GAtherton

Why Exposure to Young Children Can Increase Illness in Aspergillosis, ABPA, and Bronchiectasis — and How to Track Viral Outbreaks

Many patients with Allergic Bronchopulmonary Aspergillosis (ABPA), aspergillus-related asthma, or bronchiectasis notice that they become ill far more often when spending time around younger children. This applies whether you work with them, live with them, or spend time with grandchildren or family groups. Here’s why it happens, what other patients experience, and how to monitor viral outbreaks so you can protect yourself.

Why Young Children Increase Illness Risk

1. Young children spread far more respiratory infections

Children under 11:

  • Carry more colds, viruses, and respiratory bugs

  • Shed viruses for longer periods

  • Have high viral loads

  • Are still learning hygiene habits

  • Spend a lot of time in close physical contact with adults

Even small viral infections can cause major lung flares in ABPA and bronchiectasis.

2. Viral infections trigger flare-ups, exacerbations, and pneumonia

With:

  • Bronchiectasis → mucus doesn’t clear properly, so infections “stick”

  • ABPA → airways are inflamed, reactive, and mucus-filled

  • Asthma → viruses are the most common exacerbation trigger

A simple cold in a child can turn into:

  • Fever

  • Chest infection

  • Need for antibiotics

  • Pneumonia

  • Weeks of recovery

This pattern is extremely common.

3. Children spread viruses even when only mildly ill

Some viruses (RSV, adenovirus, flu) spread before symptoms, or for many days after a child appears well.

Adults with lung conditions may experience far more severe symptoms from these same infections.

4. Any indoor, close-contact time increases risk

This includes:

  • Teaching music or classroom work

  • Caring for grandchildren

  • Sitting in cars together

  • Birthday parties, playgroups, soft play

  • Family gatherings

  • Living in the same household

Even short exposures can be enough in winter months.

What Other Aspergillosis Patients Report

Across support groups and clinics:

  • Many patients stay well until grandchildren reach nursery/school age.

  • Switching from high school to primary/elementary teaching often leads to repeated infections.

  • People frequently report more pneumonias in winter when around young children.

This is very common and not your fault.

How to Reduce Risk (Realistically)

1. Improve ventilation

  • Open windows/doors during visits or lessons

  • Use a HEPA air purifier at home or work

  • Avoid long stays in small rooms

2. Control exposure without avoiding children

Shorter visits with good ventilation are safer than long indoor contact.

3. Keep up with airway clearance routines

Vital for preventing infections from settling.

4. Mask during periods of high virus circulation

Especially when RSV, flu, COVID, or “winter bugs” are rising.

5. Stay vaccinated

Flu, pneumococcal, COVID (if eligible), and pertussis if around infants.

6. Get medical review if you're repeatedly unwell

Your team may consider:

  • Prophylactic antibiotics

  • Nebulised saline

  • Optimising inhalers/biologics

  • Checking ABPA control

7. Use Occupational Health if exposure is workplace-related

Ask for:

  • Teaching older groups

  • Ventilation improvements

  • Reduced winter exposure

Where to Get Reliable Information on Viral Outbreaks

Tracking viral activity can help you plan safer weeks and reduce the chance of flare-ups.

1. UK Health Security Agency (UKHSA)

Weekly reports on:

  • Flu

  • COVID

  • RSV

  • Measles and other outbreaks

  • Regional activity levels

Best official national overview. Link

2. GOV.UK Infectious Disease Reports

Lists:

  • Confirmed outbreaks

  • Public health warnings

  • School/nursery clusters

  • Localised alerts

3. Local NHS Trust or ICB Websites

Many publish:

  • Weekly respiratory dashboards

  • Local flu/RSV alerts

  • Outbreak notices for schools and care settings

(Example: Greater Manchester ICB has regular respiratory activity updates.)

4. GP Surgeries & NHS App Alerts

GPs can push:

  • Local viral alerts

  • Flu surges

  • Measles/strep notifications

Often one of the earliest local signals.

5. School/Nursery Letters and Newsletters

Schools must notify families about:

  • Flu/strep outbreaks

  • High absence levels

  • Confirmed clusters

Very useful if you work with or spend time around children.

6. Zoe Health Study App

Crowd-sourced, real-time data on:

  • Colds

  • Flu-like illness

  • COVID

  • Regional spikes

Good for early warning.

7. Local Council Public Health

Check:
[Your council] + “Public Health”
They often post:

  • Local outbreak alerts

  • Enhanced infection-control notices

  • Community virus trends

8. NHS 111 Online Data

Shows real-time spikes in:

  • Cough

  • Fever

  • Chest infections

  • Sore throat or strep symptoms

A useful snapshot of local trends.

Key Message

Yes — any exposure to young children can raise infection risk when you have aspergillosis, ABPA, or bronchiectasis.
Tracking viral outbreaks helps you plan safer contact, adjust your activities, and reduce the chance of pneumonia or flare-ups.

Resources

Here are direct links to trusted resources you can use to monitor viral outbreaks and infection risk (especially helpful for those with ABPA, bronchiectasis, asthma, and other lung conditions):

by GAtherton

💙 The NHS Is Changing: What “Value-Based Healthcare” Means for People with Aspergillosis

The NHS is beginning to look not just at how many people it treats, but how well those treatments work — and whether every pound spent makes the biggest difference to patients’ lives.
This idea is called value-based healthcare (VBHC).

🧭 What “value” means

In simple terms, value =

Better health and quality of life for patients ➗ the resources and effort used to achieve it.

It’s not about cutting care.
It’s about making sure time, money, and medicines are used where they bring the greatest benefit — especially for people with long-term or complex conditions like aspergillosis.

⚙️ From “productivity” to “value”

Until now, the NHS has mostly measured productivity — how many people are seen, how many tests or treatments are delivered, and how quickly.

That approach works for short-term or simple care (like hip replacements or cataract surgery), but it doesn’t tell the full story for complex, long-term conditions such as aspergillosis, where the real goal is to stay well, avoid hospital admissions, and maintain a good quality of life.

So, over the next few years, these older productivity measures will gradually be replaced or balanced with value-based measures that ask:

“Did this care actually help patients live better and longer — and was it a good use of NHS resources?”

This means success will be judged more on outcomes and experience than on numbers and speed.

🌿 Why this matters for people with aspergillosis

Aspergillosis, whether Allergic Bronchopulmonary Aspergillosis (ABPA) or Chronic Pulmonary Aspergillosis (CPA), is often complicated and different for every patient.
Traditional NHS targets — such as waiting times or the number of appointments — don’t always show whether patients are breathing easier, feeling stronger, or coping better at home.

Value-based care changes that by focusing on:

  • Real health outcomes – fewer flare-ups, better lung function, reduced fatigue

  • Patient experience – how well care fits your needs, and how supported you feel

  • Sensible use of treatments – balancing benefit, side effects, and cost

  • Joined-up care – making sure specialists, GPs, and community teams work together smoothly

🏥 How the National Aspergillosis Centre (NAC) fits in

The National Aspergillosis Centre (NAC) already works in a value-based way:

  • It tracks outcomes such as infection control, hospital admissions, and steroid use

  • It listens to patients through groups, surveys, and education sessions

  • It combines research, expert treatment, and patient partnership to improve care

  • It shares learning with hospitals across the UK

As the NHS moves further toward value-based care, NAC’s approach — measuring what really matters to patients — is exactly the kind of model the health service wants to grow.

🔄 What might change over the next few years

You may start to notice:

  • More focus on your experience and progress: you might be asked to fill in short questionnaires about symptoms and quality of life (called Patient-Reported Outcome Measures or PROMs).

  • Better coordination between hospital, GP, and community teams — digital health records will help your care stay connected.

  • New measures of success: NAC may report things like “flare-ups prevented” or “improvement in wellbeing” rather than only how many people were seen.

  • More evidence about what works: shared data will help identify which treatments or combinations give the most benefit.

⚠️ What it does not mean

  • It doesn’t mean fewer services or reduced access for people with complex lung disease.

  • Rare conditions like aspergillosis will continue to need specialist national centres because they provide expert care that general services can’t.

  • The goal is to show that centres like NAC deliver high value — preventing complications, reducing hospital stays, and improving lives.

💬 What you can do

  • Give feedback about your health and care — this helps measure real outcomes.

  • Take part in surveys or PROMs if asked — these are how value is proven.

  • Stay involved in patient groups and discussions — your voice helps shape what “value” means for people living with aspergillosis.

🌱 In summary

The NHS is moving from counting treatments to counting outcomes.
For people with aspergillosis, that means care that’s more personalised, joined-up, and focused on what really matters — your health, comfort, and quality of life.

The National Aspergillosis Centre is well placed to lead this change and to show how specialist, patient-centred care can deliver real value for people with complex lung disease.

by GAtherton

🌬️ Breathing Easier: Keeping Your Air Clean at Home, Work and When Travelling

People with lung conditions such as aspergillosis, asthma, or bronchiectasis often find their symptoms worsen in certain environments — especially where the air feels dusty, damp, or polluted.
The good news is that there are simple, practical steps you can take to control your surroundings, reduce flare-ups, and make your home a safer, healthier place to breathe.

🏠 At Home

Keep It Dry and Well-Ventilated

  • Tackle damp and leaks early. Mould thrives in moist places — even hidden behind furniture or under wallpaper.

  • Trust your nose. If something smells damp, it probably is. A musty smell means moisture is trapped somewhere — investigate and dry it before mould can grow.

  • Ventilate daily. Open windows when outdoor air is clean, or use extractor fans in kitchens and bathrooms.

  • Prevent moisture spreading. When showering, cooking, or drying laundry, close doors to other rooms so steam and humidity don’t spread through the house.

    • Run the extractor fan during and for at least 15–20 minutes afterwards, or until humidity drops.

    • Short humidity spikes are normal. It’s common for relative humidity (RH) to rise above 60% during cooking, showering, or drying clothes — what matters is that it returns below 60% quickly once fans or windows are open.

    • If condensation lingers or humidity stays high for more than 30–40 minutes, increase ventilation or use a dehumidifier.

  • Use humidity-sensing extractor fans. These switch on automatically when humidity rises and off when it falls.

    • Choose one with a humidistat and timer, vented directly outdoors (not into a loft or wall cavity).

    • Clean the fan cover and check filters every few months.

  • Dry laundry safely. Use a vented or condenser tumble dryer and empty or clean filters and tanks regularly.

    • Avoid drying clothes on radiators unless you’re using a dehumidifier or have good airflow.

  • Monitor humidity. Use a small digital hygrometer to track RH in different rooms.

    • Aim for 40–60% most of the time — this discourages mould and keeps air comfortable.

    • Above 60% for long periods encourages condensation and spores; below 35% can dry and irritate airways.

  • Use the right size dehumidifier.

    • Check the model’s rated room area (m²) or litres per day extraction rate.

    • A compact unit may cope with a small bedroom or bathroom but not a whole flat or open-plan area.

    • Keep doors closed while it’s running for best results, and empty and clean the water tank regularly to prevent bacterial build-up.

Control Dust and Irritants

  • Vacuum regularly with a HEPA-filtered vacuum cleaner.

  • Use microfibre cloths for dusting rather than dry dusters that stir particles into the air.

  • Avoid strongly fragranced cleaning products, candles, incense, and air fresheners — they release fine particles and chemicals that irritate sensitive lungs.

  • Choose low-VOC (low-odour) paints and furnishings when redecorating.

Keep Air Clean

  • If you live near traffic or building work, keep windows closed during busy times and ventilate later.

  • A room air purifier with a true HEPA filter can remove dust, pollen, and fungal spores effectively.

  • Choose the right size for your room.

    • Check the purifier’s Clean Air Delivery Rate (CADR) or maximum room coverage and ensure it matches or slightly exceeds your room size.

    • A small desktop purifier won’t clean a large living room or bedroom effectively.

    • For open-plan or high-ceiling spaces, you may need more than one unit.

  • Maintain it properly:

    • Replace or clean filters exactly as the manufacturer recommends (usually every 6–12 months).

    • Never wash or vacuum a disposable HEPA filter unless the manual allows it.

    • A clogged or undersized filter won’t clean air effectively and may re-release particles.

🌤️ Knowing When the Outside Air Is Clean — and How to Filter It Indoors

1. Check Air Quality Before Ventilating

It isn’t always obvious when outdoor air is safe to bring inside.
Modern air-quality data helps you choose the best times to open windows or run fans.

How to check:

  • Use free apps such as Air Quality Index (AQI) UK, Breezometer, Plume Labs, or AirVisual.

  • Visit DEFRA’s UK Air Information or check BBC Weather → Air Quality.

  • Look for PM2.5 (fine particles) and NO₂ (traffic pollution) levels — these are key irritants for sensitive lungs.

  • “Good” or “Low” readings mean it’s a good time to ventilate or air rooms.

  • Avoid opening windows near busy roads during rush hour or when pollution alerts are issued.

💡 Tip: Air quality is often better early in the morning or late in the evening when traffic and heat are lower.

2. Filter the Air as It Comes In

If you live near roads, building work, or farmland, you can reduce what enters while keeping ventilation safe:

🪟 Window Vent Filters

  • Many modern trickle vents can take fine mesh or electrostatic filters to trap pollen, dust, and spores.

  • Replace or wash filters regularly — clogged filters restrict airflow.

🌀 Filtered Ventilation Systems

  • MVHR systems (Mechanical Ventilation with Heat Recovery) pull in outdoor air, filter it, and expel stale indoor air — great for energy-efficient or damp-prone homes.

    • They help control humidity and filter pollutants.

    • Filters must be cleaned or replaced every few months.

  • Positive Input Ventilation (PIV) systems bring in filtered air gently from a roof or external vent, improving airflow and reducing condensation.

🧺 DIY Improvements

  • Clip-on intake filters can fit over some wall vents or fan inlets.

  • Use a portable HEPA purifier placed near an open window to “clean” incoming air as it circulates.

  • Keep window ledges, vent grilles, and trickle vents dust-free — they collect spores over time.

3. Balance Fresh Air and Safety

It’s important not to seal up a home completely — stale, humid air encourages mould.
The goal is controlled ventilation:

  • Ventilate when outdoor air is cleanest and driest.

  • Keep extractor fans running during steamy activities.

  • When outdoor air quality is poor, use purifiers and dehumidifiers indoors until it improves.

4. Low-Cost Monitoring at Home

You can buy small indoor/outdoor air-quality monitors that track PM2.5, temperature, and humidity.
These help you:

  • Spot pollution drifting indoors (from traffic, wood smoke, etc.).

  • Choose the best times to ventilate.

  • See how quickly humidity or particles fall after cooking or cleaning.

🌱 Summary

What to Do Why It Helps
Check local air-quality apps before opening windows Avoids letting polluted air inside
Ventilate during low-pollution hours Brings in cleaner, fresher air
Fit filters to vents or use MVHR/PIV systems Reduces dust and spores from incoming air
Clean vents, trickle filters, and window frames regularly Prevents build-up of trapped dust
Use a portable HEPA purifier near open windows Cleans incoming air in real time

🧽 Dealing with Mould and Dust Safely

Even in well-kept homes, mould and dust can build up in damp weather or hidden corners. If you see black or green patches, or notice a musty smell, act promptly — but take care to protect your lungs.

⚠️ Before You Start

  • Protect yourself: wear a well-fitted FFP2 or N95 mask, gloves, and, if possible, eye protection.

  • Avoid dry brushing or vacuuming visible mould — this can spread spores into the air.

  • Keep the area well ventilated but close doors to other rooms so spores don’t travel.

  • If the mould covers more than 1 square metre, keeps returning, or is linked to a leak, ask your landlord or council for professional help.

🧴 Cleaning Small Areas of Mould

  1. Wipe gently — don’t scrape.
    Use disposable cloths or ones you can boil-wash later. Avoid wire brushes.

  2. Use mild cleaning solutions:

    • Mix a few drops of washing-up liquid in warm water, or

    • Use a dilute bleach solution (1 part thin bleach to 9 parts water) on tiles or uPVC — ventilate well and never mix bleach with other cleaners, or

    • Try a specialist anti-fungal cleaner for painted or porous surfaces.

  3. Dry the area thoroughly.
    Use ventilation or a dehumidifier; mould will return if the surface stays damp.

  4. Dispose of cloths and gloves in a sealed bag. Wash hands well afterwards.

🧹 Managing Dust and Allergens

  • Vacuum at least twice weekly with a HEPA-filtered cleaner.

  • Dust with a damp microfibre cloth, not a feather duster.

  • Wash bedding and soft furnishings regularly at 60 °C if the fabric allows.

  • Avoid clutter that collects dust (papers, books, soft toys).

  • Keep humidity within 40–60% and fix damp quickly.

🌱 Preventing Mould and Dust Returning

Action Why It Helps
Find and fix leaks or condensation sources Mould needs moisture to grow
Ventilate kitchens, bathrooms, and drying areas Removes steam before it spreads
Use humidity-sensing fans or dehumidifiers Keeps humidity in a safe range
Maintain a steady indoor temperature Reduces cold surfaces and condensation
Close doors during steamy activities Stops damp air moving into other rooms
Replace or clean HEPA filters regularly Maintains air-cleaning performance
Check behind furniture and on windowsills Finds hidden damp early
Repaint cleaned areas with mould-resistant paint Discourages regrowth

🚫 What Not to Do

  • Don’t paint over mould — it will grow back.

  • Don’t use strong chemicals or foggers in small spaces — they can irritate lungs.

  • Don’t use steam cleaners on large mould patches — they can spread spores.

  • Don’t ignore damp smells — they always mean hidden moisture somewhere.

💼 At Work

  • Ask about ventilation and report any damp, leaks, or condensation.

  • Keep your workspace tidy and free of dust-collecting clutter.

  • If cleaning sprays or perfumes cause coughing, discuss adjustments with your manager or occupational health team.

✈️ When Travelling

  • Check air-quality forecasts before travelling and avoid outdoor activity on high-pollution or pollen days.

  • Choose clean, dry accommodation — avoid musty or damp-smelling rooms.

  • Pack a small hygrometer or travel dehumidifier for longer stays.

  • Use a well-fitted FFP2 or N95 mask in crowded or polluted environments.

  • Stay hydrated and pace activities in humid or hot weather.

🩺 Listen to Your Body

Keep a short diary of when and where your symptoms flare up, along with temperature, humidity, or smells you notice. Patterns often reveal your personal triggers.

🌱 Key Points

Good Practice Why It Matters
Keep home dry, clean, and ventilated Reduces mould and spore exposure
If it smells damp, it probably is Early warning of hidden moisture
Humidity above 60% after showering or cooking is normal — keep it short Prevents condensation and mould
Close doors while cooking, showering, or drying laundry Stops moisture spreading
Use humidity-sensing extractor fans Clears steam automatically
Monitor humidity (40–60%) Keeps air comfortable and discourages spores
Match HEPA filters and dehumidifiers to room size Ensures real air-cleaning and drying effect
Maintain and replace filters regularly Keeps air safe and fresh
Check outside air quality before opening windows Avoids bringing pollution indoors
Filter incoming air with vents or MVHR/PIV systems Keeps dust and spores out
Clean small mould patches safely with mild detergent Removes spores without irritation
Fix leaks, repaint with mould-resistant paint Prevents regrowth
Avoid strong scents and aerosols Reduces airway irritation
Plan travel around clean-air days Lowers risk of flares and infections

💬 Final Thought

You can’t control every environment — but small, steady habits make a big difference.
If something smells damp, it probably is. Deal with it early, clean gently, dry thoroughly, and keep air moving.
Short humidity spikes after showering or cooking are normal — just make sure they don’t linger.
Choose purifiers and dehumidifiers that are the right size for your rooms, and maintain them well.
Check outdoor air quality before airing your home, and use filters to keep what’s good while blocking what’s not.
A dry, clean, well-ventilated home gives your lungs the best chance to stay healthy every day — wherever you are.

by GAtherton

🦠 Latest Aspergillosis Updates (Weeks 45 & 46)

Over the past two weeks, several new studies and reports have deepened understanding of aspergillosis – the group of lung and sinus infections or allergic diseases caused by Aspergillus moulds.
They cover new national guidance, emerging risk groups, drug interactions, and new ideas for diagnosis.

🔹 1. National Best-Practice Update (BSMM 2025)

What’s new:
The British Society for Medical Mycology (BSMM) has released its 2025 recommendations for diagnosing serious fungal diseases such as aspergillosis.
The update emphasises:

  • using standardised blood and imaging tests across hospitals,

  • improving access to specialist mycology laboratories,

  • faster recognition in people with chronic lung disease, transplant, or immune suppression.

Why it matters:
Patients should receive the same high-quality diagnostic work-up wherever they are treated in the UK, reducing delays and missed cases.

🔹 2. Drug Interaction: Posaconazole + Olorofim

What’s new:
Researchers discovered that combining posaconazole (an existing antifungal) with olorofim (a new one still in trials) can cancel out each other’s effect in laboratory and animal tests.

Why it matters:
Doctors will avoid using these two together until proper studies confirm safety.
This ensures that new antifungal drugs are introduced carefully and responsibly, not just because they’re newer.

🔹 3. Invasive Aspergillosis in Non-Neutropenic Patients

What’s new:
Traditionally, invasive pulmonary aspergillosis (IPA) affected people with very low white-cell counts, such as cancer or transplant patients.
A new review shows that people without immune deficiency, including those in ICU, with COPD, or taking steroids, can also develop life-threatening infection.

Why it matters:
Clinicians are being urged to consider aspergillosis sooner when patients with chronic lung disease suddenly deteriorate or fail to respond to antibiotics.

🔹 4. Severe Case in Acute Liver Failure

What’s new:
A case report describes aspergillosis spreading in a patient with acute liver failure, detected by endoscopy rather than usual lung imaging.

Why it matters:
Highlights that aspergillosis can start outside the lungs and that liver-failure patients may have hidden fungal infection even without classic risk factors.

🔹 5. Post-Partum Aspergillus flavus Infection

What’s new:
A rare infection occurred soon after childbirth, caused by Aspergillus flavus rather than the usual A. fumigatus.

Why it matters:
Shows that pregnancy and recovery can temporarily lower resistance to infection.
Unusual breathlessness or fever after delivery deserves careful investigation.

🔹 6. Immune Markers for Chronic and Allergic Forms (CPA and ABPA)

What’s new:
Researchers have mapped immune-system signals (biomarkers) that could help diagnose or monitor chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA) when scans or sputum tests are inconclusive.

Why it matters:
These blood-based tests could make diagnosis faster, less invasive, and more consistent – especially where bronchoscopy isn’t possible.

🧩 The Big Picture

Theme Main message Take-home insight
National guidance UK best-practice standardised Earlier, fairer diagnosis nationwide
Antifungal drugs New combinations must be tested Avoid mixing old + new agents unsafely
Expanding risk groups COPD, ICU, steroid use, liver disease Aspergillosis not limited to cancer patients
Case lessons Post-partum and liver-failure infections Stay alert to rare but serious forms
Chronic & allergic disease New immune biomarkers Blood tests could support follow-up

👥 What this means for you

  • Patients: if you have asthma, COPD, bronchiectasis, or another chronic lung problem and suddenly feel worse or don’t improve on antibiotics, ask whether aspergillosis has been considered.
    Modern tests can often detect it from a blood sample.

  • GPs and non-specialist staff: awareness is key. These studies stress early suspicion, use of mycology testing, and following the BSMM 2025 guidance for timely referral.

  • Researchers: note the priority areas – drug-interaction monitoring, immune-marker validation, and cross-disciplinary education between hepatology, ICU, obstetrics, and respiratory medicine.

🔗 Further reading

  • BSMM 2025 Best Practice Recommendations — Lancet Infect Dis (2025)

  • Posaconazole–Olorofim Interaction — J Antimicrob Chemother (2025)

  • IPA in Non-Neutropenic Patients — Clin Infect Dis (2025)

  • Immune Markers in CPA & ABPA — Front Immunol (2025)
    Full links: 1 | 3 | 4 | 6

by GAtherton

🧬 What IgE Is and Why It Matters

IgE is a type of antibody your immune system makes when it reacts to something it sees as harmful — such as pollen, mould, pet dander, or certain foods.
In people with allergic or fungal lung disease, IgE can rise sharply because the body’s immune system is over-reacting.

High IgE isn’t dangerous on its own, but it shows that your immune system is “switched on” and inflamed. The goal is to calm that inflammation and reduce exposure to what’s triggering it — not simply to force the number down.

✅ Best Practices for Reducing IgE Levels

1️⃣ Identify and Avoid Triggers

Reducing exposure is the first and most effective step.

  • Allergens: dust mites, moulds (especially Aspergillus), pollens, pets.

  • Environmental irritants: cigarette smoke, air pollution, strong odours, damp housing.

  • Use HEPA filters, good ventilation, and address damp or mould at home.

  • In ABPA, avoiding heavy exposure to fungal spores (e.g. gardening compost, rotting leaves, renovation dust) is particularly important.

2️⃣ Control Inflammation and Allergic Response

Because IgE is a marker of allergic inflammation, treatment focuses on calming the immune system:

  • Corticosteroids (oral or inhaled) can suppress inflammation and lower IgE over time.

  • Biologic therapies such as:

    • Omalizumab (Xolair) – directly targets IgE and lowers levels in allergic asthma or ABPA.

    • Mepolizumab, Benralizumab, or Dupilumab – reduce eosinophil-driven inflammation and may indirectly lower IgE.

    • Choice depends on your disease type and blood test results.

  • Antifungal therapy (e.g. itraconazole, voriconazole, posaconazole) can help reduce fungal load in ABPA and often leads to gradual IgE reduction as the reaction settles.

3️⃣ Manage Asthma or Lung Disease Well

Stable lungs mean fewer immune flares and less IgE activity:

  • Use prescribed inhalers regularly (preventers, not just relievers).

  • Follow your asthma or CPA action plan.

  • Attend regular reviews with your respiratory team.

  • Report any new symptoms such as increased cough, wheeze, or mucus plugs early.

4️⃣ Support Overall Immune Balance

Simple lifestyle steps can also help keep inflammation low:

  • Eat a balanced diet rich in fruit, vegetables, and omega-3 fats.

  • Sleep well and manage stress (both can worsen inflammation).

  • Avoid smoking or vaping.

  • Keep vaccinations (e.g. flu, COVID, pneumococcal) up to date.

📊 Interpreting IgE Levels

  • IgE levels naturally fluctuate and may take weeks or months to fall after treatment.

  • Doctors often look at the trend (rising or falling) rather than one number.

  • In ABPA, a fall of 35–50 % from baseline after treatment usually shows improvement.

  • It’s also possible to feel better while IgE remains high — so the result must always be interpreted alongside symptoms and scans.

🚫 What Not to Do

  • Don’t chase a “perfect” IgE number — focus on feeling better and reducing inflammation.

  • Don’t stop steroids or antifungals suddenly unless advised by medical doctor, as this can cause a rebound flare.

  • Don’t rely on supplements or “immune boosters” that claim to lower IgE — none are proven to help and some may worsen allergies.

🩺 In Summary

Goal Best Approach
Reduce IgE triggers Avoid mould, dust, smoke, allergens
Calm inflammation Steroids or biologics under medical supervision
Treat underlying disease Antifungals for ABPA/CPA, good asthma control
Support immune balance Healthy lifestyle, good sleep, stress reduction

🌱 Key Message

You can’t “switch off” IgE completely — it’s part of your immune defence.
The aim is to reduce unnecessary immune activation, keep symptoms stable, and prevent lung damage.
With the right mix of trigger avoidance, anti-inflammatory treatment, and regular monitoring, IgE levels usually fall gradually as the condition improves.

by GAtherton

🧪 Why New Antifungal Trials Start with Invasive Aspergillosis

When you hear about promising new antifungal medicines such as Olorofim or Fosmanogepix, you may wonder why the first studies always seem to involve people with invasive aspergillosis — not those with chronic pulmonary aspergillosis (CPA) or allergic bronchopulmonary aspergillosis (ABPA).

It might seem unfair, especially when chronic forms of aspergillosis are so common and long-lasting.
But there are good reasons why research has to begin with invasive disease.

Here’s how it works — and why it’s still good news for everyone living with aspergillosis.

⚠️ 1. Invasive Aspergillosis Is the Most Dangerous Form

Invasive aspergillosis happens when Aspergillus spreads deep into the lungs or bloodstream, usually in people with a very weak immune system — for example, after chemotherapy, transplant, or high-dose steroid use.

Without prompt treatment, it can be fatal within days or weeks.
Because it is so serious, regulators such as the MHRA (UK), EMA (Europe) and FDA (USA) allow new drugs for invasive infections to be tested and reviewed much faster than they would for less urgent diseases.

This approach means that if a new antifungal proves helpful and safe, it can reach patients in greatest need more quickly — often saving lives while also building the data needed for later studies in other conditions.

📈 2. It’s Easier to Measure Whether the Drug Works

For invasive disease, the goal is very clear:

The infection either clears up, or it doesn’t.

That makes the results of a study straightforward to interpret.

With chronic or allergic aspergillosis, improvement takes much longer to measure:

  • Scans may take months to show change,

  • Symptoms can fluctuate naturally, and

  • Other lung problems (like COPD or bronchiectasis) can confuse the results.

So trials in chronic disease need larger patient numbers and longer follow-up, which are expensive and take years. Starting with invasive aspergillosis lets researchers get the essential safety and efficacy answers first.

🧾 3. The Regulatory Framework Focuses on Invasive Disease

Drug-approval rules for antifungals were originally designed for the most life-threatening infections.
Official guidance documents — from the EMA, FDA and others — describe exactly how to test new drugs for invasive fungal infections, but there are no formal international standards yet for chronic or allergic aspergillosis.

That means developers start where the rules are clear — and then adapt once regulators, researchers, and clinicians agree on what a “successful outcome” looks like for chronic disease.

⚖️ 4. Safety and Ethics Come First

When a new antifungal is in early testing, doctors don’t yet know all its side-effects or how it behaves during long-term use.
For ethical reasons, it’s safer to begin in patients with very few other treatment options, where the potential benefit outweighs the risk.

As safety data builds up — including how the medicine interacts with other drugs — it becomes safer to test in people with more stable chronic conditions such as CPA.

🩺 5. Once Proven Safe, Use Can Expand

Once a drug like Olorofim or Fosmanogepix:

  • works well in invasive aspergillosis,

  • has solid safety data, and

  • earns its first licence,

the manufacturer and research partners (such as the National Aspergillosis Centre) can propose new studies in CPA or other forms of aspergillosis.

By then, regulators already know the drug’s risk profile, dosing, and monitoring needs — so further approvals for chronic disease can move faster.

🧩 In Summary

Reason Why invasive aspergillosis comes first
Urgency It’s the most life-threatening form, so ethics allow faster testing
Clear results Success or failure can be measured more easily
Existing standards Regulatory guidance already written for invasive disease
Safety first Starts with people who have no other treatment
Builds the base Data from invasive disease supports later CPA/ABPA trials

🌱 Looking Ahead

Starting with invasive aspergillosis is a gateway, not a dead-end.
Every study adds vital knowledge about how these new antifungals work, how safe they are, and which patients might benefit most.

Once enough evidence exists, clinical trials can — and almost certainly will — expand to include chronic pulmonary aspergillosis (CPA) and possibly even allergic forms of the disease.

So while the research focus may begin with the most critical cases, the progress made there ultimately helps everyone living with aspergillosis.

by GAtherton

🩺 Why New Antifungal Medicines Aren’t for Everyone (Yet)

When new medicines are announced, it’s natural to wonder:

“If they’re better than what we already have, why can’t everyone start using them straight away?”

Two new antifungal drugs — Olorofim and Fosmanogepix — are generating real excitement because they work in completely new ways and could help people whose fungal infections no longer respond to existing treatments.

But before any new drug becomes widely available, it must go through a careful process to make sure it’s safe, effective, affordable, and used in the right patients. Here’s why most people with aspergillosis will still be treated with existing antifungal medicines for now.

🧪 1. They’re Still Being Tested

Olorofim and Fosmanogepix are still classed as investigational medicines.
That means they have shown promise in early studies — especially for severe or drug-resistant infections — but they are not yet approved for general medical use.

Regulators such as the MHRA (UK), EMA (Europe), and FDA (USA) require large, carefully controlled studies to confirm:

  • that the drugs are safe for different types of patients,

  • that they work as well as or better than existing treatments, and

  • that the benefits clearly outweigh any risks.

Until that evidence is complete, they can only be prescribed within clinical trials or under special compassionate-use programmes at specialist hospitals.

💨 2. Different Types of Aspergillosis Need Different Treatments

Aspergillosis isn’t one single disease. It includes:

  • Invasive aspergillosis, a dangerous infection in people with weak immune systems.

  • Chronic pulmonary aspergillosis (CPA), a long-term infection in people with lung damage.

  • Allergic bronchopulmonary aspergillosis (ABPA), an allergic reaction rather than a true infection.

The new antifungals are currently being tested only for invasive aspergillosis — the most severe form.
They haven’t yet been studied in chronic or allergic forms like CPA or ABPA, so we don’t yet know if they would work or be safe for those conditions.

💊 3. Current Medicines Still Work Well for Most Patients

Existing antifungal drugs such as itraconazole, voriconazole, posaconazole, and isavuconazole remain effective for most people with aspergillosis.

Doctors already know:

  • how to monitor their levels in the blood,

  • how to manage side-effects, and

  • how to combine them safely with other medicines.

New drugs can bring new possibilities — but they can also bring unknown side-effects or interactions. Doctors need strong, long-term evidence before changing large numbers of patients to new treatments.

💷 4. Cost and Access Take Time

Developing antifungal drugs takes years and costs millions of pounds.
When a new medicine is finally approved, it is often very expensive at first.

In the UK, every new treatment must go through NICE (the National Institute for Health and Care Excellence).
NICE checks:

  • how well it works,

  • how safe it is, and

  • whether the NHS can afford to provide it fairly to all who need it.

Only once NICE recommends a drug can NHS England fund it for routine use — and even then, it may be limited to certain hospitals or patient groups at first.

⚖️ 5. A Step-by-Step Approach Keeps Patients Safe

New medicines are introduced gradually — starting with people who have no other treatment options.
If they prove safe, effective, and affordable in that group, their use can be expanded step by step to include more patients and other forms of disease.

This careful rollout protects patients from unexpected risks and helps prevent early resistance, so the drugs stay effective for longer.

🧭 6. Who Decides When a New Antifungal Can Be Used for CPA?

Bringing a new antifungal from its first approval to wider use in chronic diseases like CPA involves several levels of decision-making:

1️⃣ The Manufacturer

Companies such as Shionogi Europe (Olorofim) or Basilea/Pfizer (Fosmanogepix) design the trials and decide which conditions to test first — usually the most life-threatening ones.
If early results are good, they can plan new studies for CPA or other chronic lung infections.

2️⃣ Clinical Researchers and Specialist Centres

Centres such as the National Aspergillosis Centre (NAC) collect real-world data from patients who receive these drugs through compassionate-use programmes.
If several patients with CPA improve, these results may encourage formal CPA-specific trials.

3️⃣ Regulatory Authorities

Bodies such as the MHRA (UK), EMA (Europe), or FDA (USA) decide which diseases a drug can officially be marketed for.
To add CPA as a licensed use, the company must submit:

  • new clinical trial data,

  • long-term safety information, and

  • a formal request to extend the drug’s licence.

Until that happens, doctors can only prescribe it for CPA off-label — usually within strict hospital governance systems.

4️⃣ NICE and NHS England

Even after regulatory approval, NICE must review cost and benefit before the NHS can fund the drug for CPA.
Without a positive NICE recommendation, it can’t be routinely prescribed in the UK.

5️⃣ Specialist Clinical Networks

Finally, once approved and funded, expert groups like the NAC and national respiratory networks decide how and when the drug should be used — for example:

  • only for patients with azole-resistant CPA,

  • after all standard options have failed, and

  • with careful monitoring.

This information is then built into national and local treatment guidelines.

🔄 Example Pathway: Olorofim’s Future Use for CPA

Stage Who acts What happens
1️⃣ Shionogi Gains approval for invasive aspergillosis
2️⃣ NAC & academic partners Report successful CPA case studies
3️⃣ Shionogi + NAC Launch a formal CPA clinical trial
4️⃣ MHRA / EMA Extend licence to include CPA
5️⃣ NICE Reviews cost-effectiveness for CPA
6️⃣ NHS England Approves CPA use in NHS centres

🩸 In Summary

Reason Why we can’t all switch now
Still in trials Not yet fully approved for use
Different diseases Only tested for invasive aspergillosis so far
Known vs unknown Established drugs work well for most people
Cost and access NHS approval and funding take time
Safe rollout New drugs introduced step-by-step

🌱 Looking Ahead

Both Olorofim and Fosmanogepix represent the most promising antifungal advances in decades.
If they continue to perform well in trials, they could become vital options for people whose infections no longer respond to standard medicines — and, in time, for chronic conditions like chronic pulmonary aspergillosis (CPA).

For now, the safest and most effective approach remains to use proven antifungals under expert supervision, while keeping a close watch on these exciting new developments.

by GAtherton

🌿 New Antifungal Medicines on the Horizon: Olorofim and Fosmanogepix

For many years, doctors have relied on the same small group of antifungal drugs — mainly azoles (like itraconazole and voriconazole), amphotericin, and echinocandins. These have saved lives, but some fungi are becoming resistant, and some people can’t tolerate them because of side-effects or drug interactions.

Two completely new antifungal medicines — Olorofim and Fosmanogepix — are now in the final stages of research. They work in new ways and could help patients whose infections no longer respond to current treatments.

🧬 Olorofim (by F2G Ltd, UK)

How it works:
Olorofim blocks a vital process that fungi need to make DNA. It belongs to a brand-new group called orotomides, and works very differently from other antifungals.

Which infections it targets first:

  • The first planned use will be for people with invasive mould infections (for example, Aspergillus fumigatus and some rare moulds) when existing medicines don’t work or can’t be used.

  • It is especially promising for azole-resistant Aspergillus, which is becoming more common.

How it might help in the future:
Although early studies are focused on severe infections in people with weak immune systems, Olorofim has also shown good results in some patients with chronic pulmonary aspergillosis (CPA) who could not take azoles.
Once it is licensed, hospitals such as the National Aspergillosis Centre may be able to use it for difficult or resistant cases of CPA on a specialist-approval basis.

When it might be available:
F2G has completed late-stage studies and is preparing for regulatory approval.
If all goes well, Olorofim could be available around 2026–2027 in some countries, with the UK likely to follow once it is approved and adopted by the NHS.

⚗️ Fosmanogepix (by Basilea and Pfizer)

How it works:
Fosmanogepix (converted in the body to manogepix) blocks the fungus from making a protective coating around its cell surface. This prevents it from growing and spreading. It belongs to another new group of antifungal drugs.

Which infections it targets first:

  • The first major study is for Candida bloodstream infections (candidemia) and other serious yeast infections.

  • A second study focuses on invasive mould infections, including aspergillosis, in patients with few treatment options.

How it might help in the future:
Once approved for invasive infections, Fosmanogepix could later be tested in longer-term or chronic lung infections, such as CPA, if it proves safe for long-term use.

When it might be available:

  • The first approval (for Candida) may come around 2027.

  • The aspergillosis trial is still running and not expected to finish before 2028–2029, so that indication will follow later.

🩺 What This Means for People with Aspergillosis

Drug New or existing? First use likely for Could later help with When available (approx.)
Olorofim New class (orotomide) Invasive Aspergillus and resistant moulds Difficult or resistant cases of chronic pulmonary aspergillosis (CPA) 2026–2027
Fosmanogepix New class (Gwt1 inhibitor) Candida bloodstream infections Invasive mould infections, possibly CPA later 2027–2029

🧩 In summary

  • These two drugs represent the first completely new antifungal classes in decades.

  • They are being tested mainly for life-threatening fungal infections where current medicines fail.

  • Once approved, they may offer new options for people with resistant or difficult-to-treat forms of aspergillosis, including some patients with CPA.

  • They are not yet available on prescription, but progress looks very promising.

by GAtherton

When Scents Cause Symptoms: What Patients Say About Odour Triggers

Many people living with asthma, Allergic Bronchopulmonary Aspergillosis (ABPA), or bronchiectasis describe strong reactions to everyday smells — perfumes, cleaning products, paints, or air fresheners.
These reactions can cause immediate coughing, wheezing, throat irritation, or chest tightness, and they can last for hours or even days.

To understand this better, we asked members of our patient community:

“Are there any smells that don’t affect you?”

Their replies were detailed, honest, and very relatable.

💬 What patients told us

“I’m OK with most perfumes, but not Estée Lauder. Aftershaves can be troublesome.”
“Unfragranced alcohol hand sanitiser is fine — even though it smells strong.”
“Cooking smells are OK if it’s food I can eat, but not frying.”
“Crowded rooms full of cleaning products or perfume — that’s when I start coughing.”
“I use peppermint essential oil to mask other smells if I get caught off guard.”
“If I avoid mould, dust, aerosols, and detergents, I can generally stay well.”

These voices show that odour sensitivity varies hugely from person to person — and what’s tolerable one day might trigger symptoms another.

🌸 Smells people can usually tolerate

Even among those highly sensitive to scents, a few odours were commonly reported as “safe”:

  • Some light or natural perfumes

  • Alcohol-based hand sanitisers (if unfragranced)

  • Food smells from meals the person can eat

  • Saline or hypertonic saline nebulisers

  • Outdoors air after rain — described by some as “clear” or “fresh”

Many added that they simply don’t notice safe smells — because their airways stay calm.

🚫 Common odour triggers

Category Examples mentioned by patients
Fragrances & aerosols Perfume, hairspray, carpet freshener, pet grooming sprays, room sprays, vapes
Household products Detergents, polish, disinfectants, scented candles, new rugs or furniture “off-gassing”, silicone sealant, fresh paint
Environmental triggers Dust, damp wood, mould, oil fumes, cigarette smoke, some trees or plants
Crowded indoor air Theatres, shops, salons, or restaurants where several products and fragrances combine

Reactions were often described as immediate:

“Aerosols set me off straight away — I feel it in my chest before I even notice the smell.”

🧩 Why odours trigger symptoms

Odour sensitivity isn’t usually an allergy — it’s caused by airway hyperreactivity.
In these conditions, nerve endings in the bronchial walls become oversensitive.
When exposed to volatile organic compounds (VOCs), aerosols, or fine particles, the airways tighten and release inflammatory mediators — a reaction that’s stronger and longer-lasting in those with existing lung inflammation.

People with ABPA, Severe Asthma with Fungal Sensitisation (SAFS), or Chronic Pulmonary Aspergillosis (CPA) often have inflamed, mucus-filled, or scarred airways, making them far more reactive to irritants.

🧭 Factors that make reactions worse

Patients pointed out that it’s not just what’s in the air, but also:

  • Concentration – strong or enclosed fumes trigger faster responses

  • Combination – multiple scents together (perfume + cleaner + paint) are far harder to tolerate

  • Duration – prolonged exposure leaves lingering symptoms

💡 Tips for managing odour sensitivity

Plan ahead

  • Choose quiet times for haircuts, shopping, or social events.

  • Check if venues use air fresheners or scented cleaning products.

Control your environment

  • Use fragrance-free detergents and cleaning products.

  • Ventilate your home after cleaning or decorating.

  • Keep dehumidifiers and air purifiers running in damp areas.

Be prepared

  • Carry a reliever inhaler or antihistamine if prescribed.

  • Consider a FFP2/FFP3 mask in heavily fragranced or dusty places.

  • A small bottle of peppermint oil or menthol inhaler may help mask irritant odours temporarily.

Communicate

  • Let friends, family, or workplaces know that fragrances affect your breathing.

  • If public spaces (like theatres or salons) are overwhelming, it’s okay to step out — health comes first.

🧠 Understanding and empathy

“It’s not about disliking smells — it’s that my lungs treat them as an attack.”

For many, this sensitivity means planning life around exposure — avoiding crowds, timing visits, or even missing social events.
Recognising that these reactions are physiological, not psychological, can help families, friends, and employers offer real support.

❤️ Takeaway message

Odour sensitivity is part of the lived experience of reactive airway disease.
It isn’t always predictable, but understanding your triggers — and which scents are safe — can make everyday life much easier.
As one patient put it:

“If I can avoid mould, dust, aerosols, and detergents, I can generally stay well.”

By sharing these experiences, patients are helping others realise they’re not alone — and helping clinicians understand just how much “harmless” smells can matter.

by GAtherton

Understanding Risk from Aspergillosis — and What’s Improving

🧫 How risky is aspergillosis?

The outlook for people with aspergillosis has improved dramatically in the past two decades.
Two things have changed that make a huge difference:

  1. We diagnose it earlier.
    Better scans, blood tests (like galactomannan and PCR), and greater awareness mean the infection or allergic reaction is recognised much sooner.

  2. We treat it better.
    Modern antifungal medicines, steroid-sparing biologics, and specialist clinics have all transformed care and monitoring.

⚖️ Risk of death — managed vs. unmanaged

Type of Aspergillosis If well managed If unmanaged or poorly treated
Allergic (ABPA) Survival > 95 % About 90 % (may progress to chronic lung damage)
Chronic (CPA) 5-year survival ≈ 80–90 % 5-year survival ≈ 50 %
Invasive (IA) 5-year survival ≈ 50–70 % < 20 % (often fatal if untreated)

Across all forms of aspergillosis, the risk of death has fallen by roughly 50 % since the early 2000s.

💊 What’s driven this improvement

  • New antifungal drugs — triazoles (itraconazole, voriconazole, posaconazole, isavuconazole) now form the backbone of long-term therapy.

  • Rapid diagnosis — galactomannan, PCR, and CT scanning detect infection days earlier than before.

  • Improved hospital and ICU care — faster recognition and better ventilation strategies save lives in invasive cases.

  • Specialist clinics and monitoring — regular blood tests, imaging, and drug-level checks prevent deterioration and drug toxicity.

  • Biologic therapies — agents that target allergic inflammation (like anti-IgE or anti-IL-5 biologics) help reduce steroid use and preserve lung function.

🚀 What could make outcomes even better

Researchers and clinicians are optimistic about the next decade.
Future advances are already on the horizon:

Future area How it helps
Next-generation antifungals – Olorofim, Fosmanogepix Active against azole-resistant strains and safer for long-term use
Combination or personalised therapy Matching the right drug and dose to each patient’s response pattern
Routine antifungal-resistance testing Prevents treatment failure by identifying resistant Aspergillus early
Rapid home or bedside testing Detects infection flare-ups before symptoms become severe
Improved imaging and AI-supported analysis Spots fungal cavities or airway changes at an earlier, reversible stage
Global stewardship of agricultural azoles Reduces environmental resistance by limiting unnecessary fungicide use
Patient self-monitoring and digital follow-up Enables early reporting of symptoms and better long-term adherence

⚠️ Potential barriers to further progress

Even with all these advances, several important challenges could slow improvement if left unaddressed:

Barrier Why it matters
Antifungal resistance Aspergillus fumigatus is developing resistance to azoles used both in medicine and agriculture. Resistant strains can make first-line treatment fail unless resistance testing is done.
Delayed or missed diagnosis Symptoms often mimic other lung conditions. Late recognition allows infection or inflammation to cause irreversible damage.
Limited access to specialist care Some regions lack experienced clinicians, diagnostic testing, or antifungal drug availability, increasing global inequality in outcomes.
Drug toxicity and interactions Long-term antifungal therapy can affect the liver or interfere with other medicines if not closely monitored.
Environmental change Warmer, wetter climates and increased composting or construction may raise Aspergillus exposure for vulnerable people.
Healthcare strain and cost Long-term follow-up, monitoring, and expensive new drugs may challenge already stretched healthcare systems.

Each of these barriers needs attention through research, public health policy, and education to ensure the gains of the last 20 years continue.

❤️ The key message

Aspergillosis is still a serious disease, but its outlook is far better than it used to be.
With modern antifungals, biologics, and regular monitoring, most people live many years — and new treatments promise even better results.

Patients can help by:

  • Reporting new symptoms early.

  • Keeping up with regular blood and imaging checks.

  • Asking about resistance testing and treatment options.

  • Staying informed about new drugs and trials.

🌅 A hopeful future

In just twenty years, deaths from aspergillosis have halved.
If we continue improving diagnosis, drug development, and resistance control, survival will rise even higher — turning aspergillosis from a life-threatening infection into a long-term but manageable condition for most people.

by GAtherton