GAtherton

🛡️ Understanding Your Risk: Aspergillosis, Steroids, and the Immune System

If you’ve been diagnosed with an Aspergillus-related condition, such as chronic pulmonary aspergillosis (CPA), ABPA, or a fungal ball (aspergilloma), you might wonder:
“Am I immunocompromised? And do steroids or biologics put me at more risk?”

The answers depend on your underlying health, medications, and how your body responds to Aspergillus.

🌍 Aspergillus is Common — But Not Harmless

Aspergillus is a type of mould found everywhere — in soil, air, and dust. Most people breathe it in daily without problems. But in some people, it can:

  • Trigger an allergic reaction (ABPA or fungal sinusitis)

  • Cause infection in damaged lungs (CPA or aspergilloma)

  • Spread aggressively in those with very weak immune systems (invasive aspergillosis)

Understanding your level of immune defence helps explain your risk and how your treatment should be managed.

🧬 Levels of Immunocompromise: What They Mean

Immunosuppression isn't black-and-white — it's a spectrum. Here's how it applies to people with or at risk of aspergillosis:

🔴 High-Level Immunosuppression (High Risk)

  • Recent chemotherapy or bone marrow transplant

  • Stem cell or organ transplant

  • Severe neutropenia (very low white blood cell count)

  • High-dose steroids (e.g. ≥20 mg prednisolone daily for weeks)

  • Uncontrolled HIV/AIDS

  • Intensive care or mechanical ventilation

🧠 These people are at risk of serious, fast-spreading infections — including invasive aspergillosis (IA), which is rare but life-threatening.

🟠 Moderate Immunosuppression (Common in Aspergillosis Patients)

  • Long-term low-to-moderate steroids (e.g. <10–15 mg prednisolone)

  • Biologics for asthma (e.g. omalizumab, benralizumab)

  • Chronic lung disease (COPD, bronchiectasis, asthma)

  • Diabetes, malnutrition, or genetic immune traits

  • Previous TB, sarcoidosis, or other lung damage

🧠 This group is at greater risk of chronic forms of aspergillosis — especially CPA, ABPA, and aspergillus bronchitis.

🟢 Low or No Immunosuppression (Low Risk)

  • People with well-controlled asthma or sinusitis

  • Those on occasional short courses of steroids

  • No major lung or immune conditions

🧠 This group is unlikely to develop aspergillosis.

💊 What if You Already Have Aspergillosis?

If you’ve been diagnosed with CPA, ABPA, aspergilloma, or sinus disease caused by Aspergillus, some treatments may still increase your vulnerability if not carefully managed.

❗ Steroids (e.g. Prednisolone)

  • Help control inflammation (especially in ABPA)

  • But also suppress immunity, making it easier for Aspergillus to grow

  • Can worsen CPA or increase risk of bleeding in aspergilloma

  • Risk rises with higher doses and longer courses

🟠 If steroids are needed, they should usually be combined with antifungal medication (like itraconazole or voriconazole) to keep fungal growth in check.

❗ Biologics for Asthma (e.g. Omalizumab, Mepolizumab)

  • Target allergic inflammation without broadly suppressing the immune system

  • Don’t usually increase the risk of invasive fungal infections

  • May slightly alter how your immune system responds to Aspergillus

🟠 Biologics can be helpful in ABPA and severe asthma, but regular monitoring is still important.

🔍 Summary Table: Common Risk Factors and What They Mean

Factor What It Does What to Watch For
Long-term steroids Suppress immune cells, reduce inflammation Use with antifungals; monitor closely
Biologics for asthma Modulate immune pathways (e.g. IgE, IL-5) Safe in most; watch for subtle effects
TB, sarcoid, or other lung scarring Leaves cavities that allow fungal growth Regular scans and blood tests
Diabetes or malnutrition Affects immune function and tissue repair Keep well-managed
Low white blood cells (neutropenia) Limits ability to fight fungal infection Urgent action needed if fever or unwell
Lung diseases (COPD, asthma, bronchiectasis) Reduce local lung defences Increases risk of CPA, ABPA, or colonisation

✅ What Can You Do to Stay Safe?

  • Take antifungals as prescribed, especially if you're on steroids or biologics

  • Avoid unnecessary long-term steroid use — use the lowest dose for the shortest time

  • Report new or worsening symptoms early — especially breathlessness, coughing blood, fatigue, or sinus pain

  • Have regular follow-ups with your respiratory or infectious diseases team

  • Don’t stop any medication suddenly — especially steroids — without medical advice

💬 Final Reassurance

Having aspergillosis doesn’t mean you’re severely immunocompromised — but some treatments can increase your risk if not managed carefully. With the right balance of antifungals, asthma treatments, and medical support, many people live well with ABPA, CPA, and related conditions.

by GAtherton

Other forms of Aspergillosis

The majority of patients with aspergillosis will have forms that affect their lungs, as of course, that is where most exposure to Aspergillus occurs when we inhale the spores. There are, however, many more areas of our bodies that can be infected with Aspergillus. The sites of infection are much more difficult for spores to reach, so these forms of aspergillosis are much rarer compared with pulmonary forms, but they do occasionally happen, and as this is a website concerned with all forms of aspergillosis, we will try to summarise each form in this series of articles.

If you have been diagnosed with one of these rarer forms of aspergillosis you are welcome to join our support groups on Facebook, but be sure to explain which form you have, in any questions that you may ask, to avoid confusion. Different forms of aspergillosis can be treated in very different ways so be sure that the information you read is relevant to your aspergillosis.

There has long been a listing of other forms of aspergillosis in the treatment section of the Aspergillus & Aspergillosis website. These articles are intended for medical specialists so we will attempt to interpret them here for patients & non-specialists and also provide updated information where appropriate.

by GAtherton

Other forms of Aspergillosis: 🔬 Acute Invasive Aspergillus Sinusitis (AIAFS)

⚠️ A rare and severe fungal sinus infection — seen almost exclusively in people with severely weakened immune systems

🧾 What is it?

Acute Invasive Aspergillus Sinusitis (AIAFS) is a rapidly progressing fungal infection of the sinuses, caused by Aspergillus species (typically A. fumigatus). It leads to tissue invasion, destruction, and potentially fatal complications if not treated urgently.

🛡️ Who is at Risk of Acute Invasive Aspergillus Sinusitis?

Acute Invasive Aspergillus Sinusitis (AIAFS) is very rare, and affects people who are significantly immunocompromised — meaning their immune systems are unable to control even common environmental fungi.
However, “immunocompromised” is not always black-and-white. There are different degrees of vulnerability, and it's important to understand who is at greatest risk.

🔴 High-risk (severe immunosuppression)

These individuals are at the greatest risk for AIAFS:

  • Profound neutropenia (especially <500 neutrophils/μL for >10 days)

  • Acute leukaemia or stem cell transplantation

  • Solid organ transplant recipients on strong immunosuppressive regimens

  • High-dose corticosteroids (e.g. ≥20 mg prednisolone/day for ≥2 weeks)

  • Uncontrolled HIV/AIDS with low CD4 counts (<200)

  • Diabetic ketoacidosis or severe metabolic acidosis

🟠 Intermediate-risk (chronic or moderate immunosuppression)

Patients in this category may not be at risk of AIAFS, but may still be more vulnerable to chronic or allergic forms of aspergillosis or other infections:

  • Long-term oral corticosteroids at lower doses (e.g. <10 mg/day)

  • Biologic therapies for asthma (e.g. anti-IL-5, anti-IgE), which may subtly modulate immunity

  • Genetic susceptibility (e.g. subtle immune pathway deficiencies identified in CPA or ABPA)

  • COPD, bronchiectasis or severe asthma with impaired local defence

  • Malnutrition or poorly controlled diabetes

These patients are not typically at risk of invasive sinus aspergillosis, but may experience worsening of fungal conditions or atypical presentations of infection.

🟢 Low-risk (normal immune function)

People with normal immune function — even those with:

  • Allergic rhinitis

  • Chronic rhinosinusitis

  • Mild asthma or occasional infections

…are not at risk of developing AIAFS. Everyday exposure to Aspergillus spores is harmless to most people.

💬 Key Clarification:

Having aspergillosis does not automatically mean you are at risk of invasive sinus infection.
Many patients with CPA, ABPA, or SAFS are immunologically “fragile,” but not severely immunocompromised.
AIAFS typically only occurs in people with a combination of immune suppression and a very specific set of risks — especially when white blood cell function is severely impaired.

📋 Symptoms and Signs (typically <4 weeks onset)

  • Fever that does not respond to antibiotics

  • Facial pain or pressure, often severe and one-sided

  • Nasal congestion, discharge (often bloody or blackish)

  • Dark scabs (eschar) on the nasal mucosa or palate

  • Eye swelling, visual changes, or cranial nerve symptoms (if spread to the orbit or brain)

  • Altered mental state, seizures (in advanced cases)

🧪 Diagnosis

AIAFS is diagnosed based on:

  • Clinical suspicion in a high-risk patient

  • Endoscopic examination with biopsy and histology (showing hyphal invasion of tissue)

  • CT/MRI imaging to assess spread (bone, orbit, brain)

  • Culture and molecular testing of sinus material

  • Aspergillus PCR or galactomannan testing may help, but are not definitive alone

💊 Treatment Approach

Treatment must begin urgently, ideally within hours of suspicion.

1. Systemic antifungal therapy

  • First-line: Voriconazole or Isavuconazole

  • Alternatives: Liposomal Amphotericin B

  • Combination therapy may be considered in some cases

  • Therapeutic drug monitoring is essential (especially for voriconazole)

2. Surgical debridement

  • Prompt and aggressive endoscopic surgery is critical

  • Repeat procedures may be needed to remove necrotic tissue

3. Immunological support

  • Reversal of neutropenia if possible (e.g. G-CSF)

  • Reduction or withdrawal of immunosuppressive drugs

  • Management of underlying condition (e.g. glycaemic control in diabetes)

📈 Prognosis

  • Mortality is high (>50%) if not recognised and treated early

  • With rapid antifungal therapy and surgery, survival improves significantly

  • Regular monitoring, follow-up imaging, and immune recovery are crucial to long-term outcomes

🧠 Key Points to Remember

✅ This is a medical emergency, but
✅ It is extremely rare, and
✅ Almost exclusively affects those with profound immune suppression
✅ Not a risk to the general public or people with typical sinus infections

📣 Summary for Patient Awareness

Acute Invasive Aspergillus Sinusitis is very rare.
It is a fast-moving sinus infection caused by a fungus called Aspergillus, but it only happens in people with very weak immune systems, like those having chemotherapy or organ transplants.
It needs urgent treatment with antifungal medicine and sometimes surgery.
If your immune system is normal, this infection is not a risk to you.

by GAtherton

🩺 Why an Accurate Diagnosis Matters in Aspergillosis

If you've been told you have aspergillosis — or one of its forms like ABPA or CPA — you may wonder:
"Why does the exact diagnosis matter?"

Isn’t treatment just treatment?

Actually, no. In aspergillosis, getting the right diagnosis makes a huge difference to your care, safety, and long-term health.

This article explains why an accurate diagnosis is essential – not just for treatment, but also for recovery, monitoring, access to specialist care, and living well with the condition.

🔍 What Are ABPA and CPA?

Both ABPA and CPA are caused by the Aspergillus mould, but they affect the body in very different ways:

Condition Description
ABPA (Allergic Bronchopulmonary Aspergillosis) An allergic reaction to Aspergillus in the lungs. Most common in people with asthma or cystic fibrosis.
CPA (Chronic Pulmonary Aspergillosis) A chronic lung infection with Aspergillus. Often seen in people with damaged lungs (e.g. past TB, COPD, bronchiectasis).

Because the symptoms can overlap (like coughing, mucus, or fatigue), it's not always easy to tell them apart — but the treatments are completely different.

🎯 Why Accurate Diagnosis is So Important

1. ✅ Get the Right Treatment

Different types of aspergillosis need very different medicines.

Diagnosis Main Treatment Notes
ABPA Steroids (e.g. prednisolone), sometimes antifungals (like itraconazole) Helps control inflammation and allergy
CPA Long-term antifungals (e.g. itraconazole, voriconazole, posaconazole) Steroids may make CPA worse

A wrong diagnosis can lead to the wrong treatment — and that can delay recovery or cause harm.

2. 📆 Plan Your Long-Term Care

Each condition has its own journey:

  • ABPA tends to flare up and settle down, often alongside asthma.

  • CPA is usually chronic and progressive, slowly damaging the lungs if untreated.

Knowing your diagnosis helps your doctors decide:

  • How often to scan your lungs (CT or X-rays)

  • What blood tests to monitor (e.g. IgE for ABPA, IgG for CPA)

  • How long to continue medication

  • What symptoms need urgent review

3. ⚠️ Avoid Side Effects and Harm

If you're given steroids for the wrong condition (e.g. CPA), they can:

  • Weaken your immune system

  • Let the fungal infection get worse

  • Increase the risk of diabetes, weight gain, or bone thinning

And if you’re given antifungals for ABPA without treating the allergy side, you might still keep having flare-ups.

A correct diagnosis helps your team weigh up risks and benefits — and adjust safely.

4. 🏥 Access the Right Specialist Services

In the UK, some treatments are only available for specific diagnoses:

  • Biologic drugs like omalizumab or mepolizumab are only available for severe ABPA under strict NHS criteria.

  • Long-term antifungal treatment for CPA is provided by highly specialised services, such as the National Aspergillosis Centre in Manchester.

Without the right diagnosis on record, access to these treatments may be delayed or blocked.

5. 🧭 Understand What to Expect

An accurate diagnosis helps you understand:

  • What symptoms are normal, and what should be reported

  • Whether your condition is likely to get better, stay the same, or slowly worsen

  • What lifestyle changes, home monitoring, or support groups might help

It also allows your care team to link you to others with similar conditions — for advice, reassurance, and shared experiences.

🧪 What Tests Help Make the Diagnosis?

Your specialist may request:

  • Blood tests (e.g. IgE, IgG antibodies to Aspergillus)

  • CT scans to look at the shape of your lungs

  • Sputum or bronchoscopy samples to grow or detect the fungus

  • Breathing tests (lung function) to assess airflow and trapping

These help build a full picture — no one test is enough on its own.

💬 In Summary

“Aspergillosis” is an umbrella term — but the exact type you have really matters.

Getting the correct diagnosis helps ensure:

  • 🧬 You get the most effective treatment

  • 📊 You avoid unnecessary harm

  • 📆 You have the right follow-up plan

  • 🧠 You understand your condition better

  • 🩺 You can access the right NHS services

If you're not sure which type of aspergillosis you have — or you feel your diagnosis hasn’t been reviewed in a while — speak to your GP or respiratory team.

by GAtherton

🫁 Understanding Bronchiectasis, COPD, and Aspergillosis: What Patients Need to Know

Living with a lung condition can be confusing — especially when the symptoms of bronchiectasis, COPD, and aspergillosis are so similar. This guide explains the differences, how they are diagnosed, and why many people are wrongly diagnosed (or underdiagnosed) at first.

🌬️ What Are These Conditions?

Bronchiectasis

A condition where the airways become damaged, widened, and scarred, often from past infections, immune problems, or conditions like ABPA or CPA. This makes it hard to clear mucus, leading to regular infections.

COPD (Chronic Obstructive Pulmonary Disease)

A group of conditions — including emphysema and chronic bronchitis — that cause narrowed airways and damaged air sacs. Most often caused by smoking or long-term exposure to fumes or dust.

Aspergillosis

An infection or allergic reaction caused by the fungus Aspergillus. Types include:

  • ABPA (allergic bronchopulmonary aspergillosis) — mostly in asthma or bronchiectasis

  • CPA (chronic pulmonary aspergillosis) — causes lung cavities and fungal balls

  • Aspergillus bronchitis — low-grade infection in people with bronchiectasis

🔄 Shared Symptoms

All three can cause:

Symptom Bronchiectasis COPD Aspergillosis
Chronic cough ✅ ✅ ✅
Sputum (phlegm) ✅ (often a lot) ✅ (varies) ✅ (sticky, sometimes brown)
Breathlessness ✅ ✅ ✅
Recurrent infections ✅ ✅ ✅
Fatigue ✅ ✅ ✅
Wheezing Sometimes ✅ ✅ in ABPA
Coughing blood (haemoptysis) ✅ ⚠️ ✅ (especially in CPA)

Because the symptoms are so similar, many people with aspergillosis are first told they have COPD or bronchiectasis until further tests are done.

🖥️ How Are They Diagnosed?

🧪 Tests Used

Test Helps Diagnose
Spirometry (lung function) COPD or asthma (airflow obstruction)
High-resolution CT scan Bronchiectasis, CPA, emphysema
Aspergillus IgG & IgE blood tests CPA (IgG), ABPA (IgE)
Sputum culture or PCR Finds Aspergillus or bacterial infections
Eosinophil count High in ABPA
Chest X-ray May show cavities, but CT is better

🫁 CT Scan Signs: What Do Radiologists Look For?

Feature Bronchiectasis COPD CPA / Aspergillosis
Airway shape Widened, thickened (signet-ring sign) Narrowed or normal May have overlapping bronchiectasis
Lung tissue Scarring, mucus plugging Blackened areas (emphysema) Cavities, fungal balls, fibrosis
Mucus Often present Sometimes present Mucus or fungus in airways
Other signs Tree-in-bud, cystic changes Air trapping, flattened diaphragm Thickened cavity walls, pleural changes

💨 What Are Air Trapping and Hyperinflation?

These are signs that air is getting stuck in the lungs — common in asthma, COPD, ABPA, and sometimes CPA.

🔹 Air trapping

Air gets into the lungs but can’t get out fully. You may feel like you can’t finish exhaling.

  • Seen on CT scan as dark areas during breathing out.

  • Lung function tests show high residual volume (RV).

  • Common in asthma, ABPA, bronchiectasis, and COPD.

🔹 Hyperinflation

The lungs are permanently overfilled with air, even when you’re not trying to breathe in.

  • Seen on CT/X-ray as large lungs, flattened diaphragm, and horizontal ribs.

  • Lung function shows high total lung capacity (TLC).

  • Common in emphysema, severe asthma, and ABPA.

Why it matters: Both conditions make breathing harder and less efficient, especially when active. Treatment like inhalers, antifungals, airway clearance, or biologics may help.

💊 Treatment Approaches

Treatment Bronchiectasis COPD Aspergillosis
Airway clearance physiotherapy ✅ Essential Sometimes ✅ Often vital
Antibiotics ✅ Regularly used During flares ✅ For Aspergillus bronchitis/CPA
Inhalers (bronchodilators) Sometimes helpful ✅ Core treatment ✅ In ABPA if asthma is present
Steroids In flares or ABPA ✅ Often ✅ In ABPA
Antifungals (e.g. itraconazole, voriconazole) ❌ Not routine ❌ ✅ Main treatment for CPA/ABPA
Pulmonary rehab ✅ ✅ ✅ May help fatigue/breathlessness
Oxygen Rare ✅ In advanced disease ✅ In some advanced cases

🧠 Why It’s Complicated

Many patients are misdiagnosed at first:

  • Aspergillosis can develop on top of COPD or bronchiectasis

  • A long delay in diagnosis is common

  • Some people have all three conditions, or overlapping features (e.g. COPD + ABPA)

That’s why blood tests and CT scans are so important — symptoms alone aren’t enough.

✅ Summary Table

Feature Bronchiectasis COPD Aspergillosis
Cause Infection, immune issues Smoking, pollutants Fungal allergy or infection
Airway problem Widened, mucus-filled Narrowed, damaged sacs Cavities, fungus growth or allergy
Diagnostic test CT scan Spirometry CT + Aspergillus IgG/IgE
Key treatment Clearance + antibiotics Inhalers, steroids Antifungals ± steroids

💬 What Should I Ask My Doctor?

  • Could my symptoms be due to more than one condition?

  • Have I had a CT scan and Aspergillus blood tests?

  • Should I be seen by a specialist centre (e.g. for ABPA or CPA)?

  • Am I using the right inhalers or physiotherapy?

  • Could I benefit from a sputum test or antifungal treatment?

by GAtherton

🩺 Lung Function Tests Explained: What They Tell Us About Asthma, COPD, Bronchiectasis, and Aspergillosis

If you’re living with a lung condition like asthma, COPD, bronchiectasis, or aspergillosis, you may be asked to have a lung function test. These tests help your medical team understand how well your lungs are working — and how best to treat you.

🌬️ What Are Lung Function Tests?

Lung function tests (also called pulmonary function tests) measure:

  • How fast and deeply you can breathe

  • How well your lungs move oxygen into your blood

  • How much air gets trapped in your lungs

🔬 Main Tests and What They Measure

Test What It Measures Why It Matters
Spirometry Speed and volume of air breathed out Shows obstruction or reversibility (e.g. in asthma)
Lung volumes Total size of the lungs and air left after exhaling Detects air trapping and hyperinflation
Gas transfer (DLCO) How well gases pass from lungs to blood Can show scarring, emphysema, or CPA
Bronchodilator test Measures response to inhaler Helps diagnose asthma or ABPA

🧠 What Do These Tests Tell Us?

Here’s how different conditions show up in lung function testing:

🟢 Asthma

  • Airways are narrowed, but often improve with inhalers.

  • Shows obstruction that improves significantly after a bronchodilator (reversible).

  • Lung volumes usually normal; DLCO often normal or high.

🔵 COPD

  • Shows irreversible obstruction — lungs are stiff and narrowed.

  • Often shows air trapping and hyperinflation.

  • DLCO is reduced, especially in emphysema.

🟠 Bronchiectasis

  • May show mild-to-moderate obstruction or mixed patterns.

  • Sometimes reversible, depending on overlapping asthma or infection.

  • Lung volumes and DLCO often normal unless CPA or emphysema is also present.

🟣 Aspergillosis

  • ABPA: Like asthma — obstruction, often with reversibility, air trapping, high IgE and eosinophils.

  • CPA: May cause a restrictive pattern (lower lung volumes) or reduced DLCO if fibrosis or cavities are present.

  • Aspergillus bronchitis: May look like bronchiectasis with some obstruction.

💨 What Is Air Trapping?

Air trapping happens when you breathe in, but can’t get all the air back out. Some air stays stuck in the lungs.

Sign What It Means
High residual volume (RV) Too much air remains after breathing out
Expiratory CT scan shows dark areas Parts of the lungs aren’t emptying properly

Common in:

  • Asthma

  • ABPA

  • Bronchiectasis

  • COPD

🎈 What Is Hyperinflation?

Hyperinflation means your lungs are constantly overfilled with air — not just trapped temporarily, but stretched long-term.

Sign What It Means
High total lung capacity (TLC) Lungs are too large due to long-term air trapping
Flattened diaphragm Lungs are pressing downward on breathing muscles

Common in:

  • Severe asthma

  • Emphysema (COPD)

  • ABPA (when uncontrolled)

📊 Summary Table

Condition Common Lung Test Features
Asthma Obstruction, reversible, normal DLCO
ABPA Obstruction, reversible, air trapping, high IgE
COPD Fixed obstruction, hyperinflation, low DLCO
Bronchiectasis Variable obstruction, sometimes reversible
CPA Restriction or mixed pattern, reduced DLCO
Aspergillus bronchitis Similar to bronchiectasis, sputum positive for fungus

💬 Why These Tests Matter

  • They help distinguish what’s causing your symptoms.

  • They track whether treatment is working (inhalers, steroids, antifungals).

  • They identify complications like scarring, cavities, or fungal infection.

  • They help guide eligibility for biologic drugs or oxygen therapy.

📣 Ask Your Doctor:

  • Have I had a bronchodilator response test?

  • Do I have air trapping or hyperinflation?

  • Should we test for Aspergillus (IgG, IgE, sputum)?

  • Would a CT scan add helpful detail?

by GAtherton

🟣 Aspergillus Bronchitis: A Patient Guide

If you've been diagnosed with bronchiectasis, COPD, or other chronic lung problems, and keep getting infections or mucus that tests positive for Aspergillus, you might be told you have Aspergillus bronchitis. But what does that mean? And how is it different from ABPA (Allergic Bronchopulmonary Aspergillosis)?

This guide explains what Aspergillus bronchitis is, how it’s diagnosed, how common it is, and how it differs from ABPA.

🌬️ What Is Aspergillus Bronchitis?

Aspergillus bronchitis is a chronic fungal infection of the airways caused by Aspergillus fumigatus. It happens in people with damaged or scarred airways, such as:

  • Bronchiectasis

  • COPD

  • Cystic fibrosis

  • Occasionally asthma (if structural damage exists)

It’s a low-grade infection, not an allergy and not an invasive disease. The fungus lives in the mucus lining the airways, causing persistent inflammation, infection, and symptoms.

🔍 What Are the Symptoms?

Common symptoms What to know
Persistent cough Often brings up sticky or brown mucus
Worsening breathlessness Not always explained by asthma or infection alone
Fatigue or low energy Common in chronic fungal infections
Frequent infections May keep returning despite antibiotics
Wheeze Sometimes, especially in asthma or ABPA overlap
Weight loss or low-grade fever Possible in long-standing infection

📊 How Common Is It?

Aspergillus bronchitis is underdiagnosed but increasingly recognised — especially in patients referred to specialist centres.

Estimated frequency in different conditions:

Underlying condition Estimated rate of Aspergillus bronchitis
Bronchiectasis ~5–15%, higher in referral centres
COPD ~1–5%, especially with steroid use
Cystic fibrosis 5–10% (non-allergic cases)
Asthma (alone) Rare unless bronchiectasis is also present

It may be mistaken for a flare-up or chronic bacterial infection. Many people are told it’s “just colonisation” — but if symptoms persist and Aspergillus keeps growing in sputum, Aspergillus bronchitis should be considered.

🧪 How Is It Diagnosed?

There’s no single test. Diagnosis is based on clinical features plus evidence of fungal growth and a non-allergic immune pattern.

Test What it shows
Sputum culture / PCR Repeated detection of Aspergillus
Aspergillus IgG (blood) Often raised, shows chronic exposure
Aspergillus IgE & eosinophils Usually normal — helps exclude ABPA
CT scan Shows bronchiectasis, mucus plugging, but no cavitation
Response to antifungals Clinical improvement supports diagnosis

🔄 How Is It Different from ABPA?

ABPA is an allergic reaction to Aspergillus that mainly affects people with asthma or cystic fibrosis.
Aspergillus bronchitis, on the other hand, is a fungal infection in damaged airways, not an allergy.

Feature Aspergillus Bronchitis ABPA
Type of disease Chronic fungal infection Allergic lung disease
Immune markers High IgG, normal IgE High IgE and eosinophils
Sputum Repeated growth of Aspergillus May or may not grow
CT findings Bronchiectasis, mucus Central bronchiectasis, mucus plugs
Treatment Antifungals only Steroids ± antifungals
Typical patient Bronchiectasis, COPD Asthma (often severe), sometimes CF

Some patients can have both conditions at once, especially those with asthma and bronchiectasis — so testing is important.

💊 Treatment Options

Treatment Purpose
Oral antifungals (itraconazole, voriconazole) Main treatment — often for several months
Inhaled antifungals (e.g. nebulised amphotericin) Alternative if oral drugs not tolerated
Airway clearance physiotherapy Helps remove mucus and fungal load
Regular sputum testing To monitor treatment response
Steroids Not used unless there’s overlapping ABPA or asthma

🧠 Summary

Question Answer
Is it an infection? ✅ Yes — fungal infection in the airways
Is it an allergy? ❌ No — that’s ABPA
Can it coexist with ABPA? ✅ Yes, in some cases
How is it diagnosed? Repeated Aspergillus in sputum + high IgG + symptoms
How is it treated? Antifungal medication (oral or nebulised)
Will it go away? Often improves with treatment, but monitoring is essential

💬 What to Ask Your Doctor

  • Could my symptoms be from Aspergillus bronchitis?

  • Have I had sputum cultures and Aspergillus blood tests (IgG, IgE)?

  • Would antifungal treatment help me?

  • Should I be referred to a specialist centre (e.g. for CPA, ABPA, bronchiectasis)?

  • Am I on the best airway clearance and physiotherapy plan?

by 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