GAtherton, Author at Aspergillosis Patients & Carers Support

Person practising mindfulness meditation outdoors to support relaxation and emotional wellbeing while living with aspergillosis.

Mindfulness, Meditation and Relaxation for People Living with Aspergillosis

Living with aspergillosis can be physically and emotionally demanding. Many people describe feeling anxious about breathlessness, frustrated by fatigue, worried while waiting for test results, or overwhelmed by the uncertainty of living with a long-term condition.

These feelings are entirely understandable. Mindfulness is not a treatment for aspergillosis, but many people find that it helps them manage stress, cope more effectively with symptoms, and improve their overall quality of life alongside their medical care.

Several people living with aspergillosis have told us that mindfulness, meditation or related approaches have helped them cope with the emotional challenges of living with a long-term respiratory condition. Some describe it as being similar to cognitive behavioural therapy (CBT), because it can help them notice anxious thoughts, recognise unhelpful cycles, and respond more calmly.

Mindfulness and CBT are not the same thing, but there is overlap. Both can help people become more aware of how thoughts, feelings, physical sensations and behaviours influence each other. This may be especially relevant when breathlessness, anxiety and stress start to reinforce one another.

Mind and body are connected. Our thoughts and feelings can affect how we breathe, and our breathing can affect how we feel. Mindfulness may help some people break the cycle of stress, anxiety and breathlessness.

What is mindfulness?

Mindfulness means paying attention to the present moment with openness and without judgement. It involves noticing your thoughts, emotions and body sensations as they are happening, rather than becoming caught up in worries about the future or memories of the past.

The NHS describes mindfulness as becoming more aware of what is happening both inside ourselves and in the world around us. This greater awareness can help us recognise stress earlier and respond to it in healthier ways.

Can mindfulness help?

Research suggests that mindfulness-based approaches may help some people living with long-term health conditions by:

reducing stress and anxiety
improving emotional wellbeing
helping people cope with uncertainty
improving sleep in some individuals
increasing confidence in managing long-term illness
supporting overall quality of life

Mindfulness is not a replacement for medical treatment, but it may be a useful addition to an overall self-management plan.

Mindfulness and breathing

Breathing is central to many mindfulness exercises.

People living with aspergillosis may become understandably focused on their breathing, particularly during episodes of breathlessness. Gentle breathing awareness can help some people slow their breathing, reduce feelings of panic and regain a greater sense of control.

The aim is not to force deeper breaths, but to develop a calm awareness of your natural breathing pattern.

If you become uncomfortable or increasingly breathless during any exercise, stop and return to your normal breathing. Always follow the advice of your respiratory team if you have concerns about breathlessness.

Meditation

Meditation is one way of practising mindfulness. Even five to ten minutes each day may help you develop greater awareness of your breathing, thoughts and emotions.

There are many different styles of meditation. Some focus on breathing, while others use guided relaxation, body awareness or gentle visualisation. There is no single correct approach, so it is worth trying different techniques to discover what works best for you.

Tai Chi and Yoga

Gentle activities such as Tai Chi and yoga combine movement, breathing and relaxation. Many people with chronic respiratory conditions find these activities helpful for improving confidence, flexibility, balance and emotional wellbeing.

Choose exercises that match your current level of fitness and avoid pushing yourself beyond your comfort level. If you are unsure whether an activity is suitable, discuss it with your healthcare team.

Getting started

You do not need any special equipment or previous experience.

You could begin by:

spending five minutes focusing on your breathing each day
taking a slow, mindful walk while noticing your surroundings
trying a guided mindfulness session
practising gentle stretching, yoga or Tai Chi
using relaxation exercises before bed or during stressful periods

Many people find that practising little and often is easier than trying long sessions.

Useful resources

You may also find it helpful to explore aspergillosis.org resources on breathing exercises, fatigue, emotional wellbeing, exercise and gentle movement.

When should I seek additional support?

Living with a long-term illness can affect emotional wellbeing. If anxiety, low mood or stress are becoming overwhelming, speak with your GP or specialist team. Support is available, and looking after your mental wellbeing is an important part of living well with aspergillosis.

Originally published: July 2018

Last substantially updated: July 2026

Next review due: July 2028

by GAtherton

Illustration showing the close communication between the brain, lungs and nervous system, explaining how breathing is influenced by physical, neurological and emotional factors in people living with aspergillosis.

Living with Aspergillosis: Understanding the Brain–Lung Connection

Why emotions, stress, sleep, confidence and the nervous system all influence how we experience chronic lung disease

Aspergillosis Living Knowledge Hub | Built with patients | Living document

This is a Living Knowledge Hub

Unlike a traditional article, this Knowledge Hub is designed to evolve.

As new scientific research becomes available, and as people living with aspergillosis ask new questions, we will continue to expand and improve this resource.

The current version already contains evidence-based information that has been reviewed before publication, but it is only the beginning.

This approach allows us to share useful information now, rather than waiting until every section is complete, while continuing to improve the resource over time.

Current version: 0.1
Last updated: July 2026
Status: Living Knowledge Hub
Reading time: approximately 18 minutes
Who is this for? People living with aspergillosis, families, carers and healthcare professionals
Review policy: This Knowledge Hub is reviewed whenever important new evidence becomes available and at least annually to ensure it remains accurate and up to date.

Planned additions

The immune system and psychoneuroimmunology
Sleep, fatigue and breathing
Stress hormones, inflammation and infection
Living with uncertainty
Pulmonary rehabilitation and rebuilding confidence
Additional illustrations and diagrams
Expanded references and further reading

Before you begin: you are not imagining it
Why we wrote this guide
Why does my breathing feel worse when my scan has not changed?
Why does the brain matter if my lungs are the problem?
Can emotions really change my breathing?
What’s new?
Help us improve this Knowledge Hub

Before you begin...

If you have arrived here because someone suggested that stress or anxiety might be affecting your breathing, this page is for you.

If you have arrived here because you are wondering why some days are so much harder than others, this page is for you.

If you have ever worried that family members, friends or even healthcare professionals thought your symptoms were “all in your head”, this page is for you too.

And if you are a family member or healthcare professional trying to understand what it is really like to live with aspergillosis, we hope this guide helps explain an aspect of chronic lung disease that is rarely discussed in detail.

The most important message comes first.

Your illness is real.

Your symptoms are real.

Modern respiratory medicine recognises that the brain, lungs, nervous system and immune system constantly work together. Understanding that relationship does not make your illness any less real. It helps explain why living with chronic lung disease can sometimes be so challenging.

Why we wrote this guide

Over many years at the National Aspergillosis Centre, we have listened to many people living with aspergillosis.

Again and again, we hear similar questions.

“Why do I feel much worse today when my scan hasn’t changed?”

“Why does poor sleep affect my breathing so much?”

“Can stress make my symptoms worse?”

“If my emotions affect my breathing, does that mean my illness isn’t real?”

These are important questions. Unfortunately, they can be difficult to answer fully during a busy clinic appointment.

This guide has been written to provide the explanation many people tell us they never had.

It brings together modern respiratory medicine, neuroscience, immunology, pulmonary rehabilitation and the lived experience of people with aspergillosis.

Our aim is not simply to explain the science. Our aim is to help you understand your own experience.

A false choice

Many people living with chronic illness feel they have been offered two very different explanations for their symptoms.

Either the symptoms are caused by the lungs, or the symptoms are caused by anxiety.

Modern medicine increasingly recognises that this is a false choice.

The lungs are real. The brain is real. The nervous system is real. The immune system is real. Hormones are real.

Every one of these systems communicates continuously with the others. When we understand that partnership, many experiences that once seemed confusing begin to make sense.

More than just the lungs

Most of us think breathing happens entirely inside the lungs. In reality, every breath depends on an extraordinary partnership between many different parts of the body.

Body system	Its role in breathing
The lungs	Exchange oxygen and carbon dioxide.
The brain	Interprets breathing signals and decides how much air the body needs.
The nervous system	Adjusts breathing, heart rate and muscle activity.
The breathing muscles	Power every breath you take.
The immune system	Responds to infection and inflammation in the lungs.
Your previous experiences	Help the brain judge whether breathing feels safe or threatening.

Scientists often describe this constant communication as the brain–lung axis.

Understanding how this partnership works has transformed the way respiratory specialists think about chronic breathlessness.

What you will learn

By the end of this guide you will understand:

why scans and lung function tests do not always match how you feel
why frightening experiences can change the way breathing feels
why sleep, fatigue and emotions influence symptoms
what scientists know about stress and the immune system
why pulmonary rehabilitation works
how confidence can be rebuilt after serious illness
what is known, and what is still uncertain, about these important questions.

If you remember only one thing from this opening section, remember this:

Your illness is real. Your symptoms are real. The science that explains the connection between the brain and lungs is real too.

Why Does My Breathing Feel Worse When My Scan Hasn’t Changed?

This is probably one of the most common questions asked by people living with chronic lung disease.

“My doctor says my CT scan looks stable, so why do I feel so much worse?”

It is an excellent question. It is also one that causes enormous frustration.

Many people begin wondering whether they are imagining their symptoms or whether something has been missed.

Fortunately, modern respiratory medicine has a much better explanation.

The first thing to understand

A CT scan is an extraordinarily useful investigation. It allows doctors to see inflammation, cavities, bronchiectasis, scarring and many other important changes inside the lungs.

But a scan has one important limitation.

It shows what your lungs look like.

It cannot show what breathing feels like.

Those are two different things.

Structure versus function

A useful way to think about this is to separate structure from function.

Structure	Function and lived experience
CT scans	Breathing comfort and effort
X-rays	Exercise tolerance
Blood tests	Energy and fatigue
Lung function tests	Quality of life and confidence

Your medical team needs both kinds of information. One does not replace the other.

Breathlessness is an experience

The American Thoracic Society defines breathlessness, also called dyspnoea, as:

“A subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.”

That definition is important. It tells us that breathlessness is something that is experienced.

The lungs send information. The brain turns that information into the experience of breathing.

An orchestra, not a solo instrument

Imagine listening to an orchestra. You do not hear only the violins. You hear the combined sound of strings, woodwind, brass and percussion.

Breathing works in much the same way. What you experience is produced by many different systems working together.

System	Contribution
Lungs	Move oxygen and carbon dioxide.
Heart	Delivers oxygen.
Breathing muscles	Generate each breath.
Brain	Interprets signals.
Nervous system	Adjusts breathing.
Sleep	Influences fatigue and resilience.
Confidence	Changes how safe breathing feels.
Previous experiences	Influence future breathing responses.

No single instrument produces the whole performance.

What your scan cannot see

Your CT scan cannot show:

how well you slept
whether your breathing muscles are tired
whether you recently recovered from a viral infection
whether you feel anxious about another haemoptysis
whether today’s humidity is making your chest feel tight
whether your body is still recovering from yesterday’s activity
how much mental effort breathing requires today.

All of these may influence how breathing feels. None of them mean your illness is imaginary.

Research Spotlight

Why the modern definition of breathlessness matters

Older medical thinking often treated breathlessness as a simple consequence of lung damage.

Research over recent decades has shown that the experience of breathlessness depends upon interactions between the lungs, brain, nervous system and many other factors.

This is why modern respiratory medicine increasingly measures quality of life alongside scans and lung function tests.

Why this matters: it validates what patients have always known: how they feel cannot always be predicted by test results alone.

Why this matters if you have aspergillosis

If your scan has not changed but your breathing feels worse, this does not automatically mean:

the disease has suddenly progressed
the scan is wrong
your symptoms are “all in your head”.

It means breathing is influenced by many different parts of the body working together.

Understanding those interactions is one of the biggest advances in modern respiratory medicine.

Why Does the Brain Matter If My Lungs Are the Problem?

This question worries many people.

“If my doctor starts talking about my brain, are they saying my illness isn’t real?”

The answer is simple. No.

Talking about the brain is not changing the diagnosis. It is explaining how breathing works.

Your lungs cannot create the sensation of breathlessness on their own, just as your ears cannot create music on their own, or your eyes cannot create vision on their own.

Every one of these experiences depends on the brain interpreting information coming from the body. Breathing is no different.

Your brain is your body’s prediction machine

Most of us imagine the brain as a computer that simply receives information. Modern neuroscience paints a much more interesting picture.

The brain is constantly trying to predict what is about to happen.

Every second it asks questions such as:

Am I safe?
Am I getting enough oxygen?
Should I breathe faster?
How hard are my breathing muscles working?
Does this feel familiar?

It compares what it expects to happen with what is actually happening.

If everything matches, breathing usually fades into the background. If something unexpected happens, breathing suddenly becomes the centre of attention.

This is one reason healthy people rarely notice their breathing, while people living with chronic lung disease may think about it many times each day.

The smoke alarm inside your brain

A smoke alarm has one job: to detect danger. It would rather ring unnecessarily than miss a real fire.

Your brain works in much the same way.

If you have experienced:

a severe asthma attack
haemoptysis
being unable to catch your breath
an emergency admission to hospital
months of unexplained symptoms before diagnosis

your brain learns something very important.

“Breathing can sometimes become dangerous.”

Once that lesson has been learned, your brain naturally pays much closer attention to breathing than it did before.

This is not a fault. It is exactly what evolution intended. Your brain is trying to protect you.

Patient Perspective

“After coughing up blood I became frightened every time I coughed.

I knew the bleeding had stopped, but every cough made me wonder whether it was happening again.

Learning that my brain was trying to protect me, not trick me, changed the way I understood my recovery.”

The Brain–Lung Axis

Scientists describe the close communication between the brain and lungs as the brain–lung axis.

This communication works in both directions.

The lungs tell the brain...	The brain tells the lungs...
How much oxygen is available.	How fast to breathe.
How much carbon dioxide is present.	How deeply to breathe.
Whether the airways are irritated.	When to cough.
How hard the breathing muscles are working.	How to respond to exercise.

Every breath is the result of this continuous conversation.

Illustration showing the brain, lungs and nervous system communicating, explaining how breathing symptoms in aspergillosis can be influenced by physical, neurological and emotional factors. — The brain, lungs and nervous system work together continuously. Understanding this partnership helps explain why breathing symptoms can change from day to day.

Why this matters if you have aspergillosis

If you understand that breathing is created by a partnership between the lungs and brain, several confusing experiences suddenly make much more sense.

Why one day can feel much harder than another.
Why sleep affects breathing.
Why fatigue affects breathing.
Why confidence affects breathing.
Why pulmonary rehabilitation improves symptoms even when scans remain unchanged.
Why frightening respiratory events can continue to affect confidence long after the lungs have recovered.

None of these observations suggest your illness is psychological.

They demonstrate how remarkably sophisticated the breathing system really is.

Research Spotlight

Brain imaging studies have shown that breathlessness activates areas of the brain involved in attention, emotion and decision-making, as well as areas involved in sensory processing.

This reinforces an important message:

Breathlessness is not simply a signal from the lungs. It is a whole-body experience.

Can Emotions Really Change My Breathing?

Many people living with aspergillosis are reluctant to ask this question.

Some worry that even mentioning stress or emotions will mean their symptoms are no longer taken seriously. Others have experienced exactly that in the past.

Modern respiratory medicine takes a very different view.

It recognises two equally important facts.

Your lung disease is real.
Your emotional state can influence how that disease is experienced.

These statements are not contradictory. They describe how the human body normally works.

Every emotion has a physical effect

Think about the last time you were startled. Before you had time to think, your body had already responded.

Your heart rate increased.
Your breathing became faster.
Your muscles tightened.
Your mouth became dry.
Your attention narrowed onto the potential danger.

You did not choose any of those reactions. They happened automatically.

This is because emotions are not separate from the body. They are produced by the body and immediately affect the body’s physiology.

Breathing is especially sensitive

Unlike many other organs, the breathing system has to respond continuously to both physical demands and emotional demands.

Situation	What happens?
Walking upstairs	Your breathing increases because your muscles need more oxygen.
Receiving frightening news	Your breathing may also increase, even though your muscles are resting.
Laughing	Your breathing pattern changes completely.
Crying	Your breathing becomes irregular and deeper.
Feeling calm and relaxed	Your breathing usually slows and becomes more efficient.

These changes happen in everyone.

People with chronic lung disease often notice them more because their breathing system is already working harder.

Why frightening experiences matter

Imagine two people climbing exactly the same flight of stairs.

One has never experienced serious breathing problems. The other has previously been admitted to hospital with severe breathlessness.

Their lungs may be working equally hard. But their brains interpret those signals differently.

The first person thinks:

“I’m out of breath because I climbed the stairs.”

The second person may immediately wonder:

“Is something going wrong again?”

Neither response is irrational. They reflect different life experiences.

This is one reason why previous severe respiratory events can continue to influence confidence long after recovery.

Patient Perspective

“I realised I wasn’t frightened of exercise.

I was frightened of becoming breathless because, in the past, breathlessness had meant I was seriously ill.”

The vicious circle of fear

Fear itself does not damage the lungs. However, fear can unintentionally make breathing feel more difficult.

Breathlessness
       ↓
Concern
       ↓
Breathing becomes faster
       ↓
Chest muscles tighten
       ↓
Breathing feels harder
       ↓
More concern

This is not imaginary. Every stage involves genuine physical changes.

The encouraging news is that this cycle can also be interrupted.

Understanding
       ↓
Greater confidence
       ↓
Calmer breathing
       ↓
More efficient breathing
       ↓
Activity feels easier
       ↓
Confidence grows

This does not remove aspergillosis. It changes how effectively the whole breathing system works together.

Research Spotlight

Why pulmonary rehabilitation improves confidence

Research consistently shows that pulmonary rehabilitation improves quality of life, exercise capacity and confidence, even when lung function changes only modestly.

Patients often describe feeling more in control of their breathing.

This improvement reflects better physical conditioning, improved breathing efficiency, increased confidence and a better understanding of symptoms.

These benefits are recognised internationally and form an important part of managing many chronic respiratory diseases.

Why this matters if you have aspergillosis

You are not expected to ignore your emotions.

You are not expected to “stay positive” all the time.

You are not expected to pretend your illness is less serious than it is.

Instead, understanding how emotions influence breathing gives you another tool.

It helps explain why:

some days feel harder than others
confidence matters
breathing techniques can help
pulmonary rehabilitation works
being listened to is part of good medical care

Knowledge does not remove the disease.

But it can remove unnecessary fear and replace it with understanding.

Emotions do not make aspergillosis imaginary.

They are one of the many biological systems that influence how living with aspergillosis feels from day to day.

What's New?

This Knowledge Hub is updated regularly as new evidence becomes available and in response to questions from readers.

Version 0.1 – July 2026

Initial publication.
Introduced the Brain–Lung Connection.
Explained why breathlessness is more than lung function alone.
Explored how previous experiences and emotions can influence breathing.

Next planned update

The immune system and psychoneuroimmunology.
Stress hormones, inflammation and infection.
Sleep and breathing.

Help Shape Future Editions

Every month we review this Knowledge Hub.

Some improvements come from newly published scientific research.

Others come directly from the questions and experiences shared by people living with aspergillosis, their families and healthcare professionals.

Many of the most valuable pages on aspergillosis.org have started with a single patient question.

If there was something you expected to find but didn't...

If something wasn't explained clearly...

If your own experience has been different...

Or if there is a question you think every patient should have answered...

Please tell us.

Your feedback will help shape future editions of this Knowledge Hub and may inspire entirely new patient resources.

📝 Share your feedback (2–3 minutes)

Thank you for helping us build one of the world's most comprehensive patient education resources on aspergillosis.

This Knowledge Hub has evolved thanks to our readers

Future updates will be listed here so you can see how this resource has grown over time.

Version	What's changed
0.1	Initial publication introducing the Brain–Lung Connection, explaining why breathlessness is more than lung function, and describing how previous experiences and emotions can influence breathing.
0.2	Coming soon: immune system, psychoneuroimmunology, stress hormones, inflammation and sleep.
0.3	Coming soon.
1.0	First complete edition.

COPD, autoimmune disease and new approaches to antifungal treatment

Published: 29 June 2026

Every week we review the latest research on aspergillosis and related fungal diseases, selecting the studies most likely to influence patient care and clinical practice. This week's research focuses on an increasingly important theme: recognising Aspergillus disease in patient groups where it has traditionally been overlooked.

The highlight is a large systematic review suggesting that allergic Aspergillus disease may be more common in people living with chronic obstructive pulmonary disease (COPD) than previously appreciated.

Featured Paper

COPD and Aspergillus: Is allergic aspergillosis more common than we thought?

For decades, allergic bronchopulmonary aspergillosis (ABPA) has been regarded primarily as a complication of asthma and cystic fibrosis. However, respiratory specialists have increasingly reported Aspergillus-related disease in patients with COPD.

A new systematic review and meta-analysis has now brought together the available evidence.

Paper: Ajayababu A, Antony A, Goyal B, Ray A. Prevalence of allergic bronchopulmonary aspergillosis/Aspergillus sensitization in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Respiratory Investigation. 2026. PubMed PMID: 42361722

What did the researchers do?

The authors searched four major medical databases for studies reporting either:

Allergic bronchopulmonary aspergillosis (ABPA)
Aspergillus sensitisation (AS)

Among patients with COPD, the review identified 23 suitable studies, including:

1,529 patients for analysis of ABPA
3,505 patients for analysis of Aspergillus sensitisation

Pooling data from many studies provides a more reliable estimate than individual reports alone.

What did they find?

The results suggest Aspergillus-related disease is not rare in COPD.

The pooled prevalence was:

ABPA: 2.1%
Aspergillus sensitisation: 10.4%

Put another way:

around 1 in 50 people with COPD may have ABPA
approximately 1 in 10 have evidence of sensitisation to Aspergillus

Studies using Aspergillus-specific IgE as part of their diagnostic strategy detected more ABPA than studies using skin testing or total IgE alone. This suggests that the choice of diagnostic tests may influence how many patients are identified.

Why is this important?

Many symptoms of COPD overlap with Aspergillus-related disease, including:

persistent cough
breathlessness
increased sputum production
recurrent exacerbations

As a result, some patients may continue to receive repeated courses of antibiotics or steroids while an underlying Aspergillus-related condition remains unrecognised.

This study does not suggest that everyone with COPD should undergo routine fungal testing. However, it supports considering Aspergillus investigations in selected patients with:

recurrent exacerbations despite optimal therapy
unexplained eosinophilia or raised IgE
bronchiectasis
persistent mucus plugging
radiological abnormalities that do not fit the expected pattern

Strengths and limitations

This is currently one of the largest reviews examining COPD and Aspergillus disease.

Its strengths include:

systematic literature search
formal meta-analysis
inclusion of more than 5,000 patients overall

However, the included studies differed considerably in patient populations, diagnostic methods and disease severity. This statistical heterogeneity means the true prevalence almost certainly varies between different clinical settings.

The review also demonstrates an association rather than proving that COPD itself causes ABPA.

What does this mean for patients?

The main message is one of greater awareness.

For patients with COPD whose symptoms remain difficult to explain despite appropriate treatment, clinicians may increasingly consider whether Aspergillus sensitisation or ABPA could be contributing to ongoing respiratory problems.

Earlier recognition has the potential to improve diagnosis and ensure that patients receive the most appropriate investigations and treatment.

Research in Brief

Invasive aspergillosis in autoimmune inflammatory rheumatic diseases

Paper: Liang P, Zhang X, Cai S, Hu Z, Dong L. Invasive aspergillosis in autoimmune inflammatory rheumatic diseases: epidemiology, risk factors, diagnosis, management and challenges. Annals of Medicine. 2026. PubMed PMID: 42343869

A comprehensive new review highlights the growing importance of invasive aspergillosis in people with autoimmune inflammatory rheumatic diseases such as rheumatoid arthritis and systemic vasculitis.

The increasing use of corticosteroids, biologic therapies and other immunosuppressive medications has expanded the population at risk. The authors note that invasive aspergillosis remains uncommon but carries a high mortality when diagnosis is delayed.

A particular challenge is that symptoms and imaging findings can resemble a flare of the underlying autoimmune disease, making diagnosis difficult. The review emphasises combining clinical assessment with microbiological tests, including galactomannan, PCR and bronchoalveolar lavage where appropriate, and careful interpretation of imaging findings.

Why it matters: Clinicians should maintain a high index of suspicion for invasive fungal disease in immunosuppressed patients who fail to respond as expected to conventional treatment.

Cerebral aspergillosis following influenza and ibrutinib therapy

Paper: Haraguchi M, Kimura M, Uruga H, Takahashi Y, Takaya H, Arisawa K, et al. Cerebral aspergillosis caused by Aspergillus flavus following seasonal influenza infection in a patient receiving ibrutinib for Waldenström's macroglobulinemia. Journal of Infection and Chemotherapy. 2026. PubMed PMID: 42331321

A Japanese case report describes successful treatment of cerebral aspergillosis caused by Aspergillus flavus in a patient receiving the Bruton tyrosine kinase inhibitor ibrutinib after seasonal influenza infection.

The patient developed both pulmonary and cerebral aspergillosis, underwent neurosurgical debridement and was successfully treated with isavuconazole.

Although this represents a single case, it reinforces growing evidence that BTK inhibitors and severe viral infections are emerging risk factors for invasive aspergillosis.

Why it matters: Patients receiving targeted therapies who develop persistent respiratory or neurological symptoms following influenza warrant careful assessment for opportunistic fungal infection.

Looking ahead: New ways to deliver antifungal drugs

Paper: Martins YA, Anselmo-Lima WT, Tamashiro E, Ho E, Valera FCP. Next-generation drug delivery systems for aspergillosis: Overcoming barriers in antifungal therapy. Biomedicine & Pharmacotherapy. 2026. PubMed PMID: 42361622

Another review this week explores next-generation drug delivery systems designed to improve treatment of aspergillosis.

Researchers are developing inhaled formulations, nanoparticles and targeted drug-delivery technologies that aim to increase antifungal concentrations directly within the lungs while reducing systemic side effects.

Most of these approaches remain experimental, but they offer possibilities for the future management of chronic pulmonary aspergillosis and other forms of pulmonary fungal disease.

What this week's research tells us

Although these papers address different aspects of aspergillosis, they all point in the same direction.

Increasingly, Aspergillus disease is being recognised in patient groups previously considered to be at relatively low risk, including people with COPD and those receiving modern immunosuppressive therapies.

At the same time, advances in diagnostics and drug delivery are creating opportunities for earlier diagnosis and more targeted treatment.

For patients, the message is reassuring but important: persistent or unexplained respiratory symptoms deserve careful evaluation, particularly when standard treatments are not achieving the expected improvement.

As awareness continues to grow, more patients may receive the correct diagnosis earlier in the course of their illness.

References

Ajayababu A, Antony A, Goyal B, Ray A. Prevalence of allergic bronchopulmonary aspergillosis/Aspergillus sensitization in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Respiratory Investigation. 2026. doi:10.1016/j.resinv.2026.101469. PubMed
Liang P, Zhang X, Cai S, Hu Z, Dong L. Invasive aspergillosis in autoimmune inflammatory rheumatic diseases: epidemiology, risk factors, diagnosis, management and challenges. Annals of Medicine. 2026. doi:10.1080/07853890.2026.2685285. PubMed
Haraguchi M, Kimura M, Uruga H, Takahashi Y, Takaya H, Arisawa K, et al. Cerebral aspergillosis caused by Aspergillus flavus following seasonal influenza infection in a patient receiving ibrutinib for Waldenström's macroglobulinemia. Journal of Infection and Chemotherapy. 2026. doi:10.1016/j.jiac.2026.103020. PubMed
Martins YA, Anselmo-Lima WT, Tamashiro E, Ho E, Valera FCP. Next-generation drug delivery systems for aspergillosis: Overcoming barriers in antifungal therapy. Biomedicine & Pharmacotherapy. 2026. doi:10.1016/j.biopha.2026.119691. PubMed

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by GAtherton

National Aspergillosis Centre Monthly Update discussing DNA-based fungal diagnostics, adrenal insufficiency, corticosteroid management, damp homes research and living with aspergillosis.

Catch Up on the Latest National Aspergillosis Centre Monthly Update

DNA Diagnostics, Adrenal Health, Damp Homes Research and Community Discussion

The National Aspergillosis Centre (NAC) Monthly Update brings together patients, carers, healthcare professionals and researchers to discuss the latest developments in aspergillosis care, research and day-to-day management.

Held on the first Friday of each month, these sessions combine expert presentations, research updates, practical information and community discussion. They provide an opportunity to learn about emerging developments in diagnosis and treatment while hearing directly from people living with aspergillosis and other chronic respiratory conditions.

In this month's update we discussed several important topics, including respiratory virus activity, corticosteroid management, adrenal insufficiency, new DNA-based diagnostic technologies and research into damp homes and mould exposure.

If you were unable to join us live, the full recording is available below.

Watch the Recording

Watch the full National Aspergillosis Centre Monthly Update using the embedded YouTube player below.

NAC Update Meeting June 2026

What Was Covered?

Respiratory Viruses and Seasonal Infections

The meeting opened with a discussion of current respiratory virus activity and the ongoing challenges that infections can present for people living with chronic respiratory disease.

Topics included seasonal trends, infection prevention and the importance of remaining aware of changing respiratory virus activity throughout the year.

Chapter: 24:30

Improving Corticosteroid Management

Corticosteroids remain an important treatment for many people with allergic and inflammatory lung conditions, including some forms of aspergillosis. However, long-term steroid use can also lead to significant side effects and complications.

This session explored current approaches to steroid management and the importance of balancing symptom control with minimising long-term risks.

Topics included:

Why corticosteroids are used
Monitoring treatment effectiveness
Recognising steroid-related side effects
Practical challenges faced by patients

Chapters: 25:30–58:00

Adrenal Insufficiency and Cortisol Replacement

A major focus of the meeting was adrenal insufficiency, a condition that can develop when prolonged corticosteroid treatment suppresses the body's natural cortisol production.

Discussion included:

How adrenal insufficiency develops
Common symptoms and warning signs
Cortisol replacement therapy
Managing illness and stress when adrenal function is reduced
Questions raised by patients with lived experience

For many attendees this was one of the most relevant and practical discussions of the session.

Chapter: 27:00

New Approaches to Steroid Replacement Therapy

The meeting also explored newer approaches to cortisol replacement therapy that aim to more closely mimic the body's natural hormone rhythms.

Research in this area continues to develop and may improve quality of life for some patients in the future.

Chapter: 36:00

DNA-Based Bedside Diagnostics

One of the most exciting research topics discussed was the development of rapid DNA-based diagnostic technologies.

Traditional fungal diagnosis can sometimes take days or even weeks. New molecular approaches have the potential to identify pathogens much more quickly, helping clinicians make earlier and more informed treatment decisions.

The discussion explored:

How DNA-based diagnostics work
Why rapid diagnosis matters
Current research developments
Potential future applications in clinics and hospitals

Chapter: 58:00

How Rapid Genetic Testing Could Change Fungal Diagnosis

Advances in molecular biology and sequencing technology are opening the possibility of identifying fungal infections directly from patient samples without the need for lengthy culture-based methods.

Potential benefits include:

Faster diagnosis
Earlier treatment decisions
Improved identification of difficult-to-detect infections
More personalised approaches to care

Although many technologies remain under evaluation, this is one of the most rapidly developing areas of fungal medicine.

Chapter: 01:05:00

Damp Homes, Mould and Health Research

The second half of the update focused on growing evidence linking damp indoor environments and mould exposure to respiratory health problems.

This topic has received increasing attention following recent public health initiatives and growing awareness of housing-related health risks.

Discussion included:

Current evidence linking damp homes and respiratory disease
Ongoing research projects
Challenges in measuring exposure
Areas where further research is needed

Chapter: 01:55:00

Citizen Science Damp Homes and Health Project

Attendees also heard about the Citizen Science Damp Homes and Health Project, which aims to involve members of the public directly in collecting data and contributing to research.

Citizen science projects have the potential to improve understanding of real-world housing conditions and their impact on respiratory health.

Chapter: 01:56:00

Why Damp and Mould Matter for Respiratory Health

The meeting explored the ways in which damp environments can contribute to poor respiratory health, including increased exposure to mould spores, allergens and other environmental factors.

For people living with asthma, bronchiectasis and aspergillosis, understanding these risks can be an important part of managing their condition.

Chapter: 02:05:00

Patient Experiences and Open Discussion

As always, one of the most valuable aspects of the Monthly Update was the opportunity for attendees to share experiences, ask questions and support one another.

These discussions help connect people facing similar challenges while providing valuable insight into the real-world impact of living with aspergillosis.

Chapter Guide

00:00 Welcome and introductions
00:25 Community catch-up and discussion
24:30 Respiratory virus update and seasonal infections
25:00 Meeting agenda and topic selection
25:30 Improving corticosteroid management
27:00 Adrenal insufficiency and cortisol replacement
36:00 New approaches to steroid replacement therapy
43:00 Questions and discussion
58:00 DNA-based bedside diagnostics
01:05:00 How rapid genetic testing could change fungal diagnosis
01:20:00 Questions and patient discussion
01:31:00 Break and community discussion
01:55:00 Damp homes, mould and health research
01:56:00 Citizen Science Damp Homes and Health Project
02:05:00 Why damp and mould matter for respiratory health
02:20:00 Patient experiences and questions
02:30:00 Meeting summary and closing discussion

Why We Share These Updates

Not everyone can attend live events. Health issues, work commitments, caring responsibilities and geographical distance can all make participation difficult.

By recording and sharing our Monthly Updates, we hope to make expert information, research developments and community discussion accessible to as many people as possible.

The recordings also provide a valuable archive of emerging research, practical advice and patient experiences that can help people better understand and manage aspergillosis.

Join Future Monthly Updates

The National Aspergillosis Centre hosts regular online community meetings throughout the month, alongside the longer Monthly Update held on the first Friday.

Whether you are newly diagnosed, caring for someone with aspergillosis or have been living with the condition for many years, you are very welcome to join us.

For information about future events and resources, visit:

https://aspergillosis.org

by GAtherton

Medical illustration showing Aspergillus fumigatus, PCR diagnostics, lung imaging, antifungal medicines and laboratory research representing recent advances in aspergillosis diagnosis, treatment and antifungal resistance research.

Weekly Aspergillosis Research Update: New Diagnostics, CAPA Evidence, and Why Azole Tolerance Matters

Last reviewed: 23 June 2026

Author: National Aspergillosis Centre Team

Audience: People living with aspergillosis, carers, healthcare professionals, and interested readers.

In one sentence: This week's aspergillosis research highlights a possible new bronchoscopic approach to aspergilloma management, growing use of PCR diagnostics, a major review of COVID-19-associated pulmonary aspergillosis, and new discoveries explaining how Aspergillus fumigatus may survive antifungal treatment.

Research Highlight of the Week

Why azole tolerance is more complex than resistance

The most important scientific theme this week is the growing recognition that Aspergillus fumigatus can sometimes survive antifungal treatment without possessing classic resistance mutations. Three separate studies suggest that iron availability, cellular stress responses, epigenetic regulation and long non-coding RNA may all influence how the fungus responds to azole drugs. These findings do not change treatment today, but they could shape future approaches to antifungal resistance monitoring and antifungal drug development.

Who Should Read This Update?

This update may be particularly relevant for:

People living with chronic pulmonary aspergillosis (CPA)
People with aspergilloma or a history of haemoptysis (coughing up blood)
Patients receiving antifungal treatment such as itraconazole, voriconazole, posaconazole or isavuconazole
Healthcare professionals interested in aspergillosis diagnostics and antifungal resistance
Anyone following developments in fungal disease research

Key Points

A study explored bronchoscopic removal of aspergilloma in selected patients with post-tuberculosis chronic cavitary pulmonary aspergillosis.
Real-time polymerase chain reaction (PCR) testing may provide additional support when diagnosing invasive aspergillosis.
A major review confirms that COVID-19-associated pulmonary aspergillosis (CAPA) remains a serious complication of severe COVID-19.
New research suggests that antifungal treatment response is influenced by much more than simple resistance mutations.
None of these findings should lead patients to change treatment without specialist medical advice.

Overview
A possible new approach for aspergilloma
PCR testing and invasive aspergillosis
COVID-19-associated pulmonary aspergillosis
Why azole tolerance is more complex than resistance
Also noted this week
What this means for patients
When to speak to your clinical team
References

Overview

Research into aspergillosis continues to advance on several fronts. This week's papers range from practical clinical studies investigating new ways to manage aspergilloma, through to laboratory research exploring how Aspergillus fumigatus survives antifungal treatment.

While none of these studies are likely to change patient care immediately, they highlight important trends in the field. Researchers are working to improve diagnosis, develop new treatment approaches, and better understand why some infections persist despite treatment.

The strongest overall message this week is that aspergillosis research is moving beyond simple categories such as “susceptible” or “resistant”. Aspergillus fumigatus can adapt to stress, tolerate antifungal pressure, and sometimes survive long enough to acquire more stable resistance.

Most of the studies featured this week improve our understanding of aspergillosis rather than changing treatment directly. Nevertheless, several findings point towards future improvements in diagnosis, patient monitoring and antifungal therapy.

A Possible New Approach for Aspergilloma

One of the most clinically interesting papers this week investigated bronchoscopic removal of aspergilloma in patients with post-tuberculosis chronic pulmonary aspergillosis (CPA).

An aspergilloma, sometimes called a fungal ball, develops when Aspergillus grows within an existing cavity in the lung. These cavities can develop after conditions such as tuberculosis, sarcoidosis, or previous severe lung infections.

Post-tuberculosis chronic cavitary pulmonary aspergillosis refers to CPA developing in lung cavities left behind after previous tuberculosis.

Traditionally, treatment options include antifungal medication, surgery in carefully selected patients, and procedures such as bronchial artery embolisation to control significant bleeding.

This study explored whether bronchoscopy could be used to remove fungal material directly from affected cavities.

Why many patients will find this interesting: Antifungal treatment can help control chronic pulmonary aspergillosis, but it does not usually remove an established fungal ball. Surgery can sometimes be curative, but many patients are not suitable surgical candidates because of reduced lung function or other medical conditions. A successful bronchoscopic approach could eventually provide an additional option for selected patients.

Why is this important?

Many patients with chronic pulmonary aspergillosis are not suitable candidates for surgery because of reduced lung function or other health problems. A bronchoscopic approach could potentially offer a less invasive alternative in selected cases.

However, several important questions remain unanswered:

Which patients benefit most?
How often does the aspergilloma return?
What is the risk of bleeding?
Is antifungal treatment still required afterwards?
How durable are the results over longer follow-up?

At present, this should be viewed as a promising specialist-centre approach rather than a new standard of care.

Evidence strength: Clinical interventional study.

Practice-changing now? No. Potentially important, but not yet routine management.

Bottom line: Bronchoscopic removal of aspergilloma is an interesting specialist approach that may eventually help some patients who are unsuitable for surgery, but it is not yet standard treatment.

PCR Testing May Help Diagnose Invasive Aspergillosis

Another paper examined the role of real-time polymerase chain reaction (PCR) testing in diagnosing invasive aspergillosis.

PCR detects fungal genetic material and can potentially identify infection more quickly than conventional culture methods.

Why is this important?

Diagnosing invasive aspergillosis remains challenging. No single test is perfect, and clinicians often need to combine information from:

CT scans and other imaging
Bronchoscopy findings
Fungal culture
Microscopy
Galactomannan testing
Clinical risk factors

PCR has been studied for many years, but its performance varies depending on the patient group, sample type, laboratory method and whether the patient has already received antifungal treatment.

This study supports the growing role of molecular diagnostics but does not suggest that PCR should replace existing tests. Instead, it reinforces the idea that combining several diagnostic approaches usually provides the most reliable diagnosis.

A key caution is that PCR detects fungal DNA. It does not always prove invasive disease. This is especially important in people with structurally abnormal lungs, where colonisation can complicate interpretation.

Evidence strength: Diagnostic utility study.

Practice-changing now? No. PCR may be a useful additional test but should always be interpreted alongside the wider clinical picture.

Bottom line: PCR is becoming an increasingly useful diagnostic tool, but it works best when combined with scans, biomarkers, culture results and clinical assessment.

Five Years of Evidence on COVID-19-Associated Pulmonary Aspergillosis

Researchers also published a major umbrella review examining evidence from 2020 to 2025 on COVID-19-associated pulmonary aspergillosis (CAPA).

CAPA emerged during the COVID-19 pandemic as an important complication affecting some patients with severe COVID-19, particularly those requiring intensive care.

What did the review find?

The review confirms that CAPA remains associated with:

Severe illness
Intensive care admission
Mechanical ventilation
High mortality

However, estimating exactly how common CAPA is remains difficult.

Different studies used different definitions, diagnostic methods and screening approaches, making direct comparison challenging. Bronchoscopy was also limited in many settings early in the pandemic, which affected how cases were detected and classified.

Studies have also differed because of:

Different diagnostic criteria
Changes in COVID-19 treatment over time
Vaccination status
Use of corticosteroids and immunomodulators
Different intensive care unit screening practices

The review is valuable because it brings together several years of evidence, but it is unlikely to change current management directly.

Evidence strength: Umbrella review and meta-meta-analysis.

Practice-changing now? No. It reinforces awareness rather than introducing a new treatment approach.

Bottom line: CAPA remains a serious complication of severe COVID-19, but this review largely confirms what clinicians already suspected rather than changing current practice.

Why Azole Tolerance Is More Complex Than Resistance

The most scientifically important theme this week comes from three studies investigating how Aspergillus fumigatus survives exposure to azole antifungal drugs.

For many years, discussions about antifungal treatment failure have focused heavily on resistance mutations, particularly changes involving the CYP51A gene. These mutations can make the fungus less susceptible to antifungal drugs such as itraconazole, voriconazole, posaconazole and isavuconazole.

However, these new studies suggest the situation may be considerably more complicated.

Researchers found that fungal survival may also be influenced by:

Iron availability
Mitochondrial function
Epigenetic regulation
Long non-coding RNA molecules

Why this matters for patients: Laboratory testing may sometimes suggest that an Aspergillus isolate is susceptible to treatment, yet the infection can still prove difficult to control. Researchers increasingly believe that fungal tolerance and stress-response mechanisms may help explain some of these situations. Understanding these processes could eventually lead to better resistance monitoring and more effective treatments.

Resistance vs Tolerance: What's the Difference?

Resistance and tolerance are related but different concepts.

Resistance usually refers to genetic changes that allow the fungus to continue growing despite exposure to an antifungal drug.

Tolerance refers to the ability of some fungal cells to survive drug exposure without necessarily having permanent resistance mutations.

This distinction matters because tolerance may allow the fungus to persist long enough to eventually acquire more stable resistance.

In simple terms, researchers are increasingly asking whether some cases of treatment failure occur because the fungus first becomes tolerant and only later becomes resistant.

The emerging model:
Azole exposure → Temporary tolerance → Fungal survival → Opportunity for resistance mutations → Stable resistance

Iron Starvation and Azole Tolerance

One study found that iron starvation may increase azole tolerance in Aspergillus fumigatus through effects on mitochondrial function.

Iron is essential for both humans and fungi. During infection, the immune system attempts to limit fungal access to iron as part of a defence strategy known as nutritional immunity.

The study suggests that when iron becomes scarce, the fungus may alter its metabolism in ways that help it survive antifungal stress.

This does not mean that iron supplements or dietary changes would affect antifungal treatment. The work is exploring complex biological processes occurring within infected tissues.

Instead, the study provides another clue about how the fungus adapts to hostile conditions inside the body.

Evidence strength: Mechanistic laboratory research.

Practice-changing now? No.

View on PubMed

Epigenetics and the Development of Resistance

Perhaps the most influential paper this week examined an epigenetic mechanism that appears to promote azole tolerance and facilitate the later development of antifungal resistance.

Epigenetics refers to changes in gene activity that occur without altering the underlying DNA sequence itself.

In recent years, researchers have increasingly recognised that fungal adaptation is not driven solely by permanent genetic mutations. Instead, fungi can alter gene activity in response to environmental stress.

This study supports a model in which antifungal exposure may trigger a temporary tolerant state. That tolerant state may then allow some fungal cells to survive long enough to acquire permanent resistance mutations.

Importantly, this does not replace the existing understanding of CYP51A-mediated resistance. Instead, it expands it.

Rather than viewing resistance as a single event, researchers are increasingly seeing it as a process that may develop over time.

Evidence strength: Strong mechanistic evidence.

Practice-changing now? No, but potentially important for future resistance monitoring and antifungal development.

View on PubMed

Long Non-Coding RNA and Antifungal Susceptibility

The third paper identified a long non-coding RNA that appears to influence triazole susceptibility in Aspergillus fumigatus.

Long non-coding RNAs are molecules that do not produce proteins themselves but can still influence how genes are switched on or off.

Although these molecules are increasingly recognised as important regulators of biological processes, their role in fungal antifungal susceptibility remains relatively unexplored.

The researchers found that altering the activity of a specific long non-coding RNA changed how the fungus responded to azole antifungal drugs in laboratory experiments and animal models.

This is still early-stage science and has no immediate impact on patient treatment. However, it provides another example of how fungal responses to antifungal drugs may be regulated by multiple biological pathways.

Evidence strength: Moderate to strong mechanistic evidence.

Practice-changing now? No.

View on PubMed

Bottom line: These studies suggest that antifungal treatment response is influenced by much more than classic resistance mutations. Scientists are uncovering a complex network of stress responses, metabolic adaptations and gene regulation mechanisms that may help Aspergillus survive antifungal exposure. While this research will not change treatment today, it may eventually lead to better ways of predicting, preventing and overcoming antifungal resistance.

Also Noted This Week

Breakthrough Aspergillosis Despite Prophylaxis

A case report described tracheobronchial aspergillosis developing in a lung transplant recipient despite receiving combined antifungal prophylaxis. The infection involved Aspergillus calidoustus and Aspergillus niger.

While only a single case, it serves as a reminder that prophylactic treatment reduces risk but cannot eliminate it completely, particularly in highly immunosuppressed patients and where less common or resistant Aspergillus species may be involved.

Evidence strength: Case report. Clinically notable, but very low-level evidence.

Practice-changing now? No.

Read more:
View on PubMed |
Read via DOI

Therapeutic Drug Monitoring Remains Important

A bibliometric review highlighted growing interest in antifungal therapeutic drug monitoring (TDM).

Therapeutic drug monitoring means measuring antifungal drug levels in the blood to help ensure that treatment is high enough to be effective while minimising toxicity and drug interactions.

This does not provide new clinical trial evidence, but it supports the growing importance of antifungal stewardship, pharmacokinetic monitoring, toxicity prevention and pharmacy-led optimisation of antifungal treatment.

Evidence strength: Bibliometric and service-focused review.

Practice-changing now? No, but relevant to service development and pharmacy practice.

Read more:
View on PubMed |
Read via DOI

Potential Future Drug Targets

A bioRxiv preprint investigated the mannitol biosynthesis pathway in Aspergillus fumigatus, focusing on mannitol-2-dehydrogenase as a possible antifungal target.

This is early preclinical research and does not affect current treatment. However, it is worth watching as part of wider efforts to identify fungal-specific metabolic vulnerabilities that could eventually support new antifungal strategies.

Evidence strength: Preclinical antifungal-target discovery.

Practice-changing now? No. Interesting, but very early.

Read more:
Search bioRxiv for this preprint

Why This Research Matters

Diagnosis continues to improve through molecular testing.
Researchers are exploring less invasive options for managing aspergilloma.
COVID-19-associated pulmonary aspergillosis remains an important complication of severe COVID-19.
Scientists are discovering new mechanisms that help Aspergillus survive antifungal treatment.
Future antifungal therapies may target fungal stress responses as well as traditional resistance mechanisms.

What Researchers Will Be Watching Next

Whether bronchoscopic aspergilloma removal can be replicated in larger studies and specialist centres.
How PCR testing can be integrated most effectively into routine diagnostic pathways.
Whether CAPA rates continue to change as COVID-19 evolves and vaccination remains widespread.
How fungal tolerance contributes to treatment failure and acquired azole resistance.
Whether new antifungal drugs can exploit pathways such as mannitol metabolism, stress adaptation and epigenetic regulation.

What This Means for Patients

This week's research illustrates how aspergillosis science is advancing in two important directions at the same time.

Firstly, researchers are developing better ways to diagnose and manage disease through improved testing and new interventional approaches.

Secondly, scientists are learning much more about the biology of Aspergillus itself, particularly how it survives antifungal treatment and adapts to stressful environments.

Although none of these studies should change individual treatment decisions today, they contribute to a growing body of knowledge that may improve diagnosis, monitoring and treatment options in the future.

The most immediate clinical relevance comes from studies investigating diagnosis and management. The laboratory studies are less likely to affect care in the short term but may contribute to future advances in treatment and resistance prevention.

For now, the main message is that aspergillosis remains a complex condition that requires specialist assessment and interpretation of test results within the wider clinical picture.

None of the papers discussed in this update support changing treatment without specialist medical advice.

When to Speak to Your Clinical Team

Contact your clinical team promptly if you experience:

Significant haemoptysis (coughing up blood)
Worsening breathlessness
Persistent fever
New or worsening chest pain
Severe side effects from antifungal treatment
New confusion or sudden deterioration
A sudden worsening of your usual aspergillosis symptoms

Do not stop, reduce, or change antifungal treatment without discussing it with your healthcare team first.

If you cough up a large amount of blood, have severe breathlessness, chest pain, collapse, or feel acutely unwell, seek urgent medical help.

Evidence Strength Summary

Topic	Evidence type	Clinical relevance	Practice-changing now?
Bronchoscopic aspergilloma removal in post-tuberculosis CPA	Clinical interventional study	Medium to high	No
Real-time PCR for invasive aspergillosis	Diagnostic utility study	Moderate	No
CAPA umbrella review	Evidence synthesis	High	No
Iron starvation and azole tolerance	Mechanistic study	Medium	No
Epigenetic azole tolerance	Mechanistic study	Medium to high	No
Long non-coding RNA and triazole susceptibility	Mechanistic study	Medium	No
Breakthrough tracheobronchial aspergillosis case report	Case report	Low to moderate	No
Antifungal therapeutic drug monitoring	Bibliometric/service review	Moderate for services	No
Mannitol pathway preprint	Preclinical target discovery	Low at present	No

Frequently Asked Questions

What is azole tolerance in Aspergillus?

Azole tolerance describes the ability of some Aspergillus cells to survive exposure to antifungal drugs without possessing the classic resistance mutations normally associated with azole resistance. Researchers believe tolerance may sometimes contribute to persistent infection and could provide an opportunity for more stable resistance to develop later.

Can PCR diagnose aspergillosis?

Polymerase chain reaction (PCR) testing can help detect Aspergillus genetic material and may support diagnosis, particularly when combined with imaging, culture, galactomannan testing and clinical assessment. PCR alone cannot confirm invasive disease.

What is COVID-19-associated pulmonary aspergillosis (CAPA)?

COVID-19-associated pulmonary aspergillosis, or CAPA, is a form of aspergillosis that can occur in some patients with severe COVID-19, particularly those requiring intensive care treatment.

Can aspergilloma be removed without surgery?

Research is exploring bronchoscopic removal of aspergilloma in carefully selected patients. However, this remains a specialist procedure and is not currently considered standard treatment. Further studies are needed to determine which patients benefit most.

Does antifungal resistance mean treatment will stop working?

Not necessarily. Many patients respond well to antifungal treatment. Resistance is only one factor influencing treatment success. Drug levels, immune function, disease severity and fungal tolerance mechanisms may also influence outcomes.

Should I change my antifungal treatment because of these studies?

No. None of the studies discussed in this update support changing treatment without specialist medical advice. Patients should always discuss treatment decisions with their clinical team.

by GAtherton

Electric fan in a home during hot weather with infographic explaining how fans cool the body, when they may be less effective, hydration advice, heat exhaustion symptoms, and guidance for people with aspergillosis and chronic lung conditions.

Electric Fans in Hot Weather: Helpful or Harmful?

As temperatures rise across the UK, many people reach for an electric fan to stay cool. However, you may have seen advice suggesting that fans should be used with caution during very hot weather. Why is that, and what does it mean for people living with aspergillosis and other chronic lung conditions?

Key Points

Electric fans can help most people stay comfortable during UK heatwaves.
Fans cool the body by increasing the evaporation of sweat.
In extreme heat (above about 35°C), fans may become less effective for some people.
Hydration remains one of the most important ways to protect yourself during hot weather.
People with chronic lung conditions should pay particular attention to avoiding dehydration, which can make mucus thicker and harder to clear.

How do electric fans cool us?

Electric fans do not lower the temperature of the air. Instead, they move air across the skin, helping sweat evaporate more quickly. Because evaporation removes heat from the body, this can make you feel cooler and more comfortable.

For most people, particularly during typical UK summer temperatures, fans are a useful and inexpensive way to reduce discomfort during hot weather.

Why is there advice to limit fan use in extreme heat?

Some public health guidance advises caution when temperatures rise above about 35°C. At these temperatures, a fan may simply blow very hot air across the body. If a person is unable to sweat effectively because of age, illness, dehydration, or certain medications, the cooling benefit may be reduced.

This concern led organisations such as the NHS, UK Health Security Agency (UKHSA), and World Health Organization (WHO) to recommend that fans should not be relied upon as the only cooling strategy during extreme heat.

However, research over the last few years has shown that the situation is more complicated than a simple temperature cut-off. Factors such as humidity, hydration, age, and overall health all influence whether a fan is helpful.

What does the research say?

Recent studies suggest that electric fans may still provide benefits for many people, even when temperatures exceed 35°C, particularly if humidity levels are high and the body is able to sweat normally.

Researchers now recognise that there is no single temperature at which fans suddenly become harmful. Instead, their effectiveness depends on the balance between heat gained from the surrounding air and heat lost through sweat evaporation.

The overall message from researchers and public health organisations is that fans remain useful for many people but should be combined with other cooling measures such as drinking fluids, seeking shade, and cooling the skin with water.

What does this mean for people with aspergillosis?

For people living with aspergillosis, asthma, chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), or bronchiectasis, a fan is generally safe and may improve comfort during hot weather.

The greater concern is often dehydration. Hot weather can lead to fluid loss through sweating, which may cause mucus and sputum to become thicker and more difficult to clear from the lungs. This can increase coughing, breathlessness, and discomfort.

If you use a fan during hot weather:

Drink water regularly throughout the day.
Keep curtains or blinds closed on sun-facing windows.
Open windows when outdoor temperatures are cooler, particularly overnight.
Use cool showers, damp cloths, or a spray bottle to cool the skin.
Avoid strenuous activity during the hottest part of the day.
Continue any airway clearance techniques recommended by your healthcare team.

Watch for signs of heat exhaustion

Seek medical advice if you experience:

Dizziness or fainting
Severe headache
Nausea or vomiting
Excessive tiredness or weakness
Confusion or difficulty concentrating
Worsening breathlessness

The bottom line

For most people in the UK, electric fans remain a helpful way to stay comfortable during hot weather. Current evidence suggests that fans are generally beneficial during typical UK heatwaves, especially when used alongside other cooling measures.

The most important message for people with chronic lung conditions is to stay hydrated. Fans can help you feel cooler, but drinking enough fluids, avoiding overheating, and recognising the signs of heat-related illness are equally important.

Key Points

Hot weather can worsen breathlessness, fatigue and sleep quality.
Dehydration can make mucus thicker and more difficult to clear.
People with asthma, bronchiectasis, Chronic Pulmonary Aspergillosis (CPA) and Allergic Bronchopulmonary Aspergillosis (ABPA) may notice increased symptoms during heatwaves.
Stay hydrated, keep cool and avoid strenuous activity during the hottest part of the day.
Some antifungal medications can increase sensitivity to sunlight.
Seek medical advice if symptoms worsen significantly or you develop signs of heat-related illness.

Can Hot Weather Make Aspergillosis Worse?

Yes. Hot weather can worsen symptoms for some people living with aspergillosis.
Heat can increase breathlessness, contribute to dehydration, make mucus thicker
and harder to clear, disturb sleep, and increase fatigue.

People with Chronic Pulmonary Aspergillosis (CPA), Allergic Bronchopulmonary
Aspergillosis (ABPA), bronchiectasis, asthma, or adrenal insufficiency may need
to take extra precautions during heatwaves.

Why Heat Can Affect Breathing

When temperatures rise, the body works harder to keep cool. This increases demand
on the heart and lungs and can make breathing feel more difficult.

Increased breathing rate
Worsening breathlessness
Increased fatigue
More difficult airway clearance
Poorer sleep
Reduced exercise tolerance

Stay Well Hydrated

Good hydration is one of the most important steps you can take during hot weather.
Dehydration can make sputum thicker and harder to clear, particularly for people
with bronchiectasis or Chronic Pulmonary Aspergillosis (CPA).

Drink regularly throughout the day.
Carry water when travelling.
Increase fluid intake if sweating heavily.
Avoid waiting until you feel thirsty before drinking.

Signs of dehydration may include:

Dark urine
Dizziness or light-headedness
Headache
Dry mouth
Increased fatigue
Thick, sticky sputum

If you have heart failure, severe kidney disease or have been advised to restrict
fluids, follow the guidance provided by your healthcare team.

Keep Your Home Cool

Close curtains and blinds during the day.
Open windows overnight when temperatures fall.
Use fans to improve airflow.
Spend time in the coolest room of the house.
Avoid ovens and other heat-producing appliances during the hottest periods.

Plan Activities Carefully

Try to avoid strenuous activity between approximately 11am and 4pm when
temperatures are highest.

Walk early in the morning or later in the evening.
Take frequent breaks.
Pace yourself.
Ask for help with physically demanding tasks during the hottest days.

Medication Considerations

Inhalers

Continue taking inhalers exactly as prescribed. Carry reliever inhalers when away
from home and avoid leaving inhalers in hot cars or direct sunlight.

Antifungal Medicines and Sunlight

Some antifungal medicines can increase sensitivity to sunlight. This is
particularly important for people taking voriconazole.

Use high-factor sunscreen.
Wear a hat and protective clothing.
Avoid prolonged exposure to direct sunlight.
Report new or changing skin lesions to your healthcare team.

Adrenal Insufficiency

People with adrenal insufficiency may be more vulnerable to dehydration, low blood
pressure and heat-related illness.

Maintain good hydration.
Carry steroid emergency information.
Follow sick-day guidance if you become unwell.
Seek urgent medical advice if you cannot keep fluids or medication down.

Air Quality Matters Too

Hot weather is often associated with increased pollen levels, elevated ozone
pollution, wildfire smoke or other poor air-quality episodes. These can aggravate
asthma, bronchiectasis and aspergillosis-related respiratory symptoms.

Check local air-quality forecasts if symptoms worsen.
Consider staying indoors during peak pollution periods.
Keep rescue medication available.

Protect Your Sleep

Use lightweight bedding.
Close curtains during the day.
Use a fan at night if helpful.
Keep water nearby.
Cool wrists or feet with cool water before bed.

When to Seek Medical Advice

Do not assume that worsening symptoms are always caused by the heat. Seek medical
advice if you experience:

Markedly worsening breathlessness
New chest pain
A significant fall in oxygen saturation, if monitored
Confusion or fainting
High fever
Inability to clear sputum
Severe weakness
Vomiting or inability to keep fluids down

Seek urgent medical attention for severe breathing difficulties, collapse, or
signs of heatstroke.

Hot Weather Checklist

Drink regularly throughout the day.
Keep cool indoors.
Avoid strenuous activity during peak heat.
Monitor breathlessness and sputum changes.
Continue medicines as prescribed.
Protect your skin if taking voriconazole.
Check air-quality forecasts.
Keep bedrooms cool.
Seek medical advice if symptoms worsen unexpectedly.

Further Information and Trusted Resources

General Hot Weather Advice

Related Aspergillosis.org Resources

Frequently Asked Questions

Can hot weather make aspergillosis symptoms worse?

Yes. Heat can worsen breathlessness, fatigue, dehydration and sleep quality, all
of which may make symptoms feel more severe.

Why is hydration so important?

Dehydration can make mucus thicker and more difficult to clear, potentially
worsening cough and breathlessness.

Does hot weather affect Allergic Bronchopulmonary Aspergillosis (ABPA)?

Some people with Allergic Bronchopulmonary Aspergillosis (ABPA) find that heat,
pollen and poor air quality can aggravate asthma symptoms and increase
breathlessness.

Does hot weather affect Chronic Pulmonary Aspergillosis (CPA)?

People with Chronic Pulmonary Aspergillosis (CPA) may notice increased fatigue,
breathlessness and difficulty clearing sputum during hot weather, particularly if
they become dehydrated.

Should I avoid going outside?

Not necessarily. However, avoiding strenuous activity during the hottest part of
the day is often sensible, especially if you have significant lung disease.

What if I take voriconazole?

Voriconazole can increase sensitivity to sunlight. Extra sun protection is
recommended during hot weather.

When to Seek Medical Help

Contact your healthcare team if you experience worsening respiratory symptoms,
increasing fatigue, difficulty clearing sputum, or concerns about dehydration.

Seek urgent medical attention for severe breathing difficulties, collapse,
confusion, or suspected heatstroke.

Author: National Aspergillosis Centre (NAC)

Last reviewed: June 2026

Next review: June 2027

by GAtherton

Patient considering different causes of worsening respiratory symptoms while receiving omalizumab treatment, including ABPA, bronchiectasis, chest infection and mucus plugging.

Has My Omalizumab Stopped Working? Understanding Worsening Symptoms, Infections and Flare-Ups in Asthma and ABPA

Last reviewed: June 2026

Key Points

Omalizumab can remain effective for many years.
Worsening symptoms do not automatically mean the treatment has stopped working.
Increasing chest infections may be caused by bronchiectasis, bacterial infection, mucus plugging or another lung condition.
Asthma and Allergic Bronchopulmonary Aspergillosis (ABPA) can change over time.
Biologics are usually one part of a wider treatment plan and do not replace inhalers, airway clearance or routine monitoring.
A specialist review may include blood tests, sputum cultures, lung function tests and CT imaging.

Why patients ask this question
What is omalizumab?
Does omalizumab wear off?
Why symptoms may worsen after years of treatment
What else could be going on?
Possible reasons for worsening symptoms
The role of bronchiectasis and infection
Don't forget the basics
What tests might help?
Questions to ask your specialist
Frequently asked questions
When to seek medical advice
The bottom line

Why Patients Ask This Question

Many people living with severe asthma or Allergic Bronchopulmonary Aspergillosis (ABPA) experience major improvements after starting omalizumab. They may have fewer flare-ups, require fewer courses of oral steroids and enjoy a much better quality of life.

However, some patients notice that after several years they begin needing more antibiotics, more steroid courses or more medical reviews. Symptoms such as cough, sputum production, wheeze or breathlessness may start to increase again.

This often leads to a worrying question:

"Has my biologic stopped working?"

In reality, the answer is often more complicated than a simple yes or no.

What Is Omalizumab?

Omalizumab (Xolair®) is a biologic medication that targets immunoglobulin E (IgE), an antibody involved in allergic inflammation.

It is commonly used to treat severe allergic asthma and is also used in some patients with ABPA where allergic inflammation is an important part of the disease.

By reducing IgE activity, omalizumab can help reduce asthma exacerbations, improve symptom control and reduce the need for oral corticosteroids in many patients.

Does Omalizumab Wear Off?

Current evidence suggests that omalizumab can remain effective for many years. Studies following patients with severe allergic asthma have shown sustained benefits in many people over five years or more.

There is currently no strong evidence that most patients develop predictable tolerance to omalizumab simply because they have been taking it for a long time.

This means that if symptoms worsen after four, five or more years of treatment, specialists will usually look for other explanations before concluding that the medication has stopped working.

Why Symptoms May Worsen After Years of Treatment

There are several reasons why symptoms may worsen despite ongoing biologic treatment.

Lung Damage Can Continue to Cause Problems

Many patients with ABPA also have bronchiectasis. Bronchiectasis is permanent widening and damage of the airways that can develop after repeated inflammation and infection.

Even when allergic inflammation is well controlled, bronchiectasis can still cause:

Persistent cough
Sputum production
Breathlessness
Fatigue
Recurrent chest infections

In these situations, the biologic may still be helping while another aspect of the lung disease becomes more important.

Infection May Become More Important

Patients with bronchiectasis are more vulnerable to chest infections. Symptoms caused by infection can sometimes look very similar to an asthma or ABPA flare.

Signs suggesting infection may include:

Increased sputum production
Darker or thicker sputum
Fever
Feeling generally unwell
More frequent need for antibiotics

Asthma and ABPA Can Change Over Time

Asthma is not a single disease. The pattern of inflammation in the airways may change over time.

Some patients who initially respond very well to anti-IgE treatment may later develop different patterns of airway inflammation, mucus production or airway remodelling.

This is one reason why specialists sometimes review whether a different biologic may be appropriate.

What Else Could Be Going On?

When symptoms worsen after several years of successful biologic treatment, specialists often look beyond asthma and ABPA alone.

Several different conditions can cause cough, breathlessness, sputum production, fatigue and recurrent chest infections.

Bronchiectasis Progression

Even if allergic inflammation is well controlled, bronchiectasis can continue to cause mucus retention, recurrent infections and worsening respiratory symptoms.

Bacterial Infection

Repeated chest infections can become a major cause of symptoms. Common bacteria include:

Pseudomonas aeruginosa
Haemophilus influenzae
Staphylococcus aureus
Moraxella catarrhalis

Mucus Plugging

Thick mucus can block airways, causing cough, breathlessness and reduced airflow.

Aspergillus Bronchitis

Some patients develop persistent airway infection with Aspergillus species. Symptoms may include chronic productive cough, increased sputum and recurrent respiratory symptoms.

Chronic Pulmonary Aspergillosis (CPA)

Although less common, some patients with previous lung damage may develop chronic pulmonary aspergillosis. Symptoms can include fatigue, weight loss, chronic cough and sometimes coughing up blood.

Nontuberculous Mycobacterial (NTM) Infection

Patients with bronchiectasis may be at increased risk of infection caused by environmental mycobacteria.

Changing Asthma Biology

The type of airway inflammation present when treatment begins may change over time.

The important point is that worsening symptoms do not automatically mean that omalizumab has stopped working.

Several different conditions may produce similar symptoms and require different treatments.

Possible Reasons for Worsening Symptoms

Possible Cause	Typical Clues
ABPA flare	Increasing asthma symptoms, rising IgE, worsening inflammation
Bronchiectasis progression	More sputum, recurrent infections, increasing need for airway clearance
Bacterial infection	Change in sputum colour, fever, feeling unwell, antibiotics helping
Mucus plugging	Sudden worsening breathlessness, blocked airways
Aspergillus bronchitis	Persistent productive cough and sputum despite standard treatment
Chronic Pulmonary Aspergillosis (CPA)	Weight loss, fatigue, chronic symptoms, coughing up blood
NTM infection	Gradual worsening symptoms despite repeated treatment courses

The Role of Bronchiectasis and Infection

For many patients with ABPA, the most useful question is not:

"Has omalizumab stopped working?"

but rather:

"What is causing my recent increase in symptoms and infections?"

If the main change is increasing antibiotic use, sputum production or recurrent chest infections, the focus may need to shift towards understanding what is happening within the airways.

This may include reviewing sputum cultures, airway clearance techniques, physiotherapy, exercise levels and bronchiectasis management plans.

Don't Forget the Basics

One of the challenges of successful biologic treatment is that patients often feel so much better that other aspects of their disease can gradually receive less attention.

This is completely understandable. When symptoms improve, it is natural to focus less on daily disease management.

However, biologics such as omalizumab do not cure asthma, bronchiectasis or ABPA. They help control specific parts of these conditions.

For example, omalizumab may reduce allergic inflammation and asthma exacerbations, but it does not reverse existing bronchiectasis, remove mucus from the airways or prevent every chest infection.

Think of your lung health as a garden. Omalizumab may be very effective at controlling one type of weed, but the garden still needs regular maintenance. If that maintenance stops, other problems can gradually take over.

Continuing to Manage Your Lung Health

Take prescribed inhalers regularly.
Continue airway clearance techniques if recommended.
Stay physically active within your abilities.
Monitor changes in sputum volume, colour or thickness.
Attend routine specialist reviews.
Keep vaccinations up to date.
Follow asthma and bronchiectasis action plans where provided.
Report increasing breathlessness, cough or infections promptly.

Biologics can be highly effective, but they work best as part of a broader management plan rather than replacing it.

The Bottom Line

If symptoms worsen after several years on omalizumab, it does not automatically mean the medication has stopped working.

In patients with asthma and ABPA, increasing antibiotics and steroid use may reflect changing asthma control, ABPA activity, bronchiectasis-related infection, mucus plugging or another lung condition.

Successful biologic treatment can sometimes make it easy to forget that asthma, bronchiectasis and ABPA still require ongoing management. Continuing inhalers, airway clearance, exercise, monitoring and regular review remains important even when symptoms have improved.

A careful specialist review can often identify what has changed and guide the most appropriate next steps.

by GAtherton

Damp Homes

Damp homes

by GAtherton

National Aspergillosis Centre (NAC) at Wythenshawe Hospital, Manchester, providing specialist NHS care, research and support for people with aspergillosis.

About the National Aspergillosis Centre (NAC)

The UK's specialist centre for aspergillosis

The National Aspergillosis Centre (NAC) is a specialist NHS service based at Wythenshawe Hospital in Manchester, part of Manchester University NHS Foundation Trust.

NAC provides expert assessment, diagnosis, treatment and long-term management for people with complex forms of aspergillosis, particularly Chronic Pulmonary Aspergillosis (CPA). The centre also supports healthcare professionals across the United Kingdom with specialist advice, guidance and multidisciplinary case discussion.

Alongside its clinical work, NAC supports research, education and patient engagement, helping improve understanding and care of aspergillosis nationally and internationally.

National Aspergillosis Centre at a glance

Service	National Aspergillosis Centre (NAC)
Location	Wythenshawe Hospital, Manchester
Organisation	Manchester University NHS Foundation Trust
Specialty	Complex aspergillosis care
National role	NHS specialist referral service
Supports	Patients and healthcare professionals across the UK

What is aspergillosis?

Aspergillosis is a group of conditions caused by fungi from the Aspergillus family. These fungi are commonly found in the environment, and most people breathe in Aspergillus spores every day without becoming ill.

In some circumstances, however, Aspergillus can cause disease. This may occur because of underlying lung disease, asthma or allergic conditions, a weakened immune system, structural lung damage or previous lung infections.

Which conditions does NAC help manage?

Chronic Pulmonary Aspergillosis (CPA)

CPA is a long-term fungal infection of the lungs that can develop in people who already have lung damage or cavities caused by previous illness.

Allergic Bronchopulmonary Aspergillosis (ABPA)

ABPA is an allergic reaction to Aspergillus that most commonly affects people with asthma or cystic fibrosis.

Aspergillus bronchitis

Aspergillus bronchitis is a chronic airway infection in which Aspergillus is repeatedly identified in the airways and contributes to ongoing respiratory symptoms.

Other complex Aspergillus-related conditions

Aspergillus nodules
Severe Asthma with Fungal Sensitisation (SAFS)
complex diagnostic cases
difficult-to-treat aspergillosis
antifungal treatment complications
therapeutic drug monitoring

Not all patients with aspergillosis need referral to NAC. Many people receive excellent care through local respiratory, infectious diseases, allergy or severe asthma services.

How do referrals work?

Patients are normally referred by a healthcare professional. Referrals may come from respiratory physicians, infectious diseases specialists, immunologists, severe asthma services or general practitioners working with specialist teams.

NAC also supports clinicians through remote advice services and multidisciplinary discussions, helping many patients receive specialist input without needing regular travel to Manchester.

What happens at a NAC appointment?

Every patient is different, but assessment may include:

review of symptoms and medical history
review of computed tomography (CT) scans and other imaging
blood test review
review of microbiology and fungal test results
assessment of antifungal treatment
therapeutic drug monitoring
discussion of future treatment options

Patients often continue to receive much of their care locally, with specialist recommendations provided by NAC.

Specialist aspergillosis care across the UK

Although NAC is the UK's national specialist centre for chronic aspergillosis, specialist care is also provided through many hospitals and specialist services across the country.

Depending on the condition involved, patients may receive care from respiratory medicine services, bronchiectasis clinics, severe asthma centres, infectious diseases departments, allergy services or immunology services.

The most appropriate service depends on the type of aspergillosis and the patient's individual circumstances.

Research and innovation

Research is a central part of the work carried out by NAC and its partners. Areas of ongoing research include improved diagnostics, new antifungal medications, biologic therapies, therapeutic drug monitoring, imaging, disease monitoring, patient experience and clinical trials.

Education and patient support

The National Aspergillosis Centre is committed to helping patients and carers understand their condition and access reliable information.

Resources available through aspergillosis.org include:

over 1,000 patient information articles
condition-specific Knowledge Hubs
support meetings
recorded educational talks
patient stories
research updates
guidance for carers and families

Working together

Effective aspergillosis care relies on collaboration between patients, carers, local healthcare teams and specialist services.

NAC works closely with healthcare professionals, researchers, patient organisations and charities to improve awareness, diagnosis, treatment and support for people living with aspergillosis.

Frequently asked questions

What is the National Aspergillosis Centre?

The National Aspergillosis Centre is a specialist NHS service based at Wythenshawe Hospital in Manchester. It provides expert care and advice for complex forms of aspergillosis, especially Chronic Pulmonary Aspergillosis.

Where is NAC located?

NAC is based at Wythenshawe Hospital in Manchester, part of Manchester University NHS Foundation Trust.

Who can be referred to NAC?

Patients with complex or difficult-to-manage aspergillosis may be referred by a healthcare professional. Many referrals involve Chronic Pulmonary Aspergillosis, but NAC also provides advice for other Aspergillus-related conditions.

Can I refer myself to NAC?

Patients are normally referred by a healthcare professional. If you believe specialist input may be helpful, discuss this with your clinical team.

Do I have to live near Manchester?

No. Patients are referred from throughout the United Kingdom, and NAC also supports clinicians remotely.

Does everyone with aspergillosis need NAC?

No. Many patients are managed successfully by local specialist teams. NAC is primarily involved in complex cases and specialist advice.

Does NAC only treat CPA?

No. Although NAC is especially known for Chronic Pulmonary Aspergillosis, it also provides advice and support for a range of complex Aspergillus-related conditions.

What happens during a NAC appointment?

A NAC appointment may include review of symptoms, scans, blood tests, microbiology results, antifungal treatment, drug levels and future treatment options.

Does NAC provide patient support?

Yes. Through aspergillosis.org and the NAC CARES programme, patients and carers can access educational resources, support meetings and community activities.

About this page

This page was prepared by the National Aspergillosis Centre CARES team to explain the role of the National Aspergillosis Centre and how specialist aspergillosis care is provided within the UK healthcare system.

Last reviewed: June 2026

by GAtherton

GAtherton

Mindfulness, Meditation and Relaxation for People Living with Aspergillosis

What is mindfulness?

Can mindfulness help?

Mindfulness and breathing

Meditation

Tai Chi and Yoga

Getting started

Useful resources

When should I seek additional support?

Living with Aspergillosis: Understanding the Brain–Lung Connection

This is a Living Knowledge Hub

Planned additions

Contents

Before you begin...

Why we wrote this guide

A false choice

More than just the lungs

What you will learn

Why Does My Breathing Feel Worse When My Scan Hasn’t Changed?

The first thing to understand

Structure versus function

Breathlessness is an experience

An orchestra, not a solo instrument

What your scan cannot see

Research Spotlight

Why the modern definition of breathlessness matters

Why this matters if you have aspergillosis

Why Does the Brain Matter If My Lungs Are the Problem?

Your brain is your body’s prediction machine

The smoke alarm inside your brain

Patient Perspective

The Brain–Lung Axis

Why this matters if you have aspergillosis

Research Spotlight

Can Emotions Really Change My Breathing?

Every emotion has a physical effect

Breathing is especially sensitive

Why frightening experiences matter

Patient Perspective

The vicious circle of fear

Research Spotlight

Why pulmonary rehabilitation improves confidence

Why this matters if you have aspergillosis

What's New?

Version 0.1 – July 2026

Next planned update

Help Shape Future Editions

This Knowledge Hub has evolved thanks to our readers

Further reading and references

Weekly Aspergillosis Research Update: June 29

COPD, autoimmune disease and new approaches to antifungal treatment

Featured Paper

COPD and Aspergillus: Is allergic aspergillosis more common than we thought?

What did the researchers do?

What did they find?

Why is this important?

Strengths and limitations

What does this mean for patients?

Research in Brief

Invasive aspergillosis in autoimmune inflammatory rheumatic diseases

Cerebral aspergillosis following influenza and ibrutinib therapy

Looking ahead: New ways to deliver antifungal drugs

What this week's research tells us

References

Catch Up on the Latest National Aspergillosis Centre Monthly Update

DNA Diagnostics, Adrenal Health, Damp Homes Research and Community Discussion

Watch the Recording

What Was Covered?

Respiratory Viruses and Seasonal Infections

Improving Corticosteroid Management

Adrenal Insufficiency and Cortisol Replacement

New Approaches to Steroid Replacement Therapy

DNA-Based Bedside Diagnostics

How Rapid Genetic Testing Could Change Fungal Diagnosis

Damp Homes, Mould and Health Research

Citizen Science Damp Homes and Health Project

Why Damp and Mould Matter for Respiratory Health

Patient Experiences and Open Discussion

Chapter Guide