GAtherton, Author at Aspergillosis Patients & Carers Support

UK Government reports on housing safety and damp control 2025

Damp homes

Several recent UK government reports provide comprehensive guidance and data on housing safety, damp control, and associated health impacts. The most relevant publications from 2023–2025 are summarized below.

Understanding and Addressing the Health Risks of Damp and Mould (UKHSA/DHSC, 2024)

This major cross-government report outlines the health, environmental, and legal aspects of damp and mould control in residential settings. Developed by the Department of Health and Social Care (DHSC), the UK Health Security Agency (UKHSA), and the Department for Levelling Up, Housing and Communities (DLUHC), it:

Describes physical and mental health impacts, especially in children, older people, and those with chronic respiratory conditions.
Defines landlord duties under housing law and required response protocols for damp and mould complaints.
Rejects the term “lifestyle problem,” stressing structural and environmental responsibility for moisture management.
Provides prevention recommendations on ventilation, insulation, and inspection regimes.^[1]^[2]

Damp and Mould in Social Housing: Initial Findings (DLUHC, 2023)

This investigation assessed housing association and council stock across England following the Awaab Ishak case. Key findings include:

Issues in 2–4% of homes, particularly older, energy-inefficient estates.
Strong correlation between low-income tenancy and severe damp outcomes.
Recommendations for routine moisture monitoring, landlord performance audits, and education for tenants and staff.^[3]

English Housing Survey 2023–2024 (DLUHC, published July 2025)

Two reports from this survey provide quantitative analysis of damp and safety:

Drivers and Impacts of Housing Quality identifies rising levels of unsafe damp and ventilation problems, especially in the North of England and private rented sector.
Health and Housing Fact Sheet (2025) links poor-quality housing to chronic illness prevalence, noting that households in damp properties are twice as likely to include someone with a long-term condition.^[4]^[5]^[6]
Data from the Technical Report and live tables further detail rates of non-decency, energy inefficiency, and fire safety risks.^[7]^[8]

UKHSA Report: The Burden of Disease Caused by Damp and Mould (2024)

Produced by the Environmental Hazards and Emergencies Department, this research quantifies 2,800 annual Disability Adjusted Life Years (DALYs) in England caused by respiratory illness linked to damp homes. It highlights disproportionate effects on ethnic minority and low-income populations and forms the epidemiological basis for current housing policy reform.^[9]

Letter from the Secretary of State to Social Landlords (2023)

This official communication enforces updated guidance for housing providers and mandates action following coroner recommendations. It reiterates the government’s stance that landlords bear the duty for damp and mould mitigation through repair, ventilation, and structural rectification.^[1]

Local Housing Safety Strategies (2025)

Several local authorities have incorporated national safety reforms into localized housing plans, including:

Kensington and Chelsea Housing Strategy 2025–2030, prioritizing damp elimination under Awaab’s Law and maintaining 100% Decent Homes compliance.^[10]
Rotherham and Angus Healthy Homes Plans, integrating damp mitigation with public health objectives.^[11]^[12]

Together, these reports form the evidence base for the 2025 Decent Homes Standard and Awaab’s Law, requiring all social landlords to rectify identified damp and mould hazards within statutory timeframes, marking the UK’s most stringent housing safety framework to date.

⁂

https://www.gov.uk/government/publications/adult-social-care-system-reform-next-steps-to-put-people-at-the-heart-of-care/next-steps-to-put-people-at-the-heart-of-care

by GAtherton

Damp homes: UK Policy and Research 2025

Damp homes

Government and peer-reviewed research on damp and mould in UK housing between 2020 and 2025 shows a marked policy shift toward public health integration, landlord accountability, and cross-sector action led by UKHSA, NHS partners, and local government.

UK Government and Local Authority Frameworks

The UK Government’s 2024 guidance on Understanding and Addressing the Health Risks of Damp and Mould directs local authorities and landlords to treat all mould reports as potential health hazards, not lifestyle issues. It mandates inspection, remediation, and resident communication protocols consistent with the Housing Health and Safety Rating System (HHSRS) and the Decent Homes Standard.^[1]^[2]

Local authorities such as Newham, Waverley, and Rotherham have implemented Damp and Mould Action Plans (2023–2025) integrating health, climate, and housing inspection frameworks. They require proactive identification using repair logs, thermal imaging, and joint inspection with environmental health officers.^[3]^[4]^[5]

The Royal Borough of Kensington and Chelsea’s 2025–2030 Housing Strategy further emphasizes reform under Awaab’s Law (2025), ensuring swift remediation within fixed timeframes and continuous monitoring aligned with learning from the Grenfell Inquiry.^[6]

NHS and UKHSA Public Health Findings

The UK Health Security Agency’s 2024 “Burden of Disease from Damp and Mould” report provides the first national quantification of health outcomes. It attributes 2,800 annual DALYs to damp-related respiratory illnesses (especially childhood asthma and chronic bronchitis) and shows strong socio-economic and ethnic disparities in exposure.^[7]

NHS partners, including Integrated Care Boards (ICBs), have incorporated damp and mould into local health inequality programmes. The NHS Cornwall and Isles of Scilly ICB (2023) reported collaborations with housing authorities to monitor respiratory admissions linked to poor housing conditions and prevent seasonal exacerbations.^[8]

These measures align with NHS England’s “Core20PLUS5” framework, recognizing housing quality as a determinant of population health outcomes.

Peer-Reviewed Research

Recent academic studies reinforce and contextualize government data:

LSE’s “Damp and mould—the big picture” (Frontiers in Environmental Health, 2024) concludes that UK social housing dampness has structural causes worsened by aging housing stock, underinvestment, cost-of-living pressures, and climate-related moisture extremes. It calls for cross-sectoral, health-led remediation strategies.^[9]
BMJ (2024): “Law Change for Tenants in Mouldy Social Housing” analyzed the legal and public health rationale for Awaab’s Law, emphasizing its role in reducing avoidable childhood morbidity and mortality.^[10]
A 2023 study in Housing Studies (Taylor & Francis) found significant psychological and respiratory effects from chronic exposure to mould in UK homes, emphasizing that remediation improved wellbeing and reduced GP visits.^[11]
The Environmental Health Perspectives 2024 review synthesized global evidence linking damp housing with immune and respiratory dysfunction, reinforcing the urgency of UK-specific regulation.^[12]

Integrated Summary

Between 2023 and 2025, the UK’s approach shifted from advisory to enforceable frameworks. National and local policy now aligns under Awaab’s Law, reinforced by detailed health surveillance through UKHSA and NHS systems. Peer-reviewed data confirm both physiological and psychological harm from damp housing, justifying the strategy’s integration within broader health inequality reduction policies.

⁂

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

National Aspergillosis Centre – aspergillosis.org
Insmed’s brensocatib research
ClinicalTrials.gov – search “brensocatib”

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