GAtherton

Dad and the Sneaky Spores

A lovely story commissioned by the Aspergillosis Trust to raise awareness of the condition and to help children understand what it means to live with a family member affected by it. The narrative not only educates readers about Aspergillosis but is also thoughtfully crafted by Christina Gabbitas to foster empathy and understanding.

Dad and the Sneaky Spores : Gabbitas, Christina, Thomas, Rebecca, Hurst, Ursula: Amazon.co.uk: Books

by GAtherton

Aspergillosis Awareness: Conversation with Tom Bermingham - European Lung Foundation

Conversation with Tom Bermingham - European Lung Foundation

👨 Meet Tom Bermingham

  • Lives in rural County Wexford, Ireland, with his wife.

  • Works as a Rural Development Manager.

  • Diagnosed with aspergillosis in 2022 after years of lung issues.

🌪️ What Triggered His Aspergillosis

  • He grew sunflowers in a polytunnel; handling decaying heads released dust he inhaled.

  • Later, home renovation stirred up bathroom mould/dust—both likely exposures.

🏥 The Path to Diagnosis

  • 2019: Hospitalised for cavitating pneumonia and diagnosed with bronchiectasis.

  • Later treated for chronic fatigue syndrome, repeated infections, tiring quickly.

  • Feb 2022: Hospitalised again (17 days), diagnosed with severe adult-onset asthma, oxygen-dependent, with mucus positive for Aspergillus fumigatus.

  • Initially labelled with Chronic Pulmonary Aspergillosis (CPA), treated with steroids, antifungals, inhalers, antibiotics, and fatigue medications.

  • 2024: Diagnosis revised to ABPA + Severe Asthma with Fungal Sensitisation (SAFS).

  • October 2024: Hospitalised for COVID-19 and Pseudomonas lung infection treated via PICC line. European Lung Foundation

💔 How It Affects His Daily Life

  • Mornings bring coughing up “dirty mucus” daily—an unsettling reminder.

  • Extreme fatigue, headaches, regular infections dominate his life.

  • Gave up gardening (risk of soil exposure), community work, and physical chores.

  • Lives with constant fear of infection, medication side effects, and hospitalisations.

  • Chronic disease has made long-term planning impossible; relaxation and mental wellbeing are vital.

🧭 How He Manages

  • Supported by his wife and daughters and his flexible employer.

  • Practices listening to his body: rests when needed.

  • Regular check-ups—including CT scans, lung function, sputum and blood tests—keep his care monitored. European Lung Foundation

  • Accepting limitations while focusing on what he can still do helps his mindset.

✅ Key Insights for Aspergillosis Patients

  • Environmental exposures matter: mould, dust, soil may trigger illness—even long after.

  • Diagnosis can be complex and evolve: often overlaps with asthma, bronchiectasis, ABPA, SAFS.

  • Daily life can change significantly, with physical decline and emotional stress.

  • Support network and personalised care are crucial—family, employer flexibility, specialist monitoring.

  • Self-care and mindset: acceptance, rest, and focusing on abilities, not limitations.

by GAtherton

Aspergillosis Awareness: Conversation with Marcela Candeias - European Lung Foundation

Conversation with Marcela Candeias - European Lung Foundation

👩‍⚖️ Meet Marcela Candeias

🩺 Journey to Diagnosis

  • In 2020, Marcela developed a persistent, worsening cough, extreme fatigue, and significant weight loss.

  • She began coughing up thick mucus that turned green and black, culminating in an intense coughing fit lasting several hours.

  • This was the turning point that led her to seek medical help European Lung Foundation.

🩻 What Aspergillosis Felt Like

  • Severe coughing fits and bloody or discoloured phlegm.

  • Physical exhaustion and weight loss.

  • A clear sign that something serious was happening internally, not just a flare-up of old asthma European Lung Foundation.

⏭️ Why It Matters for Patients

  • Aspergillosis can emerge suddenly—even in people with previous mild asthma.

  • Early recognition of changes (e.g. mucus discoloration, fatigue, cough intensity) is crucial.

  • Once symptoms escalate, urgent medical evaluation is essential.

✅ Key Takeaways for Aspergillosis Patients

What to Watch For Why It Matters
🚨 Persistent cough with coloured or black mucus Red flag—seek medical review
Increasing fatigue and weight loss Indicates disease progression
Severe coughing fits or coughing up blood Requires immediate attention

"One of these fits lasted several hours—that was when I knew something was seriously wrong. European Lung Foundation

📌 Patient Action Guide

  1. If you have asthma or COPD and notice new symptoms—especially dark mucus, weight loss, or fatigue—don’t wait.

  2. Tell your GP or lung specialist that you’re concerned about aspergillosis.

  3. Ask about appropriate testing (e.g. imaging, sputum culture, blood markers).

  4. Early diagnosis can lead to timely treatment and better outcomes.

by GAtherton

🫁 Airway Clearance in Aspergillosis: A Patient Guide

Managing mucus to breathe easier, stay healthier, and feel more in control

💡 Why Is Mucus Clearance Important?

If you’re living with a condition like chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), or aspergillus bronchitis, you may experience ongoing mucus build-up in your lungs. This can:

  • Make breathing harder

  • Trap infection

  • Cause inflammation and damage

  • Trigger coughing, wheeze or breathlessness

Airway clearance techniques (ACTs) help loosen and remove this mucus, reduce chest infections, and improve daily comfort.

🗣️ “Before I started clearing mucus properly, I thought breathlessness was just something I had to live with. But it’s made a big difference.”

🔧 What Techniques Are Available?

Type Examples Purpose Needs Guidance?
Breathing exercises ACBT (Active Cycle of Breathing), huffing Loosens mucus, clears airways ✅ Yes – to be effective
Postural drainage Lying in specific positions Uses gravity to drain mucus ✅ Yes – to avoid reflux or fatigue
Devices Flutter, Acapella, Aerobika (OPEP devices) Vibrate airways + create back pressure to shift mucus ✅ Yes – to use correctly
Manual techniques Chest percussion, assisted cough Help loosen stubborn mucus ✅ Often needs a helper
Mechanical devices HFCWO (“The Vest”), IPV Used in severe or complex cases ✅ Prescribed in specialist settings

🗣️ “I use the Acapella in the mornings while the kettle boils. It’s part of my routine now – and it really helps.”

🗣️ What Do Other Patients Say?

People with aspergillosis often try more than one method before finding what works best. Here are some common reflections:

On devices:
“The flutter helped a lot once I got the angle and rhythm right – but I needed someone to show me how.”

On ACBT:
“Breathing control and huffing helped me get more up with less effort than coughing all day.”

On adapting to daily life:
“It’s about what fits into your day. If something’s too awkward or tiring, you won’t keep doing it – and that’s okay.”

On trial and error:
“It took me months to find the right technique – but now I can manage my mucus better and avoid antibiotics.”

⚠️ Should I Use a Flutter or Acapella Without Help?

Not at first. These devices are effective only if used correctly. Risks of incorrect use include:

  • Not moving mucus effectively

  • Fatigue or breathlessness

  • Worsening reflux or chest tightness

  • In rare cases, worsening of lung symptoms (e.g., if air trapping occurs)

🗣️ “I bought a device online and started using it myself – but it made me dizzy. A physio later explained I was blowing too hard.”

Always ask your respiratory team or GP for referral to a respiratory physiotherapist before starting.

📝 Patient Decision Guide: Should You Use ACTs?

✅ You may benefit if:

  • You cough up mucus daily or feel it’s “stuck”

  • You’ve had repeated chest infections

  • You live with CPA, ABPA, bronchiectasis, or aspergillus bronchitis

❌ Don’t start without guidance if:

  • You have COPD, asthma, or lung scarring

  • You’ve had haemoptysis (coughing up blood)

  • You experience dizziness, nausea, or chest pain during breathing exercises

  • You have gastric reflux or recent chest surgery

🧑‍⚕️ What Can I Start Safely at Home?

Without needing equipment, you can begin with:

  • 💧 Drink plenty of fluids – thin mucus is easier to clear

  • 🪑 Sit upright – especially when coughing or during infections

  • 🌬️ Use breathing control – calm, gentle breaths can reduce breathlessness

  • 🗣️ Try huffing – like breathing out a mirror; easier than deep coughing

🗣️ “Even on days when I’m tired, I try to stay upright and do a few rounds of breathing exercises. It’s become a habit that helps.”

🧭 Next Steps: What to Ask Your Doctor or Nurse

  • Could I see a respiratory physiotherapist to help with mucus clearance?

  • What technique is best for my condition (e.g., ABPA vs. CPA)?

  • Can I be shown how to use a flutter device or Acapella safely?

  • What should I do if I feel worse after using a technique?

🗣️ “The physio made all the difference – she explained what my lungs were doing and helped me pick something that actually worked.”

💬 Final Word

🗣️ “It’s not just about technique – it’s about what fits your life. Small steps like staying hydrated, using huffing, and getting guidance made a big difference for me.”

There’s no one-size-fits-all approach – but with the right support, airway clearance can help you take control of your lungs, reduce flare-ups, and breathe easier.

by GAtherton

Biologics and Long Term Side Effects

✅ What Are Biologics?

Biologics are targeted treatments made from living cells. They work by blocking parts of the immune system that cause inflammation — for example:

  • IL-4, IL-5, IL-13: linked to eosinophilic inflammation

  • IgE: linked to allergies and ABPA

They are not immunosuppressants like steroids or chemotherapy, but rather immune modulators.

💊 Long-Term Side Effects – What Do We Know?

👨‍⚕️ What research and experience show:

Biologic Used for Long-term safety known? Side effects most reported
Omalizumab (Xolair) Allergic asthma, ABPA 20+ years of use Injection site reactions, headache, very rare anaphylaxis
Mepolizumab (Nucala) Eosinophilic asthma, CPA 10+ years Fatigue, headache, shingles (rare), mild infections
Benralizumab (Fasenra) Severe asthma, CPA ~6–7 years Headache, pharyngitis, injection site issues
Dupilumab (Dupixent) Asthma, eczema, nasal polyps 6–8 years Eye dryness/redness, cold sores, joint pain (rare)
Tezepelumab (Tezspire) Severe asthma ~2 years Sore throat, joint pain, injection site reactions

⚠️ Possible Long-Term Concerns (but rare)

  • Infections: Some concern about slightly increased risk of herpes zoster (shingles) or respiratory viruses, but overall risk is very low compared to steroids.

  • Immunogenicity: Your body might develop antibodies to the drug over time, reducing its effect — this is more a loss of benefit, not a dangerous side effect.

  • Cancer risk: No consistent evidence linking asthma/ABPA biologics to cancer.

  • Unknowns: Because some biologics are new (e.g. tezepelumab), we don't yet have 20-year data — but so far the safety profile is reassuring.

🩺 Compared to Oral Steroids

Treatment Side Effects Over Time
Steroids (e.g. prednisolone) Weight gain, diabetes, infections, bone thinning, cataracts, adrenal suppression
Biologics Mostly minor – injection site pain, headache, mild infection risk, rare allergic reaction

So in most cases, biologics reduce the need for steroids and therefore reduce long-term harm.

💬 Patient Experience

Most patients report:

  • Improved quality of life

  • Reduced asthma/ABPA attacks

  • Fewer hospital visits

  • Very few stop due to side effects

✅ Summary

Question Answer
Do biologics have long-term side effects? Usually mild and rare; mostly injection reactions or mild infections
Are they safer than long-term steroids? Yes, especially over years
Should I be worried? Not usually — but always monitor with your team
How long have they been used? 6–20+ years, depending on the biologic, with very good safety data

by GAtherton

😷 Coping With Masks: Advice for People With Aspergillosis Who Struggle to Wear One

For people living with aspergillosis, asthma, or other lung conditions, wearing a facemask can sometimes feel uncomfortable — even frightening. You may feel like you can’t breathe properly, become hot or anxious, or feel claustrophobic. Some patients avoid masks altogether, even when they want to wear one to protect themselves from spores, pollution, or infection.

This guide is here to reassure you: you are not alone, and there are ways to make mask-wearing safer and more comfortable.

🫁 "I Can’t Breathe in a Mask" – Is This Normal?

Yes — many people with respiratory conditions feel this way. But here’s what the science tells us:

✅ For most people, even those with chronic lung disease, oxygen levels are not reduced by wearing a mask
❌ The feeling of not getting enough air is often caused by:

  • Anxiety or shallow breathing

  • The heat and humidity under the mask

  • The sensation of restricted airflow, not actual oxygen deprivation

💡 Helpful Tips If You Find Masks Difficult to Wear

1. Practise in a calm setting

Start wearing your mask for short periods at home, where you feel safe. Use calming breathing (slow in through the nose, out through the mouth). This helps your brain and lungs get used to the sensation.

2. Choose a mask that suits your needs

Different types of masks feel very different to wear.

Problem Suggested Mask
Feels suffocating or hot Structured FFP2 or duckbill-style masks (keep shape off your face)
Claustrophobic Surgical masks (lighter and looser fitting)
Strong reactions to smells or pollution FFP2/FFP3 masks or Vogmask with carbon filter
Sweat or overheating Lightweight cotton or disposable masks with cooling fabric or filter inserts

3. Use your inhaler beforehand (if prescribed)

Some people with asthma or ABPA find wearing a mask easier after using their reliever inhaler (blue) 10–15 minutes beforehand.

4. Take breaks when needed

If you’re in a safe place (like outdoors, away from people), it’s okay to briefly lift your mask and take a few calm breaths — especially if you're struggling. You don't need to wear it all the time to benefit.

5. Try alternatives in low-risk settings

If you genuinely can’t tolerate a mask:

  • Wear one only in crowded indoor areas (shops, clinics, transport)

  • Consider using a face shield over a mask or in short exposures (note: shields protect others less)

  • Maintain distance and ventilation in mask-free spaces

🔁 Don’t Let One Bad Experience Stop You

Struggling to wear a mask doesn’t mean you’ve failed — it just means you need to try something different. Many patients find that with the right mask and some breathing strategies, they can use one when it matters most.

Remember, even wearing a mask for short periods (e.g. clinic waiting room, pharmacy queue) offers valuable protection.

🧠 Why It Matters for Aspergillosis

People with aspergillosis often need to avoid airborne risks like:

  • Fungal spores (especially Aspergillus fumigatus)

  • Pollution and chemicals

  • Viral infections that could worsen lung damage

Wearing a well-fitting FFP2 or FFP3 mask, especially in higher-risk situations, is one of the best ways to reduce exposure.

🤝 You're Not Alone

If you feel overwhelmed, isolated, or panicked when wearing a mask — you are not alone. Many others in the aspergillosis community feel the same way. With time, support, and the right mask, it often gets easier.

📝 Summary: What You Can Try

  • ✅ Practise wearing a mask at home for short periods

  • ✅ Try structured masks (like FFP2 duckbill) for better airflow

  • ✅ Use a reliever inhaler beforehand if needed

  • ✅ Take short breaks if it becomes too uncomfortable

  • ✅ Don’t wear a mask all the time — just when it matters most

by GAtherton

🛡️ How Your Care is Changing: Understanding Antimicrobial Stewardship

A guide for patients with aspergillosis and chronic lung conditions

If you're being treated for chronic pulmonary aspergillosis (CPA), ABPA, or any long-term lung condition, you might notice changes in the way doctors use antifungal and antibiotic medicines. These changes are part of a worldwide effort to tackle antimicrobial resistance (AMR) — and to make sure the right treatment is used, in the right place, for the right reason.

💬 What is Antimicrobial Stewardship?

Antimicrobial stewardship (AMS) means using antifungal and antibiotic medications responsibly, so they work better now and stay effective for the future.

It’s about:

  • Using the right medication

  • In the right place

  • For the right reason

  • At the right dose and duration

This helps ensure patients get better faster, and we all stay protected from drug-resistant infections.

🔬 What Is Antimicrobial Resistance?

Antimicrobial resistance (AMR) happens when bacteria or fungi evolve and stop responding to medicines that used to work. This makes infections:

  • Harder to treat

  • More likely to come back

  • More dangerous for people with lung or immune conditions

There are two major types:

  • Antibiotic resistance (bacteria)

  • Antifungal resistance (fungi, including Aspergillus fumigatus)

💊 Antibiotics: Broad vs Narrow Spectrum

Doctors aim to use targeted antibiotics wherever possible. Here’s how they differ:

Type Description Examples Used For
Broad-spectrum Kills a wide range of bacteria Co-amoxiclav, meropenem, ceftriaxone Sepsis, serious infections
Narrow-spectrum Targets specific bacteria Penicillin, nitrofurantoin, flucloxacillin Simple infections

🧪 Doctors may start with broad-spectrum drugs in emergencies but switch to narrow-spectrum when test results are available — this is called de-escalation.

🦠 Antifungal Resistance and Aspergillosis

People with CPA or ABPA are often treated with antifungals like:

  • Itraconazole

  • Voriconazole

  • Posaconazole

  • Isavuconazole

But fungi can develop resistance, especially when:

  • Medications are used long-term

  • Fungi are exposed to azole sprays on crops and flowers

You may inhale resistant spores from:

  • Compost, potting soil, or garden centres

  • Fresh flowers (especially imported ones)

🏥 What Might You Notice in Hospital?

✅ Shorter or targeted treatment

  • You may be on 5–7 days of antibiotics/antifungals

  • Switch from IV to tablets happens earlier once you're stable

✅ Treatment reviews

  • Your medication will be reviewed within 48–72 hours

  • Changes may be made based on lab results

✅ More testing

  • Blood, sputum, or biopsy samples help identify infections and resistance

  • Ensures you get the right treatment

✅ Specialist involvement

  • An infection or respiratory consultant may review your case if resistant infection is suspected

✅ Infection control

  • You may notice:

    • No fresh flowers

    • HEPA filters in some wards

    • Staff using extra precautions to prevent airborne infections

🏡 What Might You Notice From Your GP?

✅ More specific prescribing

  • GPs are less likely to give antibiotics “just in case”

  • More narrow-spectrum choices based on the suspected infection

✅ Diagnostic support

  • GPs may send sputum or urine samples before prescribing

  • May test your blood for antifungal levels (TDM)

✅ Home safety advice

You may be advised to:

  • Avoid indoor compost or plant pots

  • Wear FFP2/FFP3 masks when gardening

  • Keep indoor air well ventilated

🧬 New Antifungals Being Protected for Patient Use

Several antifungals are in development and being reserved just for medical use (not agriculture), including:

Drug What it is Why it matters
Rezafungin Weekly IV echinocandin Long-lasting for serious infections
Ibrexafungerp First oral alternative to azoles Trials for aspergillosis
Olorofim New class (DHODH inhibitor) Active against resistant Aspergillus
Opelconazole Inhaled antifungal Direct treatment to the lungs
Fosmanogepix Novel target Works against drug-resistant fungi

🧠 What This All Means for You

These changes are about:

  • Better outcomes — faster recovery with fewer side effects

  • Preventing resistance — protecting future treatments

  • More personalised care — based on test results and your condition

✅ What You Can Do

Action Why It Helps
Take medications exactly as prescribed Prevents underdosing and resistance
Don’t stop treatment early Even if you feel better
Ask if your treatment has been reviewed Encourages early switch or adjustment
Use a mask and gloves for gardening Reduces spore exposure
Avoid fresh flowers and compost indoors Especially in bedrooms or when unwell
Report any new or worsening symptoms Resistance may be developing
Ask about resistance testing if you’re not improving Labs can check fungal response
Stay informed and speak up You’re part of the stewardship solution

📌 In Summary: Stewardship in Action

Antimicrobial stewardship is not about doing less — it's about doing things more precisely.
It’s how your healthcare team makes sure you receive:

The right medication, in the right place, for the right reason.

🔗 Want to Learn More?

by GAtherton

💊 General Strategies to Reduce Antimicrobial Resistance in Clinical Practice

1. IV to Oral Switch (IVOS)

One of the most effective and safe interventions in antimicrobial stewardship.

🔁 Why switch from IV to oral early?

  • Reduces complications (e.g. line infections, thrombosis)

  • Lowers costs and bed-days

  • Improves patient comfort and mobility

  • Oral options (e.g. ciprofloxacin, fluconazole, linezolid) are highly bioavailable, often matching IV efficacy

✅ When is IVOS appropriate?

  • Clinical improvement seen

  • Source controlled

  • Oral route available and tolerated

  • Suitable oral alternative exists

NHS guidance: "Start smart – then focus" encourages early IVOS reviews within 48–72 hours of antibiotic initiation.

2. "Start Smart – Then Focus" (UK NHS Framework)

This key NHS antimicrobial policy includes:

  • Start Smart: Prescribe antibiotics appropriately from the beginning

  • Then Focus:

    • Review at 48–72 hours

    • Consider stop, switch, change, or continue

    • Document clearly in records

Supported by NICE guidelines and UKHSA audits

3. Shorter Duration of Therapy

For many infections, shorter courses (e.g. 5–7 days instead of 10–14) are now preferred.

Examples:

  • Community-acquired pneumonia: 5 days

  • Pyelonephritis: 7 days

  • Cellulitis: 5–7 days

This reduces resistance pressure and side effects.

4. Diagnostics-Guided Prescribing

  • Procalcitonin and CRP tests can help distinguish bacterial from viral infections

  • Rapid PCR, MRSA, or blood culture diagnostics guide targeted therapy

The aim is avoid empirical broad-spectrum antibiotics where possible.

5. Restricted Prescribing Policies

  • Certain high-risk drugs (e.g. carbapenems, vancomycin, antifungals) are restricted to ID approval

  • Antimicrobials are tiered by risk (e.g. traffic light systems) to encourage narrow-spectrum use

6. Antimicrobial Stewardship Teams (ASTs)

Multidisciplinary teams:

  • Lead on stewardship strategy

  • Audit antimicrobial use

  • Provide decision support for complex cases

  • Educate staff and update local formularies

In the NHS, stewardship is a CQUIN target (incentivised performance indicator).

7. Education and Behaviour Change

  • Mandatory AMS training for junior doctors and prescribers

  • Behavioural nudges in electronic prescribing systems (e.g. default shorter durations, alert for IVOS)

8. Surveillance and Reporting

  • ePAMS+, ESPAUR, and PHE Fingertips dashboards track:

    • Prescribing by hospital/unit

    • Resistance trends

    • Audit compliance with IVOS, duration, and documentation

9. Patient-Facing Initiatives

  • "Antibiotic Guardian" and leaflets explaining viral vs bacterial infections

  • Empowering patients to ask:

    "Do I really need antibiotics? When can I switch to tablets?"

📦 Summary Table: Key Interventions

Strategy Purpose
IV to Oral Switch Reduce IV duration, speed discharge
Review at 48–72 hrs Reassess need, de-escalate if possible
Shorter therapy courses Lower resistance pressure
Targeted diagnostics Support narrow-spectrum prescribing
Prescribing restrictions Protect last-resort antimicrobials
Stewardship teams Oversee, audit, educate
Surveillance & feedback Monitor trends, guide policy

by GAtherton

🦠 Antifungal Resistance: What It Is, How It Happens, and Why It Matters

Antifungal resistance is a growing global health threat, especially for people with lung conditions like chronic pulmonary aspergillosis (CPA) or allergic bronchopulmonary aspergillosis (ABPA). Just like bacteria can become resistant to antibiotics, fungi like Aspergillus fumigatus can develop resistance to antifungal drugs — making infections harder or even impossible to treat.

🔍 What Is Antifungal Resistance?

Antifungal resistance occurs when fungi evolve in ways that allow them to survive exposure to medications that used to kill them or stop their growth. This makes standard treatments less effective and increases the risk of:

  • Treatment failure

  • Prolonged illness

  • More severe infections

  • Increased hospital stays and costs

  • Higher death rates in vulnerable patients

🧬 How Does It Develop?

Fungi become resistant through genetic changes, often due to:

  • Long-term antifungal treatment in patients

  • Widespread environmental exposure to antifungal chemicals — especially azoles used on crops

Once resistance develops, the fungus may stop responding to key drugs like:

  • Itraconazole

  • Voriconazole

  • Posaconazole

  • Isavuconazole

These are the mainstays of treatment for aspergillosis and other serious fungal infections.

🌾 The Role of Agriculture: A Hidden Driver

Many resistant strains of Aspergillus don’t develop in people — they develop in the environment, especially in farmland and flower production areas.

Why?

The azole fungicides used on crops are chemically very similar to the azoles used in human medicine. They target the same fungal enzyme (CYP51, involved in cell wall formation). Fungi exposed repeatedly to these sprays can adapt — and the resulting resistant spores can:

  • Survive in soil, compost, and plant debris

  • Be carried on the wind

  • Be inhaled by people — especially those with weakened lungs or immune systems

High-risk areas include:

  • Grain farming (wheat, barley, maize)

  • Fruit production (apples, grapes, citrus)

  • Ornamental flowers (e.g., roses, tulips, chrysanthemums) — especially when imported or mass-grown

  • Garden centres and potting compost

🏠 Exposure at Home: Flowers, Soil, and More

People may unknowingly bring resistant Aspergillus spores into their homes through:

  • Fresh cut flowers (especially from florists using treated imports)

  • Potting compost or stored bulbs

  • Uncovered soil and plant material indoors

This is particularly dangerous for those with lung conditions, suppressed immunity, or recent surgery.

Practical tips:

  • Avoid keeping fresh flowers or pot plants in bedrooms or living areas

  • Use gloves and masks (FFP2 or FFP3) when handling soil or compost

  • Ventilate indoor spaces after gardening

💊 What’s Being Done: Medical, Policy, and Drug Development

1. Reserving drugs for clinical use

New antifungal drugs with novel mechanisms are being designed exclusively for medical use. Some are already approved or in late clinical trials:

Drug Type / Mechanism Status Notes
Rezafungin Echinocandin (IV, once-weekly) Approved 2023 (US/EU) For Candida, with long half-life
Ibrexafungerp Oral glucan synthase inhibitor Approved 2021 (US) Active against resistant Candida, in trials for Aspergillus
Oteseconazole Oral tetrazole Approved 2022 (US) Less toxicity, fewer interactions
Olorofim Pyrimidine synthesis inhibitor Late trials First in class, active against Aspergillus
Fosmanogepix GWT1 enzyme inhibitor Trials New target, good against multi-drug resistant fungi
Opelconazole Inhaled azole Trials Direct lung delivery, potential for aspergillosis

Many of these drugs are being deliberately withheld from agriculture to protect their effectiveness.

2. Policy & regulation

  • The “One Health” approach is gaining ground: it recognises the links between human, animal, and environmental health.

  • Some countries are monitoring soil and air for resistant fungi (e.g. Netherlands, UK).

  • Campaigns are underway to regulate or ban agricultural use of triazoles that drive cross-resistance.

  • Hospitals increasingly restrict fresh flowers in high-risk wards to protect immunocompromised patients.

🧭 What Needs to Happen Next

  • Tighter coordination between agricultural and medical authorities to regulate antifungal use

  • Incentives for developing safer, non-cross-reactive fungicides for farming

  • Increased global surveillance of resistant fungi in both clinical and environmental settings

  • Patient and public education about the risks and how to reduce exposure

🧠 What Patients Can Do

If you live with aspergillosis, chronic lung disease, or weakened immunity:

✅ Take your antifungal medicine exactly as prescribed
✅ Don’t stop or change treatment without medical advice
✅ Ask about resistance testing if symptoms worsen
✅ Avoid exposure to soil, compost, and fresh flowers
✅ Use respiratory protection (FFP2/FFP3 masks) in dusty or mouldy environments
✅ Advocate for better public policies on antifungal stewardship

🔗 Want to Learn More?

by GAtherton

🛡️ FFP2/FFP3 Mask Use in Aspergillosis: Summary

Mask Type Who Might Use It When It's Used
FFP2 (95% filtration) Some patients with CPA, ABPA, or SAFS, especially during flares or hospital visits During travel on public transport, clinic waiting rooms, visiting building sites, or dust exposure
FFP3 (99% filtration) Patients who are severely immunocompromised (e.g. post-transplant, on chemotherapy, or high-dose steroids) In high-risk environments: hospital construction, building work nearby, or heavy dust/mould exposure

✅ When Masks Might Be Advisable

  • During hospital visits, particularly in winter or during flu/COVID waves

  • If you're immunosuppressed, e.g. taking long-term steroids or biologics

  • When exposed to mouldy buildings, compost, building work, or flood damage

  • In crowded indoor environments where infection risk is high

❌ When They’re Usually Not Needed

  • Day-to-day life in a clean, dry home environment

  • Low-risk outdoor activity (e.g. walking in the park)

  • If your asthma/ABPA/CPA is stable and you're not immunocompromised

🗣️ What the National Aspergillosis Centre Recommends

  • Use FFP2 masks when entering environments likely to have airborne fungal spores

  • FFP3 masks may be offered for high-risk medical procedures or when severely immunocompromised

  • Masks are one part of a broader protection strategy, which includes:

    • Good indoor air quality (HEPA filters, ventilation)

    • Avoidance of dusty environments

    • Prompt treatment of fungal infections

by GAtherton