GAtherton

Damp, Mould and Health: Be Careful About Unvalidated Tests and “Detox” Treatments

Updated 2025 – by the NAC CARES team

When you’re desperate for answers

If you live in a damp or mouldy home and your health has suffered, it’s natural to want clear answers. Many people experience coughing, fatigue, sinus trouble or breathing problems and wonder if mould exposure could be the cause.

Unfortunately, the internet is full of misleading claims about “toxic mould”, “biotoxin illness”, or “mould detox”. Some websites and private clinics sell unvalidated medical tests or promote expensive supplements claiming to “flush mould toxins” or “reverse mould illness”.

People often turn to these options out of frustration and desperation when they feel ignored or dismissed by health or housing services. But it’s important to know that these tests and products are not scientifically proven — and in some cases, they may cause harm.

The truth about “mould illness” testing

At present, there is no validated medical test that can prove a person is ill because of mould exposure in their home.

Tests often sold online or through private clinics — such as urine mycotoxin tests, mould antibody panels, or chronic inflammatory response syndrome (CIRS) profiles — are not recognised by the NHS, NICE, or the World Health Organization.

These tests may detect trace amounts of mould-related compounds that appear even in healthy people. There are no agreed normal or abnormal levels, and results can vary dramatically between labs. This means a “positive” test result does not prove illness or guide treatment.

When functional, integrative, or alternative practitioners use these tests

It’s not just online sellers. Some functional medicine, integrative health, or alternative practitioners — including some with medical or allied health qualifications — also use these same mould or mycotoxin tests in private practice.

They may genuinely want to help and believe in “root cause medicine,” but:

  • Many of these tests have never been validated in peer-reviewed clinical studies.

  • Their results cannot reliably distinguish between normal environmental exposure to fungi and actual infection or allergy.

  • People are sometimes told they have “mould toxicity” or “mycotoxin poisoning” without any scientific evidence.

Why this matters

  • It can lead to unnecessary fear and anxiety.

  • Patients may spend hundreds or thousands of pounds on testing, supplements, or “detox” treatments that do not work.

  • Most importantly, genuine medical conditions — like aspergillosis, asthma, or COPD — may be diagnosed late or missed entirely.

Even if the practitioner sounds credible, unvalidated tests remain unvalidated.
If it isn’t approved by NICE, the NHS, or recognised respiratory specialists, it isn’t a reliable diagnostic test.

The risks of “detox” and self-treatment

Many websites and practitioners also recommend “detox” products such as activated charcoal, bentonite clay, chlorella, ozone therapy, or special anti-fungal diets. None of these have been proven to remove mould or mycotoxins from the body.

Some are unsafe or can interact dangerously with prescribed medicines — especially antifungal or steroid treatments used for aspergillosis. Others can damage the gut, lungs or kidneys.

No supplement, spray, or air treatment can replace medical therapy or proper repair of damp housing.

Why these products are still allowed to be sold

These tests and supplements often remain on sale because of regulatory loopholes:

  • They’re marketed as “wellness” or “informational” tests rather than diagnostic tools.

  • Supplements are classed as foods, not medicines — they must be safe, but not proven effective.

  • Many sellers are based overseas, outside UK or EU enforcement.

That’s why public awareness is crucial. Legal does not mean scientifically valid.

If you see misleading health claims, you can report them to:

What is proven to help

Here’s what current evidence supports:

  • Talk to your NHS doctor or respiratory specialist. They can arrange validated tests for fungal disease and lung health.

  • Fix the source of damp or mould. That’s the key to protecting your health — not detox kits.

  • Seek help early from housing officers, environmental health, or Citizens Advice if your home is unsafe.

  • Work with your care team — they can support housing letters or referrals if damp is affecting your condition.

See our practical guides:

If you feel dismissed or desperate

You’re not alone. Many people living in damp conditions feel frustrated and unheard. But unvalidated tests and detox programmes will not provide the answers you deserve.
You will get more meaningful, safer support through:

🛡️ Why We Take a Cautious Approach

Some people wonder whether organisations like ours are “allied to big pharma” or dismiss alternative approaches because of financial or legal pressures.

The truth is: we are cautious because of evidence and patient safety, not loyalty to industry.

  • We recommend only treatments or tests that are scientifically proven to be safe and effective.

  • NHS and charity organisations must follow regulatory standards and cannot endorse unvalidated products.

  • Our priority is protecting patients from harm, wasted resources, and delays in care.

Being cautious doesn’t mean rejecting innovation. If a new antifungal therapy, dietary approach, or environmental test is genuinely effective, it will be validated through peer-reviewed research — and we will share it.

Until then, our guidance focuses on evidence-based medicine and environmental interventions, because those are proven to help people with aspergillosis.

Key message

Damp and mould can make you unwell — but there is no quick test, no secret biomarker, and no miracle detox that can prove or cure it.
Stick with evidence-based medicine, protect your living environment, and seek support from trustworthy sources.

Save your money, protect your health, and trust science.

by GAtherton

When Sleep Won’t Come: Coping with Anxiety and Restless Nights in Aspergillosis

“My GP prescribed 5 mg diazepam. I’m desperate for sleep. Could I take more than this, do you think?” — R, ABPA patient

R’s words echo the experience of many people living with aspergillosis. Between breathlessness, coughing, and the anxiety that chronic illness brings, nights can become long, restless, and exhausting. Sleep problems are one of the most common — and most distressing — challenges faced by people with Aspergillus-related lung disease.

But when medication doesn’t seem to help, it’s important to know what’s safe and what other strategies might make a difference.

💊 Understanding Diazepam and Sleep Medication

Diazepam (Valium) is sometimes prescribed by GPs to help with acute anxiety or severe insomnia. However, it’s a powerful sedative, and taking more than prescribed can be dangerous — leading to confusion, slowed breathing, or even overdose, especially if mixed with alcohol or other medications.

If your prescribed dose isn’t helping, don’t increase it on your own. Contact your GP or specialist nurse; they can safely adjust your treatment or explore alternative medications that are gentler and more effective for long-term sleep support.

🌙 Safer, Soothing Sleep Strategies

While medication can help in the short term, many people with aspergillosis find that calming the body and mind before bed can make a big difference over time.

🫁 1. The 4–7–8 Breathing Technique

  • Inhale quietly through your nose for 4 seconds

  • Hold for 7 seconds

  • Exhale slowly through your mouth for 8 seconds
    Repeat several times — this pattern lowers your heart rate and helps trigger your body’s relaxation response.

🧘 2. Progressive Muscle Relaxation

  • Start from your toes: tense the muscles for 5 seconds, then release.

  • Move upward through your body — legs, stomach, shoulders, face.
    This can reduce muscle tension from coughing or pain, and helps the mind unwind.

🧠 3. Grounding Exercise (5–4–3–2–1)

If anxiety or breathlessness make your thoughts spiral:

  • 5 things you can see

  • 4 things you can touch

  • 3 things you can hear

  • 2 things you can smell

  • 1 thing you can taste
    This brings your attention gently back to the present moment.

🛏️ 4. Your Sleep Environment

  • Keep lights dim and screens off before bed.

  • Try a cool, comfortable room (around 18°C).

  • Avoid clock-watching — it increases stress.

  • Gentle background noise, like soft music or a fan, can help mask coughing or household sounds.

❤️ When to Reach Out

If you’re still struggling, please reach out for help — to your GP, specialist team, or the Aspergillosis Trust or NAC Patient Support Group.
And if you ever feel overwhelmed or hopeless, you’re not alone. In the UK, you can call Samaritans (116 123) for free, 24 hours a day.

As R’s story reminds us, it’s okay to feel desperate for rest — but help is available, and there are safe, gentle ways to support your body and mind until better nights return.

by GAtherton

🌿 Aspergillosis in the Sinuses (Allergic Fungal Rhinosinusitis – AFRS)

It’s quite possible for Aspergillus to affect both the lungs and the sinuses.
The sinuses are small air-filled spaces behind the nose, eyes, and cheeks that normally drain mucus freely. When Aspergillus spores become trapped there, they can trigger an allergic or inflammatory reaction — rather like ABPA in the lungs.

This allergic form is called Allergic Fungal Rhinosinusitis (AFRS).
It isn’t a contagious infection — it’s an overreaction of the immune system to fungal spores. Over time, it can lead to thick mucus, nasal blockage, and sometimes nasal polyps.

🩵 Common symptoms

  • Persistent nasal congestion or blockage

  • Thick or sticky mucus (sometimes with brown or dark flecks)

  • Reduced or lost sense of smell

  • Facial pressure, pain, or fullness (especially around the eyes or cheeks)

  • Post-nasal drip (mucus running down the throat)

  • Fatigue or worsening asthma symptoms

🔬 Diagnosis

  • CT scan of the sinuses – shows thickened or blocked areas

  • Nasal endoscopy – a tiny camera used to look inside

  • Fungal culture or microscopy from mucus samples

  • Blood tests – sometimes show raised total IgE or Aspergillus-specific IgE

💊 Treatment

  • Topical nasal steroids (sprays or rinses) or short courses of oral steroids to reduce inflammation

  • Saline rinses to help keep the sinuses clear

  • ENT surgery if sinuses are blocked or filled with thick fungal debris

  • Antifungal medication in some cases, especially if fungal growth is confirmed

🌸 The Main Types of Aspergillus Sinus Disease

There are several recognised types of sinus aspergillosis. Most people with ABPA or asthma experience only the allergic form (AFRS).

1️⃣ Allergic Fungal Rhinosinusitis (AFRS)

  • Caused by an allergic reaction to Aspergillus

  • Leads to inflammation, thick mucus, and polyps

  • Non-invasive – the fungus stays on the surface

  • Managed with steroids, nasal rinses, and sometimes surgery
    ✅ This is the type most relevant for ABPA patients.

2️⃣ Fungal Ball (Mycetoma)

  • A clump of fungus (usually A. fumigatus) in a single sinus, often the cheek (maxillary) sinus

  • Common in otherwise healthy people

  • Causes chronic congestion or facial pain

  • Treated surgically – antifungals rarely needed

  • Not allergic and not invasive

3️⃣ Invasive Aspergillus Sinusitis

  • Rare, seen mostly in people with severely weakened immunity (e.g., chemotherapy, bone marrow transplant, uncontrolled diabetes)

  • The fungus invades surrounding tissue and blood vessels

  • Causes severe facial pain, swelling, fever, sometimes affecting the eyes

  • Needs urgent treatment with antifungal drugs and surgery
    ⚠️ Very rare in people with ABPA or CPA.

🤝 Specialist care

If you have lung aspergillosis (such as ABPA or CPA) and start noticing more nasal congestion, sinus pressure, or post-nasal drip, it’s sensible to mention it to your respiratory or mycology team.
At the National Aspergillosis Centre (NAC), sinus disease is often co-managed by ENT surgeons, respiratory physicians, and mycology specialists, ensuring coordinated care.

With the right combination of treatments — and early recognition of symptoms — most people find their sinus symptoms improve, and controlling sinus inflammation can even help with overall breathing and energy.

by GAtherton

🩵 Coughing and Aspergillosis: Why You Might Still Cough Even When You Feel Well

Many people living with Allergic Bronchopulmonary Aspergillosis (ABPA) or bronchiectasis notice that they still cough regularly — even when their blood tests and scans show their condition is stable. It can be confusing to feel well and yet still have daily coughing or occasional coughing fits.

This article explains why that happens and when you should be concerned.

🌿 Why coughing can continue between flare-ups

ABPA and other forms of aspergillosis can cause long-term changes in the airways. Even when the allergic inflammation has settled and your Immunoglobulin E (IgE) levels are back to baseline, the airways may remain a little widened or scarred. This means:

  • Mucus can collect in the airways more easily.

  • The lining of the bronchi can stay slightly “twitchy” or reactive.

  • Your lungs may continue to produce small amounts of sticky, clear mucus that needs to be cleared out.

Coughing is your body’s way of keeping those airways clear — so a light, regular cough can actually be a sign that your lungs are doing their job.

💨 Why you might not cough during exercise

Many patients notice something surprising:

“I can walk or exercise in the gym for a couple of hours without coughing at all — but later, I get a coughing fit and bring up mucus.”

This is quite normal. When you exercise, you breathe more deeply and more rapidly. This helps:

  • Keep the airways open

  • Move mucus towards the larger airways

  • Reduce the irritation that triggers coughing

When you stop exercising, mucus that’s been loosened can settle again — and that’s often when a coughing fit happens to clear it out. It’s part of your lungs’ natural “housekeeping” system.

🌬️ What you can do to help

  • Stay active: Gentle exercise is good for your lungs. It keeps the airways open and improves mucus clearance.

  • Hydration helps: Drinking enough water or warm fluids keeps mucus less sticky.

  • Airway-clearance techniques: Ask your physiotherapist about huff coughing or devices like the Aerobika or Acapella, which help loosen and move mucus.

  • Watch for changes:

    • Mucus turning yellow, green, or brown

    • Increased shortness of breath or fatigue

    • A rise in IgE or worsening symptoms

If any of these occur, contact your respiratory or mycology team — it might mean an infection or early flare-up.

💙 The key message

A mild, regular cough between flare-ups is normal for many ABPA or bronchiectasis patients.
It doesn’t mean your condition is worsening — it’s often your lungs simply clearing secretions.
If your IgE levels are stable and you feel well, that’s a strong sign your disease is under good control.

by GAtherton

💚 Living With Aspergillus fumigatus and Starting Antifungal Treatment

Question: “I have Aspergillus fumigatus and I’d like to ask a few questions.
After starting antifungal treatment, how long did it take before you noticed improvement or a stop in the bleeding cough?
Has anyone reached a stable condition or full recovery?
Please share your experiences — it would really help to hear from you.” 💚

🌿 A Supportive Note

Many people ask this question when they first begin treatment — and it’s a very normal concern. Aspergillus fumigatus can cause a range of lung problems such as chronic pulmonary aspergillosis (CPA), aspergilloma, or Allergic Bronchopulmonary Aspergillosis (ABPA), and each responds differently to antifungal therapy.

Improvement can take time and patience.
Some notice changes within weeks, while for others, it can take several months before symptoms start to ease or stabilise.

💊 Understanding How Antifungal Treatment Works

Antifungal medicines — such as itraconazole, voriconazole, or posaconazole — don’t destroy Aspergillus overnight.
They work by slowing or stopping fungal growth, allowing the body’s immune system and lung healing processes to gradually take over.

Because these infections are often chronic, the goal is usually to:

  • Control symptoms

  • Prevent further damage

  • Reduce inflammation and flare-ups

  • Stabilise lung function

For most patients, this means aiming for long-term stability rather than complete eradication of the fungus.

⏳ How Long Before You Feel Better?

Every patient is different, but this is a general pattern doctors often see:

Time after starting treatment What you might notice
First few weeks Some reduction in coughing or mucus; fewer night sweats; side effects settling as your body adjusts.
1–3 months Energy may start to improve; less coughing or blood in sputum; breathing slightly easier.
3–6 months Signs of stability — symptoms no longer worsening, CT scans showing improvement, or blood markers (e.g. Aspergillus IgG) falling.
6–12 months Some people achieve remission or long-term stability. For others, antifungal therapy continues as maintenance.

If you have a fungal ball (aspergilloma), improvements are often slower, and sometimes bleeding episodes take longer to settle.

🩸 About Bleeding (Haemoptysis)

Coughing up blood can be one of the most distressing symptoms.
It usually improves once antifungals reduce inflammation, but if bleeding continues:

  • Doctors may prescribe tranexamic acid to help the blood clot more easily.

  • In some cases, embolisation (a targeted procedure to seal a bleeding blood vessel) may be needed.

  • Ongoing bleeding should always be reported — even small amounts — so your team can reassess treatment or check for infection changes.

🫁 Why “Stable” Can Be a Positive Outcome

Although “cure” is possible in some early or mild cases, most people live with aspergillosis as a chronic condition.
With consistent antifungal therapy, airway clearance, and monitoring, many reach a stable stage — where symptoms are minimal, life feels more predictable, and flare-ups are rare.

This stability is a real success.
It means your body and treatment are keeping the infection under control, preventing further lung damage.

💚 Real Experiences

Patients often describe:

  • Energy and breathlessness improving slowly

  • Bleeding stopping after several months

  • A new sense of normality once medication side effects settle

Some take antifungals for a set course (e.g. 6–12 months), while others remain on long-term maintenance to stay stable.
It’s common for treatment to be adjusted based on blood levels, side effects, or new sputum results.

💬 Patient Voices

Many people in our community say they wish they’d known:

  • “Improvement isn’t quick — it’s gradual, but it does come.”

  • “Side effects can be managed — don’t stop without advice.”

  • “It’s okay to ask your team what ‘stable’ looks like for you.”

  • “You’re not alone — others have been through this too.”

🧭 Looking After Yourself Along the Way

  • Keep up airway clearance (physiotherapy, saline nebulisers, or airway devices).

  • Attend regular clinic appointments for blood levels and liver tests.

  • Report side effects early — dose adjustments or switching antifungals often helps.

  • Maintain good nutrition and hydration.

  • Reach out for emotional support. Living with a chronic infection can be mentally exhausting; anxiety and fatigue are common.

💬 We’d Love to Hear From You

If you’ve been through antifungal treatment, please share your story:

  • How long it took before you felt a difference

  • What helped you most

  • How you manage side effects or flare-ups

Your experience could make a real difference to someone who’s just starting this journey. 💚

by GAtherton

💨 Why Chest Infections Keep Coming Back — and What Can Help

Lisa asks:

“Hi, how do you get rid of chest infections? I had one, and the doctors gave me Clarithromycin. It didn’t clear, so they did a sputum test — it showed Haemophilus influenzae. Then I was given Co-trimoxazole, but that didn’t clear it either. The next test still showed it, so now I’m on Amoxicillin. Is this normal? I’m losing hope of it ever going away.”

💬 You’re Not Alone, Lisa

It’s very common for people with aspergillosis, bronchiectasis, or chronic lung disease to find that chest infections take a long time to clear.
Even with the right antibiotics, infections like Haemophilus influenzae can hang on for weeks or even months — but that doesn’t mean treatment isn’t working.

🦠 Why These Infections Keep Coming Back

  • Thick mucus and biofilms:
    In damaged airways, bacteria can hide deep in sticky mucus or biofilms (protective layers). This makes them hard to reach, even with antibiotics.

  • Narrow or scarred airways:
    In bronchiectasis and aspergillosis, parts of the lung don’t drain properly, so infection pockets linger.

  • Reinfection rather than relapse:
    Sometimes, you clear one infection but pick up another of the same type from your own airways later.

  • Inflammation:
    Even when bacteria are gone, airway inflammation can cause ongoing cough and sputum, making it feel as if the infection hasn’t cleared.

💊 Why Doctors Change Antibiotics

Each antibiotic works in a different way.
Your team chooses them based on sputum culture results, which show which antibiotics your bacteria are sensitive to.
It’s quite normal to:

  • Start with a broad antibiotic (e.g. clarithromycin)

  • Switch after sputum results come back

  • Need longer or combination treatment if infection persists

For people with chronic lung conditions, antibiotic courses may last 2–3 weeks, not the usual 5–7 days.

💨 What Can Help You Recover

  • Regular airway clearance:
    Using devices like an Acapella, Aerobika, or chest physiotherapy helps move mucus out of the lungs. This allows antibiotics to reach infection sites better.

  • Stay hydrated to keep mucus thin.

  • Nebulised saline (if prescribed) can help loosen secretions.

  • Avoid skipping doses — consistent antibiotic levels help stop bacteria from regrowing.

  • Regular sputum tests guide your doctors in choosing the next best treatment.

  • See your specialist team if infections return frequently — they might check for fungal infection, resistant bacteria, or airway blockages.

❤️ The Take-Home Message

Yes — it’s quite normal for lung infections like Haemophilus influenzae to need several antibiotics and take time to clear when you have chronic lung disease.
It doesn’t mean your body isn’t fighting — it just means your lungs need a bit more help.
Keep in touch with your specialist nurse or clinic, and don’t lose hope — with good airway care, the right antibiotics, and patience, things usually improve.

by GAtherton

🧬 The Story of Brensocatib: A New Way to Calm Lung Inflammation

What Is Brensocatib?

Brensocatib is a new type of anti-inflammatory medicine being developed to protect the lungs from long-term damage caused by overactive immune cells, especially neutrophils.
It is being tested by the company Insmed in people with bronchiectasis, but it may also help those with aspergillosis and other chronic lung diseases where inflammation is a major problem.

Brensocatib is taken as a once-daily tablet—not an injection.

Why Was It Developed?

In conditions like ABPA (Allergic Bronchopulmonary Aspergillosis) and CPA (Chronic Pulmonary Aspergillosis), inflammation is often persistent.
The lungs attract neutrophils, which are immune cells that normally destroy germs.
However, when too many neutrophils gather, they release enzymes that damage healthy lung tissue, thicken mucus, and make infection easier for fungi and bacteria.

Researchers realised that if they could turn down the destructive part of neutrophil activity—without turning off the immune system completely—they might be able to break the cycle of inflammation and infection.

How Brensocatib Works

Brensocatib blocks a switch inside the bone marrow called DPP1 (dipeptidyl peptidase-1).
DPP1’s job is to “activate” enzymes inside newly formed neutrophils before they enter the bloodstream.

By blocking DPP1, brensocatib stops neutrophils from producing harmful enzymes such as neutrophil elastase.
These neutrophils can still travel to the lungs and fight infection, but they cause less collateral damage.

👉 In short: brensocatib reduces lung injury caused by over-active immune cells, not by suppressing immunity itself.

Not a Biologic – A Different Type of Treatment

It’s important to understand that brensocatib is not a biologic.

Feature Biologic drugs (e.g. mepolizumab, dupilumab) Brensocatib
Made from Complex proteins or antibodies Small chemical molecule
How it’s given Injection or infusion Oral tablet
What it targets Specific immune pathways (e.g. IL-5, IL-4) Enzyme activation in neutrophils
Purpose Block inflammatory signals Reduce tissue-damaging enzymes
Typical use Severe asthma, ABPA, autoimmune diseases Bronchiectasis, chronic airway inflammation

So, while biologics act by targeting immune messengers in the bloodstream, brensocatib works deeper—at the level of neutrophil development.
The two approaches are different but potentially complementary.
Some people in future may benefit from a combination, depending on their pattern of inflammation.

The Development Story

  • Early research (2010s): Scientists found that blocking DPP1 prevented lung injury in animal studies.

  • Insmed’s discovery: Brensocatib was developed as an oral, selective DPP1 inhibitor.

  • Phase 2 WILLOW trial (2020): In people with bronchiectasis, brensocatib significantly reduced flare-ups and lowered airway inflammation.

  • Phase 3 ASPEN trial (2022–2025): A large international study now nearing completion; results are expected soon.

If successful, brensocatib could become the first approved DPP1 inhibitor for long-term inflammatory lung disease.

Why This Matters for Aspergillosis Patients

People living with aspergillosis often also have bronchiectasis, where inflammation causes persistent mucus, infection, and breathlessness.
Current treatments such as steroids, antifungals, and biologics can help, but each has limits.

Brensocatib could:

  • Reduce airway inflammation without steroid side-effects

  • Protect lung tissue from further damage

  • Possibly lower the number of flare-ups or infections

  • Work safely alongside antifungals or biologics

It represents a new way of calming inflammation—by modifying neutrophil behaviour rather than blocking the immune system.

What Happens Next

The ASPEN Phase 3 results are expected soon. If positive, Insmed plans to apply for approval in the UK, EU, and USA.
Researchers are also studying brensocatib in:

  • COPD (Chronic Obstructive Pulmonary Disease)

  • Cystic fibrosis

  • Nontuberculous mycobacterial (NTM) infections

If licensed, it could mark the first new oral anti-inflammatory class for chronic lung disease in decades.

Key Take-Home Messages

  • Brensocatib reduces harmful lung inflammation by blocking the enzyme DPP1.

  • It is a small-molecule tablet, not a biologic injection.

  • It aims to protect the lungs by preventing damage from overactive neutrophils.

  • It may offer a steroid-sparing option for chronic airway diseases like bronchiectasis and aspergillosis.

  • It’s currently in final clinical trials, with results expected soon.

💬 Find Out More

by GAtherton

🧩 NAC Aspergillosis Research Digest Aspergillosis (October 2025: week 43)

Highlights

  • Post‑transplant GVHD & IFI risk: In paediatric liver transplant recipients with GVHD, invasive fungal infection (aspergillosis/candidiasis) was the dominant cause of death; paper advocates PK‑guided monitoring of JAK inhibitors and tacrolimus for safer immunosuppression. (Pediatr Transplant; free full text) PMID: 41039701 | PMCID: PMC12491760
  • Inhaled opelconazole: In‑vitro + clinical data suggest negligible drug–drug interaction (DDI) risk for the investigational inhaled triazole opelconazole, supporting development for pulmonary aspergillosis. (JAC) PMID: 41105437
  • Isavuconazole DDI mapping: PBPK modelling compares isavuconazole with other azoles and proposes model‑informed dosing for anticancer drugs—useful in haem‑onc co‑prescribing. (CPT:PSP) PMID: 41104611
  • CAR‑T fungal infections: Registry analysis after CD19 CAR‑T for B‑cell lymphoma reports invasive aspergillosis as the commonest mould IFI (11/32). (CMI) PMID: 41109429
  • Air pollution & IPA: Two multicentre cohorts link higher fine particulate (PM2.5) exposure before admission with invasive pulmonary aspergillosis in severe pneumonia. (EBioMedicine) PMID: 41106023
  • Mechanisms of resistance/virulence: A bioRxiv preprint identifies a long non‑coding RNA (afu‑182) that modulates triazole susceptibility and virulence in A. fumigatus. (Preprint) PPR: PPR1101933
  • Burden estimates (Poland): National modelling updates burden for IA, CPA, ABPA, SAFS—useful for service planning and advocacy. (Sci Rep; open) PMID: 41087447 | Full text

Diagnostics

  • Dental/ENT interface: In a retrospective implant‑centred series, chronic sinusitis and aspergillosis were histopathologically confirmed in a subset of sinus augmentation candidates; authors discuss when 3D imaging is warranted pre‑procedure. (Int J Oral Maxillofac Implants) PMID: 41105467
  • Environmental surveillance: Post‑hurricane housing study identified Aspergillus spp. in water‑impacted homes, contextualising environmental exposure risk for ABPA/CPA. (Sci Rep; open) PMID: 41087584

Therapeutics & stewardship

  • Opelconazole (inhaled triazole) DDI profile appears favourable (see above). Consider future role for adjunct/targeted lung delivery once efficacy data mature. PMID: 41105437
  • Isavuconazole PBPK‑based recommendations may aid co‑administration with anticancer agents; still requires centre‑specific DDI checks and, where available, TDM. PMID: 41104611
  • Novel antifungal target: A selective acetyl‑CoA synthetase inhibitor shows antifungal activity in Nat Commun—early‑stage discovery but potentially relevant to future azole‑resistant IA/CPA. (Nat Commun; open) PMID: 41087359

Epidemiology & special populations

  • CAR‑T recipients: IA predominance among mould IFIs underscores the need for surveillance, rapid diagnostics (GM/PCR), and early therapy in post‑CAR‑T care pathways. PMID: 41109429
  • Air quality: Association between PM2.5 and IPA suggests including environmental history in risk assessments for severe pneumonia patients. PMID: 41106023
  • Veterinary reservoir: Review from Turkey highlights aspergillosis as a major poultry disease—relevance for occupational exposures and broader One‑Health messaging. (Vet Med Sci; open) PMID: 40988581

Surgery & case‑based learning

  • CPA with infected bulla: Case report supports surgical resection as an option in selected CPA phenotypes with localised disease. (Clin Case Rep; open) PMID: 41103592

Guidance / practice notes

  • For post‑transplant GVHD, ensure PK monitoring (tacrolimus, JAK inhibitors) and early IFI screening (GM/LFA ± PCR) to balance GVHD control against infection risk. PMID: 41039701
  • In CAR‑T and severe pneumonia pathways, include combined diagnostics (BAL GM, Aspergillus PCR ± culture) and rapid initiation of active triazoles where IA is probable.
  • Consider air quality and environmental exposures (post‑disaster housing, poultry) in patient education and prevention.

References & links

  • Sawada K et al. PK Monitoring of JAK Inhibitor and Tacrolimus in post‑LT GVHD. Pediatr Transplant. 2025. PMID: 41039701 | PMCID: PMC12491760
  • Cass LMR et al. Opelconazole DDIs. J Antimicrob Chemother. 2025. PMID: 41105437
  • Goosen TC et al. Isavuconazole DDI PBPK. CPT: Pharmacometrics Syst Pharmacol. 2025. PMID: 41104611
  • Bouvier A et al. IFIs after CD19 CAR‑T. Clin Microbiol Infect. 2025. PMID: 41109429
  • Zhou H et al. PM2.5 & IPA. EBioMedicine. 2025. PMID: 41106023
  • Poudyal NR et al. lncRNA afu‑182 & azole susceptibility. bioRxiv. 2025. Preprint
  • Tamagawa K et al. Lung resection in CPA with infected bulla. Clin Case Rep. 2025. PMID: 41103592
  • Vélez‑Torres LN et al. Aspergillus in water‑impacted homes. Sci Rep. 2025. PMID: 41087584
  • Krzyściak PM et al. Burden of serious mycoses in Poland. Sci Rep. 2025. PMID: 41087447
  • Alhassani ANA et al. Aspergillosis in poultry (Turkey). Vet Med Sci. 2025. PMID: 40988581

 

by GAtherton

🫁 “Lung Flush” (Bronchoalveolar Lavage) in ABPA – What It Is and Why It Brings Only Short-Term Relief

A lung flush (also called a bronchoalveolar lavage, or BAL) isn’t a regular treatment for Allergic Bronchopulmonary Aspergillosis (ABPA), but it’s sometimes used selectively in NHS hospitals.

💧 What Happens During a Lung Flush

It’s done during a bronchoscopy, where a thin, flexible tube is passed through the nose or mouth into the lungs.
A small amount of sterile saline is washed into part of the lung and then gently suctioned back out.
The fluid is tested for:

  • Aspergillus growth or DNA

  • Other infections (bacteria, fungi, viruses)

  • Signs of inflammation or allergic activity

You’re given local anaesthetic and light sedation, so you stay comfortable but sleepy. Most people go home the same day.

🧪 Main Purpose – Diagnosis

In most ABPA cases, a lavage is done to find out what’s causing symptoms – whether they’re due to Aspergillus, another infection, or ongoing inflammation.
The results help doctors fine-tune treatment, such as adjusting antifungal doses or deciding if a biologic drug might help.

🫁 Sometimes Used to Clear Mucus

In certain situations – especially when thick mucus plugs are blocking airways or causing part of a lung to collapse – doctors may use lavage as a therapeutic “flush.”
This can wash out sticky secretions and temporarily improve airflow, helping physiotherapy and medication work more effectively.

It’s usually a short, day-case procedure, and most people feel back to normal after a day or two.

⚠️ Why It’s Only Short-Term Relief

Although lavage can clear mucus, ABPA is caused by an allergic immune reaction, not by the mucus itself.
Unless that reaction is controlled with:

  • Corticosteroids (to reduce inflammation),

  • Antifungal drugs (to lower the fungal load), or

  • Biologic injections (to block allergy pathways),

…the lungs will continue to produce thick, sticky mucus, which can re-accumulate within days or weeks.
So while a “lung flush” can make breathing easier in the short term, the effect is temporary – like clearing a blocked drain while the tap is still running.

⚠️ Risks and After-Effects

A bronchoscopy with lavage is generally safe, but it is still an invasive procedure. Possible effects include:

  • Temporary sore throat, cough, or hoarseness (common)

  • Mild bleeding or streaks of blood in sputum for a short time

  • Low oxygen levels during or after the procedure (monitored carefully)

  • Chest tightness, infection, or fever – uncommon but possible

  • Bronchospasm (airway narrowing) in people with very sensitive lungs, which is why it’s done in a hospital with respiratory support available

Because of these small but real risks, the NHS uses lavage only when the benefits outweigh the downsides – for example, when mucus is causing serious blockage or when test results will change management.

💬 In Summary

A “lung flush” can temporarily clear mucus and ease breathing, but it doesn’t stop ABPA’s underlying allergic inflammation.
The mucus often returns unless that inflammation is brought under control with long-term medical treatment.
It’s a useful tool when needed, but not something done regularly or lightly.

by GAtherton

🌟 Vitamin B12 (Cobalamin) and Iron – What Patients Should Know

People living with chronic lung or fungal conditions sometimes develop low vitamin B12 or iron, especially if appetite, diet, or absorption are affected.
Here’s how to understand your results and treatment options.

🌟 Vitamin B12 (Cobalamin)

✅ What’s a Normal B12 Level?

Level (pmol/L) What It Means
> 300 Normal
200–300 Borderline – may need extra tests (e.g. MMA or homocysteine)
< 200 Deficiency likely

Some labs report B12 in ng/L — the ranges are similar. Your doctor will interpret them based on the lab reference range.

⚠️ What Happens If B12 Is Low?

Low B12 can cause:

  • Fatigue and weakness

  • Brain fog or memory issues

  • Numbness or tingling in hands or feet

  • Low mood or irritability

  • In severe cases, nerve damage

💉 B12 Treatment

Cause Typical Treatment
Dietary deficiency (e.g. vegan diet) High-dose oral B12 tablets or injections
Pernicious anaemia (autoimmune) Lifelong B12 injections every 8–12 weeks
Malabsorption (gut issues) Long-term injections often required

In the UK, injections are usually hydroxocobalamin 1 mg every 2–3 months for maintenance, after an initial “loading phase” (several doses over 2 weeks).

🌟 Iron (Ferritin and Haemoglobin)

✅ Key Iron Markers

Test Normal Range (Women) What Low Levels Mean
Ferritin 30–200 µg/L (some doctors prefer >50) Reflects iron stores — low = iron deficiency
Haemoglobin 120–160 g/L Measures oxygen-carrying capacity — low = anaemia

You can have low iron without anaemia (low ferritin, normal Hb) or both together.

💉 Iron Infusions (e.g. Ferinject)

Used when:

  • Iron tablets don’t work or cause side effects

  • Iron levels are very low or symptoms severe

  • Ongoing blood or iron loss (e.g. heavy periods, inflammatory bowel disease)

Iron infusions raise levels more quickly than tablets. Some people need repeat infusions every 6–12 months depending on the cause.

🔄 Ongoing Monitoring and Follow-Up

Condition Typical Follow-Up
Low B12 (pernicious anaemia) Injections for life; blood tests yearly
Low B12 (diet-related) May stop if diet improves and levels remain stable
Iron deficiency (no bleeding cause) Tablets for 3–6 months, then reassess
Chronic iron loss (e.g. periods, IBD) Maintenance iron or repeat infusions

✅ Reliable Information Sources

📣 Final Advice

If you’re unsure about your test results or treatment:

  • Ask your GP for a copy of your blood test results

  • Request a referral to a dietitian or haematologist

  • Agree a treatment plan and review dates

Always let your healthcare team know if you’re feeling more tired, dizzy, or unwell — sometimes simple tests and supplements make a big difference.

by GAtherton