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

🌬️ Living with Asthma and Aspergillosis: Understanding the Overlap, the Immune System, and the Right Treatment

If you live with asthma and have been told you also have aspergillosis, such as ABPA (Allergic Bronchopulmonary Aspergillosis) or SAFS (Severe Asthma with Fungal Sensitisation), your situation is more complex than most people realise.

This guide explains:

  • The different types of asthma

  • How aspergillosis complicates asthma

  • The role of eosinophils, IgE, and the immune system

  • Why some people don’t have “typical” symptoms (like wheeze)

  • What treatments are available — and how to personalise your care

🧠 Asthma Isn’t One Disease

Asthma is a condition where the airways (breathing tubes) become:

  • Inflamed (swollen and irritated)

  • Overreactive to certain triggers (allergens, cold air, infection, etc.)

  • Narrowed and often filled with mucus, making breathing difficult

But not everyone with asthma has the same cause, symptoms, or treatment response. Asthma actually includes many subtypes — and understanding your type is key to getting the right care.

🧬 Common Asthma Types in Aspergillosis

Asthma Type Cause / Trigger Key Features
Allergic asthma IgE-driven allergy to pollen, dust, pets, fungi Common in early-life asthma
Eosinophilic asthma High levels of eosinophils (a white blood cell) Often adult-onset and hard to control
SAFS Allergy to fungi (especially Aspergillus) Severe, steroid-resistant asthma
ABPA Allergic reaction to Aspergillus growing in lungs Very high IgE, eosinophils, mucus, lung damage
Cough-variant asthma Inflammation without wheeze Dry cough as the only symptom
“Silent” asthma Reduced or absent warning signs No wheeze, may present with fatigue, cough or breathlessness only

🫢 New Section: What Is “Silent Asthma”?

“Silent asthma” is not an official medical term, but it’s used to describe:

  • Asthma without the classic wheeze (often just cough or tightness)

  • Or where asthma attacks happen suddenly, without clear warning

This is important because:

  • People may not realise they have asthma

  • Diagnosis may be delayed or missed

  • Flare-ups can be severe or even life-threatening

  • It may occur in people with fungal asthma, ABPA, or airway damage

Silent asthma is especially relevant in:

  • Older adults

  • People with ABPA or SAFS

  • People with cough-variant asthma

  • Anyone whose asthma doesn’t “sound” typical

🧪 Tests like FeNO, spirometry, and blood eosinophil counts are vital for confirming what’s really happening inside the lungs — even if symptoms are subtle.

🔬 Why ABPA Adds Complexity

If you have ABPA, the asthma symptoms are made worse by:

  • A hypersensitive immune reaction to Aspergillus fumigatus

  • Mucus plugging and blocked airways

  • Lung damage (bronchiectasis) that doesn’t improve with inhalers alone

  • A mix of allergic and eosinophilic inflammation

Key signs include:

  • Extremely high IgE levels

  • Raised eosinophils

  • Positive blood tests for Aspergillus

  • Lung CT scan changes

💊 Treatment Options Based on Asthma Type

Treatment Used For
Inhaled corticosteroids (ICS) All types, first-line
Antifungal medications ABPA, SAFS
Oral steroids (e.g. prednisolone) ABPA flares, severe asthma
Biologics (e.g. mepolizumab, omalizumab) Severe allergic or eosinophilic asthma
Chest physiotherapy Mucus clearance in ABPA or bronchiectasis

Each treatment is tailored based on whether your asthma is driven by:

  • IgE (allergy)

  • Eosinophils (inflammation)

  • Fungal exposure or colonisation

📍 What to Discuss with Your Healthcare Team

If you:

  • Have asthma that isn’t well controlled

  • Need frequent steroids

  • Have a chronic cough, thick mucus, or lung damage

  • Have high IgE or eosinophils

  • Or don’t wheeze, but still get breathless or fatigued…

… it’s important to ask your doctor:

  • Could I have ABPA or SAFS?

  • Is there a fungal or eosinophilic component to my asthma?

  • Should I be tested for Aspergillus allergy or IgE?

  • Am I a candidate for biologics or antifungals?

✅ Final Takeaway

Asthma with aspergillosis is more than just “bad asthma” — it’s a complex condition involving allergy, inflammation, fungal exposure, and in some cases, permanent airway changes. Some patients don’t experience wheeze — this is called “silent asthma,” and it deserves just as much attention.

You don’t have to manage this alone — and there are now targeted treatments that can help reduce symptoms, prevent damage, and improve quality of life.

by GAtherton

Telecare Devices and the UK Digital Switchover: What Aspergillosis Patients and Carers Need to Know

Background By the end of 2025, traditional landline telephone networks in the UK will be phased out and replaced by digital (VoIP) systems delivered via broadband. This national "Digital Switchover" affects anyone using landline-based devices, including many telecare systems vital to people with chronic illnesses like chronic pulmonary aspergillosis (CPA), ABPA, and SAFS.

This document provides clear guidance for aspergillosis patients and carers concerned about how this change affects telecare equipment such as fall alarms, pendant buttons, and GPS trackers.

Why This Matters for Aspergillosis Patients Many people with aspergillosis rely on telecare to remain safe at home. These may include:

  • Fall detectors
  • Emergency pendant alarms
  • Door sensors
  • GPS trackers
  • Daily wellbeing check-in devices

These systems were typically connected to analogue landlines. Once the switch to digital phone lines is made, some older devices may stop working correctly unless they are upgraded or adapted.

What Changes with the Digital Switchover?

Feature Current (Analogue Landline) Future (Digital via Broadband)
Phone line works during power cuts Yes No (unless battery backup is added)
Telecare devices plug into phone socket Yes Only with compatible router or adapter
Works independently of broadband Yes No, relies on internet connection

Common Concerns and Solutions

  1. "Will my current telecare alarm still work?"
    • Possibly not. Many older alarms won't function over digital broadband lines.
    • Solution: Ask your alarm provider if your device is VoIP compatible or if they can supply a digital-ready or cellular version.
  2. "Will full fibre broadband stop my telecare from working?"
    • Not automatically, but older devices may be incompatible.
    • Solution: If switching to full fibre, ensure your telecare system can plug into the new router or ask about an analogue telephone adapter (ATA) with battery backup.
  3. "What happens during a power cut?"
    • Digital lines go down unless you have a UPS (Uninterruptible Power Supply) or the telecare device is cellular-based.
  4. "Can I upgrade to something more future-proof?"
    • Yes. Many councils and private providers now offer mobile-enabled alarms with built-in SIM cards and GPS.
    • These do not rely on landlines or home Wi-Fi.

What You Should Do Now

  1. Contact your telecare provider
    • Ask if your current device is digital-compatible.
    • Request upgrade options if needed.
  2. Speak to your broadband provider
    • Let them know you use telecare. Ask about battery backup or compatibility.
  3. Contact your local Adult Social Care team
    • Many councils are offering free or subsidised upgrades to digital or mobile telecare.
  4. Test your system
    • Before and after switching broadband providers, run a test call with your alarm provider.

Summary As the UK phases out analogue landlines, it's essential for patients and carers to act early. Ensuring your telecare system is compatible with digital broadband will help maintain your independence and safety. Monitoring your oxygen saturation may also support early detection of lung health changes.

Resources for Further Help

If you have questions or need help contacting the right services, the National Aspergillosis Centre support team can guide you.

by GAtherton

📄 Why Might My Posaconazole Levels Be Undetectable?

Understanding Antifungal Monitoring in Aspergillosis Treatment

If you’re taking posaconazole to treat Aspergillus-related conditions like ABPA (Allergic Bronchopulmonary Aspergillosis) or CPA (Chronic Pulmonary Aspergillosis), your doctor may ask for blood tests to check if the drug is reaching the right levels in your body.

Sometimes, those tests come back showing “undetectable” or “very low” levels, even when you’ve been taking the medication exactly as prescribed.

This can be worrying — but there are several common reasons this happens, and it doesn’t always mean the medicine isn’t working or that you’ve done something wrong.

❓ What Is Posaconazole?

Posaconazole is an antifungal medicine used to treat infections caused by the Aspergillus fungus. It comes in tablet, liquid, or IV forms. Most people take the tablet once a day — often for many weeks or months.

To work properly, the drug needs to reach a certain level in your bloodstream. This is why your team may request a blood test to check how well your body is absorbing it.

🔍 Reasons Your Posaconazole Levels May Be Low or Undetectable

1. Not Enough Fat in Your Diet

Posaconazole needs some fat in your meal to be absorbed properly — especially the liquid version.
Try to take it with a meal that includes:

  • Dairy (cheese, yoghurt, full-fat milk)

  • Eggs, nuts, or oily fish

  • A little olive oil or butter in cooking

Tip: Never take it on an empty stomach!

2. Other Medications or Supplements

Some medications and remedies can reduce how well posaconazole is absorbed, including:

  • Proton pump inhibitors (e.g. omeprazole, lansoprazole)

  • Antacids

  • Rifampicin

  • Herbal supplements like St John’s Wort

Let your doctor or pharmacist know about everything you take — even vitamins and over-the-counter products.

3. Timing of the Blood Test

The blood test should be taken just before your next dose (called a trough level).
If it’s taken too early (after a fresh dose), or too late (if you missed a dose), it may give a misleading result.

4. Problems with Absorption

Some medical conditions can make it harder for your body to absorb medications, including:

  • Coeliac disease

  • Crohn’s or colitis

  • Chronic diarrhoea or digestive issues

If you have any of these, your doctor may suggest an alternative form — like switching from liquid to tablet or tablet to IV.

5. Lab or Sample Error

Occasionally, there may be a problem with the blood sample — like a delay in handling, or a lab processing issue. In that case, your team may simply repeat the test.

✅ What You Can Do

✔️ Take your medicine with food (especially with fat)
✔️ Tell your team about other medications
✔️ Check which form you’re taking (tablets are usually better absorbed than the liquid)
✔️ Ask when your blood test should be done
✔️ Don’t panic if the result is low — just repeat the test with support from your team

🩺 Why This Matters

Getting the right amount of posaconazole in your body is essential to:

  • Help clear fungal infection

  • Prevent it from spreading

  • Reduce symptoms like coughing, breathlessness, and mucus

  • Avoid the risk of fungal resistance

💬 Talk to Your Healthcare Team

If you’re concerned about your levels or not feeling better, don’t stop your medication — contact your team. There may be a simple fix like adjusting your dose, changing the form of medicine, or switching how and when you take it.

📘 For more information

Visit: www.aspergillosis.org
Or speak to your GP, pharmacist, or specialist team.

by GAtherton