Understanding the Different Types of Chronic Pulmonary Aspergillosis (CPA)

CPA is a long-term lung condition caused by a common fungus called Aspergillus. It usually affects people who already have lung damage — from infections like tuberculosis (TB), conditions like COPD or asthma, or diseases such as sarcoidosis.

There are five main types of CPA. Knowing which one you have can help guide your treatment and follow-up.

🟠 1. Chronic Cavitary Pulmonary Aspergillosis (CCPA)

Most common form

  • Caused by Aspergillus growing in one or more cavities in the lungs

  • Cavities may slowly get larger or thicker

  • Often develops in people with previous lung disease

Symptoms:

  • Long-term cough

  • Fatigue and weight loss

  • Breathlessness

  • Sometimes mild or moderate coughing up blood

Treatment: Long-term antifungal tablets (e.g. itraconazole or voriconazole)

⚠️ 2. Chronic Fibrosing Pulmonary Aspergillosis (CFPA)

Advanced stage of CPA

  • Happens when long-term infection causes lung scarring (fibrosis)

  • Lungs become stiff, making breathing harder

Symptoms:

  • Worsening breathlessness

  • Low oxygen levels

  • Severe fatigue

Treatment: Focuses on antifungals, symptom relief, and oxygen if needed

🟢 3. Simple Aspergilloma

A single fungal ball in a lung cavity

  • A round ball of fungus (aspergilloma) forms in an existing lung cavity

  • Often found during scans done for other reasons

  • Some people have no symptoms at all

Main risk: Coughing up blood (sometimes serious)

Treatment:

  • Monitoring if mild

  • Surgery or embolisation if bleeding occurs

🔴 4. Subacute Invasive Aspergillosis (SAIA or CNPA)

Faster-moving form of CPA

  • Occurs over weeks to months

  • Often seen in people with weaker immune systems (e.g. due to diabetes, steroids, or alcohol dependence)

  • Infection starts to invade deeper lung tissue

Symptoms:

  • Fever

  • Worsening breathlessness

  • Severe weight loss

Treatment: Prompt antifungal treatment and close medical monitoring

🟡 5. Aspergillus Nodules

Small lumps caused by Aspergillus

  • These are solid nodules in the lungs, often found by chance on a CT scan

  • They may be mistaken for cancer at first

  • Often cause no symptoms

Treatment:

  • Usually watch and wait

  • Sometimes surgery or biopsy if uncertain

🩺 Why Knowing Your CPA Type Matters

Understanding your CPA type helps your medical team:

  • Choose the best treatment for you

  • Monitor for bleeding or lung damage

  • Decide when to repeat scans or adjust medication

💬 Questions to Ask Your Doctor

  • Which type of CPA do I have?

  • Will I need long-term antifungal treatment?

  • How often should I have scans or blood tests?

  • What should I do if I cough up blood?

🧘 Final Note

CPA is a chronic condition, but many people manage it well with the right treatment and regular check-ups. You are not alone — support and information are available.

by GAtherton

🌿 The Different Forms of ABPA

Understanding Your Diagnosis and What It Means

Allergic Bronchopulmonary Aspergillosis (ABPA) is a condition where your immune system overreacts to a fungus called Aspergillus fumigatus, which can be found in air, soil, and compost. This allergic reaction happens mostly in people with asthma or bronchiectasis.

But not everyone with ABPA has the same experience. Doctors now recognise that ABPA can appear in several different forms or stages, depending on how far it has progressed and what’s happening in your lungs.

Here’s a simple guide to help you understand where you might fit — and what it means for your care.

✅ 1. ABPA-S (Serologic ABPA) — The early stage

This is the mildest form of ABPA. It means your immune system is reacting to Aspergillus, but your lungs haven’t been damaged yet.

What’s usually found:

  • High levels of IgE (allergy antibodies)

  • Positive test for Aspergillus-specific IgE

  • Normal or near-normal scans (X-ray or CT)

  • Asthma or mild chest symptoms

🟢 This form is often picked up with blood tests before any permanent changes in the lungs happen.

🟠 2. ABPA-CB — ABPA with Central Bronchiectasis

This is a more typical form of ABPA, where the ongoing allergic reaction has started to damage your airways. “Bronchiectasis” means some airways have become widened and scarred.

What’s usually found:

  • All of the features above plus

  • Changes on a CT scan showing central bronchiectasis

  • More mucus, coughing, or breathlessness

🟠 This form may need regular treatment to reduce inflammation and protect the lungs.

🔴 3. Severe ABPA — ABPA with frequent flares

This isn’t a separate type, but a more active or harder-to-control version of ABPA.

What’s usually happening:

  • Frequent flare-ups (exacerbations)

  • Need for ongoing steroids or antifungals

  • Possible use of biologic medicines (e.g. Xolair/omalizumab)

  • More serious asthma symptoms

🔴 This form can still be well-managed, but needs close monitoring and a good treatment plan.

⚠️ 4. ABPA-CPF — ABPA with Lung Scarring (Fibrosis)

This is the late stage of ABPA, where ongoing inflammation over many years has caused permanent damage to the lungs. It’s now much rarer thanks to earlier diagnosis and treatment.

What’s usually found:

  • Extensive scarring or fibrosis on lung scans

  • Breathlessness or tiredness

  • May overlap with another condition called chronic pulmonary aspergillosis (CPA)

⚠️ This stage needs careful support, but many people can still manage symptoms and improve quality of life.

📈 How doctors track your ABPA

Some doctors will also use stages to describe how your ABPA is behaving, though this does not comply with the most recent guidelines (ISHAM 2024):

  • Stage 0 – No symptoms, but abnormal blood test

  • Stage 1 – Newly diagnosed (active symptoms)

  • Stage 2 – Responding to treatment

  • Stage 3 – In remission (no active disease)

  • Stage 4 – Flare-up

  • Stage 5 – Long-term lung damage (fibrosis)

🩺 Why this matters to you

Knowing what form of ABPA you have helps you and your healthcare team:

  • Choose the right treatments

  • Decide how often you need scans or blood tests

  • Spot early signs of flare-ups

  • Protect your lungs from long-term damage

💬 Final message:

No matter which form you have, there are treatments that work. Many people with ABPA live full lives with the right support.
If you're unsure what form of ABPA you have, ask your doctor — it can help you understand what to expect and how to take care of your lungs.

by GAtherton

🧪 Understanding Blood Tests in ABPA-S

How Aspergillus-specific IgE and Eosinophil Counts Help with Diagnosis

If you’ve been told you might have Allergic Bronchopulmonary Aspergillosis – Serologic type (ABPA-S), you’ve probably had blood tests measuring your Aspergillus-specific IgE and your eosinophil count. These markers help doctors understand whether your immune system is reacting unusually to a common fungus called Aspergillus fumigatus.

This article explains what those tests mean — and why normal results don’t always rule out ABPA-S.

🌾 What is Aspergillus-specific IgE?

This blood test checks whether your immune system is producing allergy antibodies (IgE) against Aspergillus fumigatus. High levels suggest that your body is reacting to this fungus — a key sign in ABPA.

What do the results usually look like in ABPA-S?

  • Above 0.35 kUA/L – this is the minimum level needed for ABPA diagnosis

  • Above 1.5–6.5 kUA/L – this is very common in ABPA-S

  • Above 20 or even 50 kUA/L – these are often seen in more active or severe cases

🔍 Low or normal levels (below 0.35) are rare in ABPA-S unless:

  • You are already receiving treatment

  • You are in remission

  • There was a problem with the test

  • Your condition might be a different type of fungal allergy

So if your Aspergillus-specific IgE is high, that strongly supports the diagnosis. If it’s low, your doctor may retest or look at other factors.

🧬 What is an eosinophil count?

Eosinophils are a type of white blood cell linked to allergic inflammation. In many allergic conditions, including ABPA-S, these levels can go up.

What levels are typical in ABPA-S?

  • Above 500 cells/µL – commonly seen in untreated or active ABPA-S

  • Above 1,500 cells/µL – often seen in flare-ups

  • Below 500 cells/µL – can occur in people with milder disease or if they’ve started treatment

🟡 Normal eosinophils are not rare in ABPA-S
Many people with ABPA-S — especially those already on steroids or antifungals — may have eosinophil levels in the normal range. Up to a third of people with ABPA-S may show normal counts at some point.

🩺 What This Means for You

Test What’s Common in ABPA-S Is It Rare in ABPA-S?
Aspergillus-specific IgE High levels (often >1.5 or 6.5) Low or normal levels are rare
Eosinophils High counts often seen Normal counts are not rare, especially during treatment

So if your blood tests show:

  • High Aspergillus-specific IgE → that strongly supports ABPA-S

  • Normal eosinophils → this does not rule it out

💬 What patients often ask:

“Can I have ABPA-S with normal eosinophils?”

Yes. Especially if you’re already on steroids, or your symptoms are mild, your eosinophil count may appear normal.

“Does a low Aspergillus-specific IgE mean I don’t have ABPA?”

Not necessarily. Your doctor will consider your symptoms, scan results, and other blood tests too. Sometimes the test needs repeating.

🤝 Patient voices matter

If you’ve had these tests and been diagnosed with ABPA-S, sharing your experience can help others feel less alone — and more informed when navigating lab results.

Need help understanding your lab report?

Ask your care team:

  • What was my Aspergillus-specific IgE level?

  • What was my eosinophil count?

  • Are these results typical for someone with ABPA-S like mine?

Understanding your blood tests can help you take more confident steps in managing your condition.

by GAtherton

🦠 From Baby Guts to Adult Lungs: Why Your Microbiome Matters More Than You Think

We often think of gut bacteria as something that helps with digestion—but new research is showing they do much more than that. In fact, the tiny microbes in your gut may be playing a major role in protecting your lungs, especially from infections and long-term inflammation.

A recent UK study found that newborn babies with a healthy balance of gut bacteria had half the risk of serious lung infections. But what does this mean for people living with chronic lung conditions like aspergillosis?

Let’s take a look.

👶 The Baby Biome Breakthrough

Researchers followed over 1,000 babies in the UK for the first two years of life. They found that those with high levels of Bifidobacterium—a helpful gut bacteria—were far less likely to be hospitalised with chest infections like bronchiolitis.

This protective effect was:

  • Most common in babies born vaginally

  • Linked to how the immune system developed early on

  • Thought to involve chemical signals from the gut to the lungs, helping the lungs prepare for infections

In short: a baby’s gut bacteria helped protect their lungs.

🫁 What Does This Have to Do With Chronic Aspergillosis?

If you have a chronic condition like Chronic Pulmonary Aspergillosis (CPA), Allergic Bronchopulmonary Aspergillosis (ABPA) or aspergillus bronchitis, this research might feel far removed—but it’s actually quite relevant.

Here’s why:

1. The gut and lungs are connected

Known as the gut-lung axis, this two-way communication means that what’s happening in your digestive system can affect how your lungs respond to inflammation, infection, and allergens.

2. Long-term medications can harm gut balance

People with aspergillosis often need antifungal medicines, steroids, or antibiotics—all of which can disturb the natural balance of gut bacteria. This may weaken the immune system’s ability to manage fungal growth or increase inflammation in the lungs.

3. A healthier gut may support immune stability

Although the research is still developing, supporting a healthy gut microbiome might help reduce flare-ups, inflammation, or secondary infections—especially if you’ve had lots of antibiotics or are steroid-dependent.

🌿 What Can You Do?

While we don’t yet have a proven probiotic "treatment" for aspergillosis, there are safe and practical steps you can take to support your microbiome and, potentially, your lung health:

  • Eat more plant fibre (e.g. oats, vegetables, legumes)

  • Limit ultra-processed foods

  • Consider fermented foods like kefir, sauerkraut or yoghurt—only if tolerated and not contraindicated (important in ABPA)

  • Ask your doctor if a probiotic supplement might help you—especially if you’ve had frequent antibiotics or digestive symptoms

  • Avoid unnecessary antibiotic use

⚠️ Always check with your healthcare team before starting new supplements, especially if you're on antifungals or immunosuppressants.

🧪 What’s Next?

Researchers are already testing whether giving newborns the right bacteria (like Bifidobacterium longum) in the first few weeks of life can prevent infections. Similar trials may follow in older children and adults with chronic lung conditions.

For now, the message is clear:

Looking after your gut health isn’t just about digestion—it could be an important part of protecting your lungs too.

by GAtherton

🧾 Why Do Some People Need Higher Doses of Antifungal Medication?

If you're being treated for ABPA or another aspergillosis-related condition, you might wonder why your doctor has prescribed you a higher or lower dose of your antifungal medication than someone else. You're not alone—this is a common and important question.

The answer is that antifungal medicines don't work the same way in everyone. Your dose may need adjusting based on how your body handles the medication.

🔍 Here's why doses can vary from person to person:
1. Absorption differences
Some antifungal medicines (like itraconazole capsules) are harder for the body to absorb.

Things like what you eat, how acidic your stomach is, or even other medications can affect how well your body takes in the drug.

For example, acid blockers like omeprazole can reduce absorption.

2. How your body processes the drug
Your liver breaks down antifungal medicines.

Some people process them very quickly (which can make the drug less effective), while others process them slowly (which can increase side effects).

This is due to genetic differences, and you can’t predict it without blood tests.

3. Other medications you're taking
Some drugs interfere with antifungals, making them work less well or increasing side effects.

Your doctor might need to adjust your antifungal dose to compensate.

4. Your weight and body size
People with larger body size or more body fat may need a slightly higher dose to get the drug to the right level in the lungs.

5. How severe your condition is
If your ABPA or infection is more severe, your doctor may aim for a higher drug level in your body to make sure it works well.

🧪 Why do I need blood tests?
To make sure your antifungal is working properly, your doctor might check blood levels of the drug. This helps:

Avoid side effects if the level is too high

Make sure it’s effective if the level is too low

This is especially important for itraconazole and voriconazole.

✅ Key points to remember:
Your dose is personalised to you.

Don’t compare your dose to someone else’s—it’s not a one-size-fits-all treatment.

Always take your medication exactly as prescribed, and let your doctor know if you’re taking any new medicines, including over-the-counter ones.

by GAtherton

Are there withdrawal effects once voriconazole is stopped?

There are no classic withdrawal effects in the way we think of for drugs like steroids, opioids, or benzodiazepines when voriconazole is stopped. However, some patients do experience transient symptoms or rebound effects, especially if the drug was managing an active infection or inflammation.

Here’s what you should know:

✅ What Usually Happens When Voriconazole Is Stopped?

1. No physiological withdrawal syndrome

  • Voriconazole does not cause dependence or withdrawal at a chemical level.

  • You don’t need to taper it for pharmacological reasons — it can generally be stopped abruptly.

⚠️ But Some Symptoms May Still Appear

These aren’t “withdrawal” symptoms in the classical sense, but can occur:

A. Return of underlying symptoms

  • If the aspergillosis was only partially controlled, symptoms like cough, chest pain, or fatigue may recur.

  • Especially in CPA or ABPA, stopping antifungals too soon can cause flare-ups.

B. Immune rebound

  • Very rarely, immune reconstitution reactions (like in ABPA or after neutropenia) may occur as the immune system re-engages with fungal antigens.

  • This is not true withdrawal, but a host response shift.

C. Psychological or sensory changes

  • Some patients who had visual disturbances or strange dreams while on voriconazole report a brief “readjustment” period after stopping (often relief, but occasionally some lingering discomfort).

  • These effects usually resolve quickly.

👩‍⚕️ What To Watch For After Stopping

Symptom Likely Cause What to Do
Return of cough, sputum, fatigue Infection flaring again Recheck IgE, CRP, imaging, sputum
Headache, dizziness Rarely linked to stopping, more likely underlying illness or fatigue Monitor; seek review if worsening
Mood shifts, anxiety Possibly related to underlying illness stress, or stopping long-term meds Supportive care, discuss with clinician

🧾 Summary

  • No true withdrawal syndrome with voriconazole

  • Symptoms that return are usually related to underlying disease or immune changes

  • Best to stop under specialist advice, ideally with a plan for monitoring over 2–6 weeks

 

by GAtherton

🧠 Understanding Health Evidence: A Guide for Patients

This guide helps patients and the public understand how to judge the quality of health information, especially around treatments, supplements, and medical claims.

📚 Menu

  1. How Science Works
  2. Assessing the Strength of Evidence
  3. Trusting Online Medical Information
  4. Scientific Journal Quality and Bias
  5. Herbal Remedies and Industry Influence
  6. Unrecognised Syndromes and Clinics
  7. Predatory Journals and Peer Review

🔬 How Science Works

Medical advice and treatments are ideally based on well-tested science. Here’s how that process usually works:

  1. Research is done by scientists who ask questions and collect data.
  2. Peer review: Experts examine the study to ensure it’s fair and thorough.
  3. Publication: If it passes peer review, it's published.
  4. Replication: Other researchers try to repeat it. If they can't, confidence in the findings drops.

One study rarely proves something on its own. Medical certainty comes when multiple high-quality studies agree.

📊 Assessing the Strength of Evidence

🔎 Use these steps to check whether a claim is solid or uncertain:

  • Is it based on one study or a pattern of studies?
  • Has the result been replicated by others?
  • Is it a randomised controlled trial, or a weaker type (like a case report)?
  • Does it appear in a systematic review or meta-analysis?
  • Was it published in a known, peer-reviewed journal?

Always check with a trusted clinician if unsure.

🌐 Trusting Online Medical Information

Look out for:

✅ NHS, NICE, university, or respected charity sources ✅ References to studies or expert guidelines ✅ Recently published or reviewed content ❌ Claims that sound too good to be true ❌ Articles trying to sell you something

Good places to check information:

🧾 Scientific Journal Quality and Bias

Even good journals may publish studies with industry funding. That’s not wrong by itself, but look out for signs of bias:

  • Conflict of interest statements (often near the beginning or end)
  • Funding sources: Drug companies vs. independent organisations
  • How results are framed: Are benefits overstated? Risks ignored?
  • Compare with other studies: Are the results too good to be true?

The strongest evidence comes from independent replication.

🌿 Herbal Remedies and Industry Influence

Some believe herbal treatments are suppressed by drug companies. In truth:

  • Most herbal products haven’t had large, well-run trials.
  • Companies don’t fund them because they can’t be patented.
  • It’s not suppression — it’s a lack of commercial incentive.

Even if early research looks good, we need repeatable, well-controlled studies to ensure safety and effectiveness.

Doctors can’t recommend unproven treatments — not because they don’t work, but because we don’t yet know enough.

⚠️ Unrecognised Syndromes and Clinics

Some private clinics promote treatments for self-defined syndromes. They often:

  • Rely on a few early or small studies
  • Use unrecognised diagnostic tools
  • Sell unproven or expensive treatments

Mainstream medicine needs strong, repeated evidence before accepting a new condition or treatment. It’s about safety and evidence, not disbelief or conspiracy.

⚖️ Is It Legal — and Ethical?

In many countries, including the UK, it is legal for clinics to offer non-mainstream treatments if they do not break safety, advertising, or professional conduct laws. However, legality does not always mean ethical acceptability.

Offering treatments that are unsupported by high-quality evidence may be seen by many as amoral or unethical, especially when:

  • Patients are vulnerable or desperate
  • Treatments are expensive
  • Claims are overstated or misleading
  • Alternatives with better evidence are not discussed

Healthcare professionals are expected to put patient welfare before profit, be transparent about evidence limitations, and avoid offering false hope. Patients should always ask questions, seek second opinions, and verify claims with trusted sources.

Some private clinics promote treatments for self-defined syndromes.

They often:

  • Rely on a few early or small studies
  • Use unrecognised diagnostic tools
  • Sell unproven or expensive treatments

Mainstream medicine needs strong, repeated evidence before accepting a new condition or treatment. It’s about safety and evidence, not disbelief or conspiracy.

Other examples of self-defined or poorly validated syndromes promoted by certain clinics include:

  • Adrenal fatigue (not the same as adrenal insufficiency)
  • Leaky gut syndrome (distinct from recognised intestinal permeability disorders)
  • Multiple chemical sensitivity (MCS)
  • Chronic Lyme disease (as distinct from recognised post-treatment Lyme syndrome)
  • Sick building syndrome (& similar relating to treating those in a damp home)

These conditions are often treated with:

  • Specialised tests with unclear scientific validity
  • Supplements, detox regimes, or off-label drug use
  • Expensive personalised programmes with limited oversight

📉 Predatory Journals and Peer Review

Some journals publish low-quality or unreviewed research for money. Warning signs:

❌ Generic names, vague editorial boards, fast publication ✅ Indexed in PubMed, Web of Science, or Scopus ✅ Member of COPE or listed in DOAJ

Peer-reviewed journals differ in quality. Just because something is published doesn’t mean it’s reliable.

 

by GAtherton

✈️ Hints & Tips: Travel Guide for Aspergillosis Patients

This detailed article is designed to help patients with aspergillosis (including CPA, ABPA, SAFS, and those on antifungals or steroids) prepare for safe and enjoyable travel. It includes a complete travel plan, medication management, oxygen guidance, and destination risk information.

📚 Menu

  1. Planning and Medication Management
  2. Asthma, Photosensitivity, and Insurance
  3. Travelling with Oxygen Therapy
  4. Regions Riskier for Aspergillosis or Asthma
  5. Driving and Motorbiking Concerns
  6. Wheelchair Support When Travelling
  7. Why a Pulse Oximeter May Be Useful When Travelling
  8. Additional Resources
  9. Final Travel Checklist

</>

🧳 Planning and Medication Management

✅ Plan Ahead

  • Request repeat prescriptions 3–4 weeks before travel.
  • Coordinate hospital-only meds (e.g. posaconazole, biologics).
  • Obtain a doctor's letter listing your diagnosis, meds, doses, and any special handling (e.g., refrigeration).

🎒 Pack Smart

  • Bring enough medication for the trip + 7 extra days.
  • Keep meds in original packaging with pharmacy labels.
  • Split meds between hand luggage and checked bags.
  • Carry a paper and digital medication list.

❄️ Storage Requirements

  • Use a travel cool bag for biologics or antifungals that require refrigeration.
  • Ask hotels for a fridge or minibar in your room.
  • Bring a digital thermometer to monitor storage conditions.

🌍 Getting Meds Abroad (Emergency Only)

  • Private doctors/pharmacies may help with basic meds, but antifungals are rarely stocked.
  • NHS prescriptions won’t be accepted abroad; some private scripts might.
  • Register for an EHIC/GHIC card if travelling in Europe.

🛃 Customs and Legal

</>

🌬️ Asthma, Photosensitivity, and Insurance

Asthma Risks While Travelling

  • Triggers: dry air, cold air, perfume, anxiety, smoke
  • Always carry your rescue inhaler
  • Use a preventer consistently in the lead-up to travel
  • Pack a spacer if used

Photosensitivity (especially on Voriconazole)

  • Use SPF 50+, cover up with UV-blocking clothing
  • Avoid direct sunlight between 10am–4pm
  • Be careful near windows or during flights

Travel Insurance Challenges

  • Declare aspergillosis, asthma, biologics, antifungals, hospitalisations
  • Use specialist providers (e.g., AllClear, Insurancewith, Avanti)
  • Get a GP letter confirming stability

</>

🫁 Travelling with Oxygen Therapy

Planning Ahead

  • Get a letter from your doctor about oxygen requirements
  • Book a pre-flight oxygen assessment if needed

Flying with Oxygen

  • Notify airlines 3–4 weeks in advance
  • Check if onboard oxygen or POCs (Portable Oxygen Concentrators) are accepted
  • Bring enough batteries (150% of flight duration)

Travelling in the UK or EU

  • Arrange oxygen through providers like Baywater Healthcare or Dolby Vivisol
  • Outside UK/EU: you’ll likely need private supply — plan in advance

Legal and Insurance Notes

  • Declare oxygen use in travel insurance
  • Carry pulse oximeter and chargers

</>

🌍 Regions Riskier for Aspergillosis or Asthma

🔥 High-Risk Areas

  • Tropical/humid countries: SE Asia, India, Sub-Saharan Africa, Brazil
  • Dusty deserts: Arizona (USA), Middle East, North Africa
  • Polluted cities: Delhi, Beijing, Cairo, Lagos, some UK cities during heatwaves

Safer Destinations

  • Northern Europe, Scandinavia, highland areas, and coastal regions with good air quality.

Tips:

  • Avoid mouldy buildings, dusty markets, unregulated AC systems.
  • Wear FFP2/FFP3 masks in high-risk environments.
  • Stay indoors during dust storms or poor air quality alerts.

</>

🛵 Driving and Motorbiking Concerns

Medication Side Effects That Can Impair Driving

Medication Risk
Voriconazole Visual disturbance, hallucinations
Steroids Mood changes, insomnia
Painkillers (opioids) Drowsiness, slowed reaction

DVLA Guidelines

Biking and Sun Risk

  • Long UV exposure while biking is dangerous on voriconazole
  • Use UV-blocking visors, wear protective clothing

Other Tips

  • Avoid long journeys without breaks
  • Keep hydration and rescue meds close

</>

♿ Wheelchair Support When Travelling

Airport Wheelchair Support

  • Request wheelchair assistance when booking your flight.
  • Arrive early and inform check-in or help desks of your needs.
  • Most airports have dedicated support staff to help with boarding, disembarking, and security checks.

Travelling with Your Own Wheelchair

  • Airlines allow you to bring your own manual or electric wheelchair free of charge.
  • Label your chair clearly and bring any detachable parts in your carry-on.

Hotel Accessibility

  • Contact hotels in advance to confirm:
    • Step-free access
    • Lift availability
    • Wheel-in showers or accessible bathrooms

Rental Options

  • Many cities have wheelchair rental services — check availability online before travelling.

🩺 Why a Pulse Oximeter May Be Useful When Travelling

A pulse oximeter is a small device that clips onto your finger to measure your blood oxygen levels (SpO₂) and pulse rate. For aspergillosis patients, especially those with CPA, ABPA, or coexisting conditions like asthma or bronchiectasis, oxygen levels can drop unexpectedly during illness, flight, or physical exertion.

Having a pulse oximeter can help you:

  • Monitor for early signs of low oxygen during travel or exertion
  • Track changes if you're recovering from infection or flare-up
  • Provide data to healthcare providers during emergencies

They're small, affordable, and highly recommended when travelling, especially if you use oxygen, have unstable symptoms, or are flying.

📄 Additional Resources

Asthma + Lung UK: Travel Safely with a Lung Condition

Asthma + Lung UK's web guide on travelling safely with a lung condition offers clear and practical advice for every step of the journey. Key topics include:

  • Planning ahead: Inform your healthcare team early and check vaccination and visa requirements.
  • Medication and equipment: Tips for transporting oxygen, packing extra meds, and navigating airport security.
  • Flying: How to prepare if you need oxygen or are concerned about air pressure and dry air on planes.
  • Travel insurance: Advice on declaring lung conditions and finding appropriate cover.
  • During your trip: Staying safe in heat or cold, managing humidity and pollution, and what to do in an emergency.

This guide is especially useful for patients with asthma, COPD, bronchiectasis, or those using nebulisers and oxygen.

📖 Read the full guide online: Travel safely with a lung condition – Asthma + Lung UK

📌 Final Travel Checklist

  • Enough medication + 7 days extra

  • Doctor’s letter and prescription list

  • Insurance (specialist provider)

  • Rescue inhaler, spacer, antifungals

  • SPF and protective clothing (if on photosensitive meds)

  • Pulse oximeter (if applicable)

  • Contact details for your consultant

  • Face masks for flights/dusty areas

  • Travel cool bag and thermometer (if needed)

  • EHIC/GHIC card if travelling in Europe

  • Approved portable oxygen concentrator (if applicable)

  • Medical summary on phone and paper

by GAtherton

🏥 Surgery in Patients with ABPA or CPA: Can It Worsen Symptoms, and Should It Proceed?

Patients with Aspergillus-related lung diseases, such as Allergic Bronchopulmonary Aspergillosis (ABPA) and Chronic Pulmonary Aspergillosis (CPA), sometimes report worsened symptoms after undergoing surgery under general anaesthetic. While this is a recognised clinical pattern, it does not mean surgery should be avoided. Instead, it requires preparation and close perioperative management to reduce risk.

🔍 Can Surgery Worsen Aspergillosis Symptoms?

Yes — and here's why:

✳️ 1. Airway Irritation from Intubation

  • Endotracheal tubes can irritate airways already inflamed by ABPA or structurally altered by CPA.

  • Mechanical ventilation can impair mucus clearance and exacerbate cough or infection.

✳️ 2. Postoperative Immunosuppression

  • Surgery temporarily suppresses immune function.

  • Perioperative corticosteroids or stress-induced immune suppression can permit fungal flare-ups or reactivation.

✳️ 3. Impaired Mucus Clearance

  • Pain, immobility, and sedation reduce the patient’s ability to cough and clear secretions.

  • In CPA or ABPA, this can lead to plugging, fungal regrowth, or secondary bacterial infection.

✳️ 4. Drug Interactions

  • Azole antifungals (e.g. itraconazole, posaconazole) interact with many anaesthetics, opioids, and steroids.

  • These interactions can alter drug levels, reduce antifungal efficacy, or increase toxicity risk.

✳️ 5. Stress and Inflammation

  • Surgical stress may worsen the inflammatory or allergic component of ABPA.

  • CPA-related cavities may bleed or become re-infected post-op.

✅ Should Surgery Still Go Ahead?

Yes — surgery can and often should proceed when it is medically indicated.

Delaying needed procedures (e.g. for cancer, fractures, or pain relief) can lead to worse outcomes than the potential risks related to aspergillosis.

🛡️ Recommended Precautions

🔷 Pre-Operative Planning

  • Ensure all care teams are aware of the diagnosis.

  • Review lung imaging, baseline oxygenation, and current antifungal/steroid regimens.

  • Arrange for pre-op airway clearance if sputum is a concern.

🔷 Antifungal Management

  • Continue antifungal therapy through the perioperative period.

  • Use IV formulations if oral administration isn’t possible.

  • Check for drug interactions with anaesthetic or post-op medications.

🔷 Steroid Cover (ABPA and CPA on steroids)

  • Patients on chronic steroids may need perioperative hydrocortisone supplementation (adrenal cover).

  • Apply “sick day rules” or use the patient’s adrenal insufficiency plan, if applicable.

🔷 Post-Op Monitoring

Watch for:

  • Worsening cough, breathlessness, or sputum

  • Fever or signs of secondary infection

  • Raised IgE (in ABPA) or haemoptysis (in CPA)

  • Any signs of antifungal failure or drug toxicity

⚠️ When Might Surgery Be Delayed?

Consider postponing non-urgent surgery if:

  • There is active haemoptysis

  • The patient has uncontrolled inflammation or fungal burden

  • A recent scan shows expanding cavities or new infiltrates

  • Antifungal resistance is suspected or not yet managed

💬 Key Message for Patients

“Having ABPA or CPA doesn’t mean you can’t have surgery — but we do need to take extra care around your airways, your antifungal treatment, and your recovery. With the right team and planning, we can safely support you through your procedure.”

by GAtherton

Allergic Bronchopulmonary Aspergillosis (ABPA) Without Asthma: A Hidden Reality

Most people – including many doctors – associate Allergic Bronchopulmonary Aspergillosis (ABPA) almost exclusively with asthma or cystic fibrosis. In fact, the current diagnostic criteria for ABPA often assume the presence of asthma as a prerequisite. But what happens when a patient has all the features of ABPA… without ever having had asthma?

This article explores the possibility – and growing recognition – of ABPA without asthma.

🔍 What Is ABPA?

ABPA is an allergic (hypersensitivity) reaction to the fungus Aspergillus fumigatus, which can colonise the lungs and cause:

  • Severe allergic inflammation

  • Damage to lung tissue (bronchiectasis)

  • High levels of IgE (often >1000 IU/mL)

  • Positive skin tests or blood tests for Aspergillus

Traditionally, ABPA is diagnosed in people with asthma or cystic fibrosis, where the airways are already vulnerable.

❗But Can ABPA Occur Without Asthma?

Yes. Though uncommon, there are confirmed cases where ABPA occurs in people who:

  • Do not have asthma

  • Have no wheeze, breathlessness or variability in symptoms

  • Show no reversibility on a bronchodilator test

  • May not respond to inhaled corticosteroids

This presentation is now increasingly recognised – particularly:

  • After viral infections like COVID-19

  • In people exposed to environmental moulds

  • In those with no personal or family history of asthma

🧪 Diagnostic Clues

Patients with ABPA but no asthma typically still show:

  • Very high total IgE levels

  • Positive Aspergillus-specific IgE and IgG

  • Radiological changes like central bronchiectasis

  • Sometimes eosinophilia in blood

But they do not show:

  • Classic asthma symptoms (e.g. wheeze, reversible breathlessness)

  • Improvement with bronchodilators

  • Variable peak flow readings

🧬 How Might This Happen?

There are a few theories:

  • Some people have a strong allergic immune response (IgE-driven) to Aspergillus alone, even without underlying asthma

  • COVID-19 and other infections may prime the immune system or damage airways enough to allow fungal colonisation

  • Not all bronchial hypersensitivity is asthma — the airway inflammation in ABPA is unique and not always “asthmatic” in pattern

✅ What Tests Can Help Confirm or Rule Out Asthma?

For patients who have ABPA but no clear asthma symptoms:

  • Bronchodilator reversibility test → May be negative

  • Methacholine or histamine challenge test → Gold standard for confirming asthma

  • FeNO test → Measures eosinophilic airway inflammation (may be high in both ABPA and asthma)

  • Peak flow monitoring → Often stable in ABPA without asthma

These tests can help clarify the diagnosis and prevent mislabeling patients as asthmatic when they are not.

🧭 Why Does It Matter?

Correct diagnosis matters because:

  • Not all ABPA patients benefit from inhaled corticosteroids or asthma drugs

  • Treatment should be tailored — e.g. antifungals and oral steroids for ABPA, but not unnecessary asthma medications

  • Misdiagnosis may delay the right treatment and overburden patients

🩺 A Call to Clinicians

If a patient has high IgE, bronchiectasis, and strong Aspergillus sensitisation — but no clinical asthma — consider ABPA without asthma.

Request confirmatory tests before labeling someone asthmatic for life. In these rare cases, asthma criteria do not fully apply — but the patient still needs support for ABPA.

🧾 Summary

Feature ABPA With Asthma ABPA Without Asthma
Wheeze/breathlessness Common May be absent
Bronchodilator response Often positive Usually negative
Total IgE High High
Aspergillus IgE/IgG Positive Positive
Imaging (HRCT) Bronchiectasis Bronchiectasis

🙋 What Can Patients Do?

If you’ve been diagnosed with ABPA but don’t believe you have asthma:

  • Ask your doctor about further testing to confirm or rule out asthma

  • Keep a record of your symptoms, peak flow (if used), and medication response

  • Discuss your IgE levels, CT scan results, and whether other diagnoses (e.g. chronic pulmonary aspergillosis) might apply

by GAtherton