responds. This represents a shift toward combining antifungal treatment with targeted immune modulation—although this approach is still at an early, experimental stage.

3. Isavuconazole pharmacokinetic modelling (preprint)

Choules MP et al.
Development of an Isavuconazole Physiologically-based Pharmacokinetic Model for Adult and Pediatric Populations.
Research Square, 17 April 2026 (preprint).

This study uses physiologically based pharmacokinetic (PBPK) modelling to predict how isavuconazole behaves in adults and children, including potential drug–drug interactions.

The findings suggest broadly similar interaction risks across age groups, but highlight greater uncertainty and caution in children under 3 years, particularly with drugs such as digoxin and warfarin.

As a preprint, this is best viewed as supportive pharmacology data, not a change to clinical practice.

4. Histopathology in infectious disease diagnosis

Boubacar E et al.
Histopathological Diagnosis of Infectious Diseases: Experience From a Tertiary Care Center in a Sub-Saharan African Country.
International Journal of Surgical Pathology, 16 April 2026.
View on PubMed (PMID: 41989331)

This broader study included a small number of aspergillosis cases and highlights the continued importance of histopathology, particularly when infections mimic cancer or other conditions.

5. Avian aspergillosis biomarker research

Vieu S et al.
Falcon plasma proteomics to improve avian aspergillosis diagnosis.
Journal of Proteomics, 14 April 2026.
View on PubMed (PMID: 41990917)

This veterinary study explores new plasma biomarkers for diagnosing aspergillosis in birds. While not directly applicable to human care, it reflects a broader research trend toward earlier, less invasive diagnosis.

What matters most this week?

The most important development is the blood mNGS study, which targets a real diagnostic gap. The immunology paper is conceptually important for future treatments, while the isavuconazole modelling work supports ongoing improvements in antifungal use.

Bottom line

This week reinforces three key directions in aspergillosis research:

  • Earlier and more accurate diagnosis
  • Better understanding of immune-driven lung damage
  • More precise antifungal drug use and interaction modelling

by GAtherton

Kefir and aspergillosis infographic

Can People with Aspergillosis Drink Kefir or Take Probiotics?

Many people with aspergillosis ask whether they can safely drink kefir or take probiotics. Kefir is a fermented drink containing live bacteria and yeasts, which raises understandable questions for people with lung conditions. This article explains what is known, what is uncertain, and why advice can differ between chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and more severe forms of aspergillosis.

Short answer: this is not something with a simple yes-or-no answer. For people with chronic forms of aspergillosis, kefir and probiotic products are not routinely discussed in the same way as they are for people who are severely immunocompromised. However, there is also not enough evidence to say they are helpful for aspergillosis, and people’s experiences vary.

Key Points

  • Advice about live foods is often stricter for people with invasive aspergillosis or severe immune suppression
  • For chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and related long-term conditions, the picture is usually less clear-cut
  • There is no strong evidence that kefir specifically helps or harms chronic aspergillosis
  • Some people feel fine with fermented foods; others feel they do not suit them
  • The aim here is to inform, not recommend

What Is Kefir?

Kefir is a fermented drink, usually made from milk, containing a mixture of bacteria and yeasts. It is often described as a probiotic food because it contains live microorganisms.

People may use kefir or probiotic products because of interest in:

  • gut health
  • recovery after antibiotics
  • the microbiome

If you are interested in the wider role of food and nutrition in lung health, see our article on diet and aspergillosis: what helps, what doesn’t, and what matters most.

Why Does This Question Come Up in Aspergillosis?

Different forms of aspergillosis have different risk profiles

It is important not to group all forms of aspergillosis together.

  • Invasive aspergillosis usually affects people with very weakened immune systems. In that setting, clinicians are often more cautious about foods or products containing live microorganisms.
  • Chronic pulmonary aspergillosis (CPA) usually affects people with underlying lung damage or structural lung disease. Many patients are not severely immunocompromised in the same way.
  • Allergic bronchopulmonary aspergillosis (ABPA) and related allergic conditions raise slightly different questions again, because symptom flares may relate more to sensitivity and inflammation than to infection risk.

That distinction matters, because advice that is appropriate for one group may not automatically apply to another.

Chronic vs Invasive Aspergillosis: Why It Matters

For people with chronic pulmonary aspergillosis, the question is usually less about needing to avoid kefir as a rule, and more about recognising that there is no established role for it in treatment. In other words, kefir is not a treatment for CPA, but nor is it routinely listed as something that every patient with CPA must avoid.

For people with ABPA, the picture is slightly different again. Some patients are very aware of foods that seem to trigger symptoms, but that still does not create a universal rule that fermented foods should always be avoided.

What Does the Evidence Say?

At present, there is no strong evidence showing that kefir has a specific benefit for aspergillosis, and there is also no clear evidence that it is harmful in most people with chronic aspergillosis.

Most discussion around kefir and probiotics comes from broader research on:

  • the gut microbiome
  • antibiotic-associated bowel symptoms
  • general digestive health

That is not the same as proving benefit for lung symptoms, fungal disease, or long-term respiratory outcomes.

For related discussion about how antibiotics affect symptoms, infections, and the microbiome, you may also find this helpful: why antibiotics do not always work.

Probiotics and the Gut–Lung Connection

Research into the gut–lung axis suggests that the gut microbiome may influence immune responses elsewhere in the body, including the lungs. This is an active area of research, but it is still early, and it does not yet mean that fermented foods or probiotic supplements should be seen as treatments for aspergillosis.

Some people are interested in probiotics because of repeated antibiotic courses, bowel side effects, or a general wish to support gut health. Those are understandable reasons, but the evidence for a direct lung benefit in chronic aspergillosis remains limited.

Why Do People React Differently?

The main reasons for caution are usually not “aspergillosis” on its own, but the wider clinical picture.

For example, extra caution may be more relevant in people who are:

  • severely immunocompromised
  • taking high-dose steroids or other immunosuppressive treatment
  • acutely unwell
  • known to react poorly to fermented foods or probiotic products

In some people, symptoms after kefir may be more about tolerance than infection risk. Patients sometimes describe:

  • bloating
  • nausea
  • abdominal discomfort
  • a sense that fermented foods do not suit them

Others report no obvious problems at all. This is one reason it is safer to frame kefir as an individual tolerance issue rather than something routinely recommended or routinely banned.

Kefir in Chronic Pulmonary Aspergillosis (CPA)

For people with CPA, the question is usually less about fungal exposure from kefir and more about whether it suits the individual patient. Many people with CPA have damaged lungs rather than profound immune suppression, so the same dietary warnings used in invasive fungal disease do not automatically apply.

  • kefir is not a standard treatment for CPA
  • it is not routinely listed as something that must be avoided in all patients with CPA
  • individual circumstances, treatments, and tolerance still matter

If you are newly diagnosed or want a broader overview, see our CPA information page.

What About ABPA and Other Allergic Conditions?

In ABPA and related conditions, some people are understandably more alert to foods that seem to trigger symptoms. Fermented products may not suit everyone, but there is not a clear universal rule that they should be avoided.

As with many food-related questions in chronic lung disease, experiences are mixed and difficult to generalise. If you would like a fuller explanation of ABPA itself, visit our ABPA information page.

Homemade vs Shop-Bought Products

Some people also ask whether homemade kefir is different from commercial products. In general terms, homemade fermented products may be less standardised than commercially prepared ones, but that does not automatically mean they will cause a problem. It simply adds another layer of variability.

This is another reason why broad, one-size-fits-all advice is difficult.

How Should This Be Framed for Patients?

A cautious and balanced way to put it is:

Kefir is a fermented drink containing live bacteria and yeasts. Questions about it often come up in aspergillosis because advice is sometimes stricter for people who are severely immunocompromised. For people with chronic conditions such as CPA or ABPA, there is no clear evidence that kefir is either beneficial or harmful for aspergillosis itself. People’s experiences vary, so it is best thought of as an individual tolerance issue rather than something routinely recommended or routinely banned.

When Extra Caution May Be Needed

Extra caution may be more relevant if someone is:

  • severely immunocompromised
  • on significant immunosuppressive treatment
  • recovering from serious illness
  • already experiencing ongoing gut symptoms or unexplained food intolerance

In those situations, questions about probiotics, supplements, or fermented foods are often best discussed with a clinician who understands the wider medical picture.

When to Seek Medical Advice

It is sensible to discuss diet or probiotic questions with a clinician or specialist team if:

  • you are severely immunocompromised
  • you are on significant immunosuppressive treatment
  • you develop persistent gut symptoms after using a probiotic product
  • you are unsure how advice applies to your particular diagnosis or treatment

Healthcare professionals looking for more formal clinical material can visit our Information for Professionals page.

Common Questions

Can kefir treat aspergillosis?

No. There is no evidence that kefir treats aspergillosis.

Is kefir dangerous with chronic pulmonary aspergillosis?

There is no clear evidence that kefir is harmful in most people with chronic pulmonary aspergillosis, but there is also no evidence that it is beneficial for the condition itself. Tolerance varies between individuals.

Should people with ABPA avoid fermented foods?

Not necessarily. Some people feel certain foods do not suit them, but there is no universal rule that all fermented foods should be avoided in ABPA.

Summary

  • Kefir is a fermented probiotic drink containing live bacteria and yeasts
  • Advice that applies to invasive aspergillosis does not always apply in the same way to chronic pulmonary aspergillosis or allergic bronchopulmonary aspergillosis
  • There is no strong evidence that kefir treats or worsens chronic aspergillosis
  • The safest educational position is a neutral one: not a recommendation, not a blanket prohibition
  • Individual circumstances, treatments, and tolerance matter

Last reviewed: April 2026
Reviewed by: National Aspergillosis Centre patient information team perspective
Please note: This article is for general education and should not be used as individual medical advice.

by GAtherton