Mental Health Awareness Week: Supporting the Emotional Impact of Aspergillosis
Mental Health Awareness Week is a reminder that health is not only physical.
For people living with aspergillosis, and for the family members and carers who support them,
the emotional impact of a long-term lung condition can be significant.
Aspergillosis can bring uncertainty, fatigue, breathlessness, repeated appointments,
medication changes, worries about test results, and concerns about the future.
It is understandable that some people experience anxiety, low mood, frustration,
isolation, or disturbed sleep.
Carers may also feel under pressure. Supporting someone with a chronic illness can be rewarding,
but it can also be tiring and emotionally demanding. Looking after your own mental health is not selfish;
it helps you continue to support the person you care about.
Small steps can help
- Talk to someone you trust about how you are feeling.
- Stay connected with friends, family, or peer support groups.
- Pace your activities and allow time for rest.
- Try gentle movement if this is safe and manageable for you.
- Write down worries or questions before appointments.
- Ask your healthcare team for support if anxiety, low mood, or stress is affecting daily life.
You are not alone
Many people with aspergillosis find it helpful to speak with others who understand what it is like
to live with a rare fungal lung condition. Peer support can reduce isolation and help patients and carers
feel more informed and understood.
The National Aspergillosis Centre and associated patient organisations provide support, information,
and opportunities to connect with others affected by aspergillosis:
- Aspergillosis support resources for families and carers
- Weekly aspergillosis support meetings
- Aspergillosis Support Facebook group
When to seek help
If you are feeling persistently overwhelmed, very low, anxious, unable to cope,
or if your mental health is affecting your day-to-day life, please speak to your GP,
specialist nurse, or healthcare team. Mental health support is an important part of healthcare.
If you feel at immediate risk of harming yourself, or you do not feel safe,
seek urgent help by calling emergency services or going to your nearest emergency department.
More information about Mental Health Awareness Week is available from the
Mental Health Foundation
Your mental health matters. Support, understanding, and connection can make a difference.
Dry Mouth, Aspergillosis and Dental Health
Why oral health problems may be more common than many patients expect
People living with aspergillosis often focus understandably on symptoms such as breathlessness, coughing, fatigue, wheezing or chest infections. However, many patients also notice problems affecting the mouth, throat and teeth — particularly dry mouth, soreness, altered taste and worsening dental health.
Although Aspergillus itself does not usually directly infect the mouth, the wider effects of chronic respiratory disease, medications and long-term treatment can sometimes have a significant impact on oral health and wellbeing.
Key points
- Dry mouth is commonly reported by patients with chronic respiratory disease and aspergillosis.
- Saliva is important for protecting teeth and gums.
- Steroid inhalers, mouth breathing and oxygen therapy can all contribute to dryness.
- Long-term dry mouth may increase the risk of tooth decay, gum disease and oral infections.
- Good oral hygiene and regular dental care are especially important.
- Dentists should be informed about antifungal medications and steroid treatment.
Why does dry mouth happen?
Dry mouth, sometimes called xerostomia, occurs when the mouth does not produce enough saliva or when saliva does not protect the mouth as effectively as usual.
Saliva plays several important roles. It helps protect teeth from decay, controls bacteria and fungi, reduces acidity in the mouth, supports swallowing and speech, and protects the delicate tissues inside the mouth.
When saliva levels fall, patients may notice:
- a sticky or dry feeling in the mouth;
- waking with a dry mouth;
- difficulty swallowing dry foods;
- sore gums, tongue or throat;
- bad breath;
- cracked lips;
- increased thirst;
- altered taste;
- mouth soreness or burning.
Why might aspergillosis patients be affected?
In many cases, the problem is not caused directly by Aspergillus itself. Instead, several factors linked to respiratory disease and treatment may combine together.
Steroid inhalers
Inhaled corticosteroids are commonly used in asthma, Allergic Bronchopulmonary Aspergillosis (ABPA), severe eosinophilic lung disease and other respiratory conditions.
These medicines are important and should not be stopped without medical advice, but they can sometimes contribute to mouth irritation, dryness, hoarseness, oral thrush and throat discomfort.
Using a spacer device, where appropriate, and rinsing the mouth after inhaler use may help reduce some local side effects.
Long-term steroid tablets
Some patients with aspergillosis or severe asthma have taken oral steroid tablets such as prednisolone, sometimes for prolonged periods. Long-term steroid exposure may affect immunity and can increase the risk of infections such as oral thrush.
Some patients may also develop adrenal suppression or adrenal insufficiency after prolonged steroid exposure. Patients with known adrenal insufficiency should make sure their dentist and healthcare team are aware before significant dental treatment or procedures.
Mouth breathing
Many people with chronic respiratory disease breathe through their mouth more often, especially overnight. This may happen because of blocked nose, sinus disease, breathlessness, coughing, asthma symptoms or poor sleep.
Over time, regular mouth breathing can dry the mouth and throat, especially during the night.
Oxygen therapy and CPAP
Supplemental oxygen and continuous positive airway pressure (CPAP) devices may dry the upper airways, particularly if humidification is not used.
Some patients notice dry lips, sore throat, dry nose, thick mucus or increased mouth discomfort overnight.
Medication side effects
A number of commonly prescribed medicines may contribute to dry mouth. These can include antihistamines, antidepressants, some pain medicines, bronchodilators and some blood pressure medicines.
The combined effect of several medicines may become significant, especially in people managing complex long-term health conditions.
Why does dry mouth matter for dental health?
Dry mouth is more than simply uncomfortable. Saliva normally helps protect the teeth and gums. Without enough saliva, plaque bacteria can grow more easily, acids remain in contact with teeth for longer, enamel may weaken and gums may become inflamed.
Some patients are surprised by how quickly dental problems can develop after periods of illness, long-term treatment or persistent dry mouth.
Possible problems include:
- tooth decay;
- gum disease;
- sensitive teeth;
- mouth ulcers;
- oral thrush;
- cracked lips;
- denture discomfort;
- difficulty eating or speaking comfortably.
Oral thrush and fungal infections
Patients with aspergillosis sometimes worry that oral fungal infections mean Aspergillus is spreading in the mouth. In most cases, oral thrush is caused by Candida yeast rather than Aspergillus.
Symptoms of oral thrush may include white patches, soreness, redness, altered taste, painful swallowing or cracking at the corners of the mouth.
Steroid inhalers and dry mouth can both increase the risk of thrush. Patients should seek medical or dental advice if symptoms persist or recur.
Important information for dentists
Patients should inform their dentist about:
- their aspergillosis diagnosis;
- inhaled or oral steroid use;
- adrenal insufficiency or adrenal suppression;
- antifungal medicines;
- oxygen therapy or CPAP use;
- significant breathlessness or difficulty lying flat.
This is important because some antifungal medicines, including itraconazole, voriconazole and posaconazole, can interact with other medicines. Dentists and doctors can help check for possible interactions when procedures, antibiotics, pain relief or sedation are being considered.
Practical tips that may help
Some patients find the following measures helpful:
- sip water regularly;
- avoid excessive alcohol and caffeine;
- use sugar-free gum or lozenges if suitable;
- ask a pharmacist or dentist about saliva replacement sprays, gels or mouthwashes;
- rinse the mouth after steroid inhalers;
- use a spacer device if recommended;
- brush twice daily with fluoride toothpaste;
- clean between teeth if able;
- attend regular dental reviews;
- avoid smoking;
- discuss persistent symptoms with a GP, dentist, pharmacist or specialist team.
Patients using oxygen or CPAP may wish to ask their respiratory team whether humidification is appropriate.
When to seek medical or dental advice
Seek advice if dry mouth is persistent, worsening or causing problems with eating, sleeping, swallowing or speaking.
Medical or dental review is particularly important if there are mouth ulcers, white patches, bleeding gums, rapid tooth decay, severe soreness, repeated oral thrush, signs of dehydration, dizziness or marked weakness.
Patients with adrenal insufficiency, severe respiratory disease or complex medication regimens should make sure healthcare professionals are aware before major dental procedures.
A commonly overlooked part of chronic illness
Living with aspergillosis often involves managing far more than lung symptoms alone. Dry mouth and dental health problems may seem minor at first, but over time they can affect comfort, nutrition, sleep, confidence, communication and overall quality of life.
Recognising these issues early may help patients seek support sooner and reduce longer-term complications.
Further information
Author and review information
Prepared by: National Aspergillosis Centre CARES Team / Aspergillosis Website Editorial Team
Last reviewed: May 2026
References and further reading
- NHS information on dry mouth and oral thrush.
- Dental and oral medicine guidance on xerostomia and prevention of tooth decay.
- Respiratory guidance on inhaled corticosteroids and inhaler technique.
- Medicines information for azole antifungals and corticosteroids.
Can Lung Function Improve After Infection or Treatment?
Last reviewed: May 2026
Audience: Patients, carers, and non-specialists
Key Points
- Lung function often can improve after infections, chemotherapy, or inflammation—but recovery may take weeks to months.
- A drop in peak flow usually reflects airway narrowing, inflammation, or mucus, not always permanent damage.
- Normal oxygen levels (e.g. 95–100%) are reassuring and suggest gas exchange is still working well.
- Symptoms like breathlessness and wheeze can persist even while the lungs are gradually recovering.
- If symptoms are not improving, further assessment may help identify treatable causes.
Contents
- Can lung function recover?
- Why has my lung function dropped?
- Why does recovery feel slow or “stuck”?
- What might help?
- Breathing techniques in detail
- When might further tests be needed?
- Common questions
- When to seek medical advice
Can lung function recover?
In many cases, yes—lung function can improve after a significant illness such as a chest infection, chemotherapy, or inflammation affecting the airways.
However, recovery is often gradual and not always straightforward. It may take:
- Several weeks after an infection
- Several months after more severe illness or treatment
It is also common for symptoms to fluctuate during recovery rather than steadily improve.
Why has my lung function dropped?
A reduction in peak flow or increased breathlessness does not always mean permanent damage. Common causes include:
- Airway inflammation (swelling inside the breathing tubes)
- Mucus build-up, which can block airflow
- Airway narrowing or spasm, similar to asthma
- Post-infectious sensitivity (airways remain irritated after infection)
- Reduced fitness after illness (deconditioning)
In some patients, conditions such as Allergic Bronchopulmonary Aspergillosis (ABPA) or other airway diseases can contribute to ongoing symptoms.
Important: If oxygen levels remain normal (for example, around 97%), this suggests that the lungs are still transferring oxygen effectively, which is reassuring.
Why does recovery feel slow or “stuck”?
Many people feel frustrated because they are doing everything “right” but not seeing improvement. This is very common.
Possible reasons include:
- Residual mucus that is difficult to clear
- Ongoing low-level inflammation
- Airways that remain sensitive after infection
- Effects of steroid treatment, especially during dose changes
- Fatigue and reduced activity levels
Recovery can happen slowly in the background, even when symptoms remain noticeable.
What might help?
Different approaches may support recovery. These should be discussed with your clinical team where appropriate.
1. Airway clearance
- Regular airway clearance techniques can help remove mucus
- Some people benefit from devices that assist mucus clearance
2. Breathing techniques
Breathing techniques can help reduce breathlessness and improve control. A more detailed guide is provided below.
3. Gradual activity
- Slowly increasing activity levels can rebuild strength
- Pacing is important—avoid pushing too hard too quickly
4. Optimising treatment
- Ensuring inhaler technique is correct
- Reviewing whether airway inflammation is fully controlled
Breathing Techniques in Detail
Breathing techniques can help reduce breathlessness, improve airflow, and make breathing feel more controlled—especially when airways are inflamed or narrowed.
They do not treat the underlying condition directly, but they can improve symptoms, confidence, and daily activity.
Pursed-Lip Breathing
What it does: Helps keep airways open for longer during breathing out, reducing air trapping and easing breathlessness.
How to do it:
- Breathe in slowly through your nose (about 2 seconds)
- Purse your lips (as if whistling)
- Breathe out slowly through your lips (about 4 seconds)
- Keep the breath out gentle, not forced
When to use it:
- During breathlessness
- With activity (e.g. walking, stairs)
- To regain control of breathing
Tip: Aim for a longer out-breath than in-breath.
Diaphragmatic (Belly) Breathing
What it does: Encourages more efficient breathing using the diaphragm rather than upper chest muscles.
How to do it:
- Sit or lie comfortably
- Place one hand on your chest, one on your abdomen
- Breathe in through your nose and allow your abdomen to rise
- Breathe out slowly (through pursed lips if helpful)
Tip: Keep shoulders relaxed and avoid lifting the chest.
Breathing Control (for flare-ups)
- Pause and rest
- Breathe slowly through the nose
- Breathe out gently through relaxed or pursed lips
- Release tension in shoulders and neck
Helpful positions:
- Sitting leaning forward with arms supported
- Standing leaning on a surface
“Blow as You Go”
Use during activity:
- Breathe in before effort
- Breathe out during effort (e.g. standing up, climbing)
This helps prevent breath-holding and reduces strain.
Important: These techniques should feel comfortable and controlled. If symptoms worsen, stop and rest.
When might further tests be needed?
If symptoms are persistent, worsening, or not improving as expected, your clinical team may consider:
- Spirometry (lung function tests)
- Imaging such as a chest CT scan
- Assessment for:
- Airway inflammation
- Bronchiectasis
- Fungal-related lung disease
Common Questions
Does a drop in peak flow mean permanent damage?
No. Peak flow mainly reflects how open your airways are and can improve with treatment.
Why do I feel breathless if my oxygen levels are normal?
Breathlessness is often caused by airway narrowing or inefficient breathing, not low oxygen.
Can lungs fully recover?
Some people return to their previous baseline. Others improve significantly but may not reach exactly the same level.
When to seek medical advice
- Worsening breathlessness
- Increasing wheeze or chest tightness
- New or persistent cough
- Changes in sputum (including blood)
- No improvement over time
If symptoms suddenly worsen, seek urgent medical attention.
Final Thoughts
A drop in lung function after infection or treatment can feel worrying, but it often reflects treatable airway changes. Improvement is possible, although recovery may take time.
Staying in contact with your healthcare team helps ensure that any ongoing issues are identified and managed appropriately.
References & Further Reading
- British Thoracic Society (BTS) guidance
- European Respiratory Society (ERS) patient resources
- National Aspergillosis Centre patient information
This article is for general information only and does not replace medical advice. Always consult your healthcare team.
ABPA or Steroid Side Effects? Understanding Symptoms During Long-Term Treatment
Last reviewed: April 2026
Many people living with Allergic Bronchopulmonary Aspergillosis (ABPA) who take long-term steroids find it difficult to tell whether their symptoms are caused by the condition or the treatment.
Symptoms in ABPA can come from both the condition and long-term steroid treatment. Fatigue, weakness, mood changes, and general unwellness are common to both, making it difficult to identify a single cause without clinical review.
This is especially true for people taking corticosteroids such as methylprednisolone or prednisolone.
---
Key Points
- ABPA and steroid treatment can cause overlapping symptoms.
- Fatigue, low mood, and general unwellness can come from either the condition or medication.
- Long-term corticosteroid use can cause additional side effects.
- It is common to feel unsure what is causing symptoms.
- Ongoing or worsening symptoms should be discussed with your healthcare team.
---
Why is it hard to tell the difference?
ABPA is an immune-driven lung condition that causes inflammation. Treatment often includes corticosteroids such as methylprednisolone or prednisolone, which reduce inflammation but can also affect many systems in the body.
This means that:
- The disease itself can cause symptoms
- The treatment can also cause symptoms
As a result, people often experience a combination of both.
---
Symptoms caused by ABPA
ABPA commonly affects the lungs but can also cause more general symptoms.
- Fatigue and low energy
- Breathlessness
- Cough and mucus production
- Chest tightness
- General feeling of being unwell
Fatigue can be particularly prominent, especially during flare-ups.
---
Side effects of long-term steroids
Corticosteroids such as methylprednisolone are highly effective treatments, but long-term use can lead to a range of side effects.
- Fatigue and weakness (including muscle loss)
- Mood changes (anxiety, low mood, irritability)
- Easy bruising (skin becomes thinner)
- Stomach irritation or pain
- Dizziness or feeling unwell
- Sweating
- Bone or joint discomfort
Learn more about treatment approaches in aspergillosis treatment options.
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Where symptoms overlap
Some symptoms can be caused by both ABPA and steroid treatment, making them difficult to interpret.
| Symptom | Possible cause |
|---|---|
| Fatigue | ABPA inflammation or steroid effects |
| Low mood / anxiety | Medication effects or impact of chronic illness |
| Weakness | Muscle loss from steroids or reduced activity |
| General unwell feeling | Both |
This overlap is one of the most challenging aspects of long-term management.
🔎 Not sure what’s causing your symptoms?
Many people with ABPA feel exactly the same—this overlap is one of the most common challenges during long-term treatment.
---
Understanding specific symptoms
Some symptoms are more commonly linked to treatment effects:
- Easy bruising – often related to steroid use
- Heel or ankle pain – may relate to tendon or joint effects
- Stomach pain – can be linked to steroid irritation
Other symptoms, such as fatigue, dizziness, and nausea, may have multiple possible causes.
Because of this, it is often not possible to attribute symptoms to a single cause without clinical review.
---
When to seek medical advice
You should contact your healthcare team if you experience:
- Persistent or worsening fatigue
- New dizziness or nausea
- Ongoing stomach pain
- Increasing weakness
- Mood changes affecting daily life
These symptoms do not necessarily indicate a serious problem, but they may mean that treatment or support needs to be reviewed.
---
Summary
In ABPA, symptoms such as fatigue, weakness, and low mood can arise from both the condition and its treatment. Long-term steroid use can add additional effects, making it difficult to distinguish between causes.
If symptoms are persistent or worsening, it is important to discuss them with your healthcare team so that appropriate adjustments or support can be considered.
---
Further Reading
- Allergic Bronchopulmonary Aspergillosis (ABPA)
- Treatment of Aspergillosis
- Weight Loss and Weakness in Aspergillosis
---
Author & Review
Prepared for aspergillosis.org to support patient understanding. Content reflects current clinical knowledge and patient-reported experience.
Disclaimer
This information is for general education only and does not replace advice from your healthcare team.
Weight Loss and Weakness in Aspergillosis: Why It Happens, How It Feels, and What Helps Recovery
Last reviewed: April 2026
Unexpected weight loss and severe weakness are among the most worrying symptoms people report after being diagnosed with aspergillosis. Many describe feeling unlike themselves—physically drained, thinner than they have ever been, and struggling with everyday activities.
This article explains why this happens, what is going on in the body, and what recovery typically looks like.
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Key Points
- Weight loss and fatigue are common in aspergillosis, particularly early in the illness or during flare-ups.
- They are usually caused by a combination of inflammation, increased energy use, reduced appetite, and muscle loss.
- Medication side effects can contribute but are rarely the main cause.
- Many people improve over time, but recovery is usually gradual and can take weeks to months.
- Stabilising weight is often the first important step before regaining strength.
---
Contents
- Why does aspergillosis cause weight loss?
- What is happening inside the body?
- Which types of aspergillosis are affected?
- Why does it feel so severe?
- Does it get better?
- What can help day to day?
- Nutrition and rebuilding strength
- When to seek medical advice
- Common questions
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Why does aspergillosis cause weight loss?
Weight loss in aspergillosis is rarely due to a single cause. Instead, it is usually the result of several overlapping processes.
1. Increased energy use (hypermetabolism)
When the body is dealing with infection or inflammation, it requires more energy. This is sometimes described as a hypermetabolic state.
- The immune system is active and consumes energy
- The body produces inflammatory signals
- Breathing effort may increase
This means you may be burning more calories than usual—even at rest.
2. Reduced appetite
Many people notice they are eating less, sometimes without realising it. This may be due to:
- Feeling unwell or fatigued
- Shortness of breath when eating
- Changes in appetite driven by inflammation
3. Medication effects
Some treatments can affect appetite or digestion. For example:
- Antifungal medications such as itraconazole or voriconazole may cause nausea or taste changes
- Steroids may increase appetite but can also contribute to muscle weakness over time
Medication effects vary widely and are usually only part of the overall picture.
4. Muscle breakdown
During illness, the body may break down muscle to meet energy needs. This can happen quickly, especially if activity levels fall.
This leads to:
- Loss of strength
- Reduced stamina
- A feeling of being “weak” rather than just lighter
5. Underlying lung disease
Many people with aspergillosis also have conditions such as bronchiectasis, asthma, or chronic obstructive pulmonary disease (COPD). These can increase the effort required for breathing and contribute to ongoing energy use.
---
What is happening inside the body?
Several biological processes contribute to weight loss and fatigue:
- Inflammatory signalling: The immune system releases chemical signals that affect metabolism and appetite
- Catabolism: The body breaks down tissues (including muscle) to release energy
- Energy imbalance: More energy is used than consumed
This combination can make weight loss feel rapid and difficult to control.
---
Which types of aspergillosis are affected?
These symptoms are most commonly seen in:
- Chronic Pulmonary Aspergillosis (CPA)
- Allergic Bronchopulmonary Aspergillosis (ABPA), particularly during flare-ups
However, not everyone experiences weight loss, and severity varies.
---
Why does it feel so severe?
Many people describe this stage as one of the most difficult parts of their illness. This is because several factors are happening at once:
- Physical energy is reduced
- Muscle strength has declined
- The body is under ongoing stress
- Recovery has not yet begun
This can make everyday activities—such as walking, cooking, or even eating—feel unusually difficult.
---
Does it get better?
In many cases, yes—there is gradual improvement over time, especially once treatment begins to control the condition.
Recovery often follows a pattern:
- Initial phase: weight loss and severe fatigue
- Stabilisation: weight loss slows or stops
- Recovery: gradual return of strength and energy
This process is usually slow and uneven, with good and bad days.
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What can help day to day?
1. Focus on maintaining nutrition
- Eat small amounts regularly rather than large meals
- Choose foods that are easy to prepare and eat
- Include protein to support muscle maintenance
2. Pace activity carefully
- Gentle movement can help maintain strength
- Avoid pushing too hard, as this can worsen fatigue
- Increase activity gradually as energy improves
3. Look at trends over time
It can be helpful to focus on gradual changes such as:
- Weight stabilising
- Small improvements in energy
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Nutrition and rebuilding strength
Recovery often happens in stages:
- Stage 1: Stabilising weight
- Stage 2: Gradually increasing intake
- Stage 3: Rebuilding muscle and strength
Regaining muscle mass takes time and usually follows once the underlying condition is better controlled.
---
When to seek medical advice
You should contact your healthcare team if you experience:
- Continued or rapid weight loss
- Increasing weakness
- Difficulty eating or swallowing
- New or worsening symptoms
This may indicate the need for additional support or adjustment of treatment.
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Common questions
Is weight loss just due to poor appetite?
No. Reduced appetite is only one factor. Increased energy use and muscle loss are also important contributors.
Are medications the main cause?
Medications can contribute, but they are rarely the main reason for weight loss.
Will I regain my strength?
Many people do regain strength over time, although recovery is usually gradual.
Why does recovery take so long?
The body needs time to reduce inflammation, restore energy balance, and rebuild muscle.
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Summary
Weight loss and weakness in aspergillosis are common and can feel severe, particularly early in the illness. They are usually caused by a combination of increased energy use, reduced appetite, muscle loss, and underlying lung disease.
Although recovery can take time, many people improve gradually as treatment takes effect.
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Further Reading
- Chronic Pulmonary Aspergillosis (CPA)
- Allergic Bronchopulmonary Aspergillosis (ABPA)
- Treatment of Aspergillosis
---
Author & Review
Prepared for aspergillosis.org to support patient understanding. Content reflects current clinical knowledge and patient-reported experience.
Disclaimer
This page is for general information only and does not replace advice from your healthcare team.
Can People with Aspergillosis Drink Kefir or Take Probiotics?
Many people with aspergillosis ask whether they can safely drink kefir or take probiotics. Kefir is a fermented drink containing live bacteria and yeasts, which raises understandable questions for people with lung conditions. This article explains what is known, what is uncertain, and why advice can differ between chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and more severe forms of aspergillosis.
Short answer: this is not something with a simple yes-or-no answer. For people with chronic forms of aspergillosis, kefir and probiotic products are not routinely discussed in the same way as they are for people who are severely immunocompromised. However, there is also not enough evidence to say they are helpful for aspergillosis, and people’s experiences vary.
Key Points
- Advice about live foods is often stricter for people with invasive aspergillosis or severe immune suppression
- For chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and related long-term conditions, the picture is usually less clear-cut
- There is no strong evidence that kefir specifically helps or harms chronic aspergillosis
- Some people feel fine with fermented foods; others feel they do not suit them
- The aim here is to inform, not recommend
What Is Kefir?
Kefir is a fermented drink, usually made from milk, containing a mixture of bacteria and yeasts. It is often described as a probiotic food because it contains live microorganisms.
People may use kefir or probiotic products because of interest in:
- gut health
- recovery after antibiotics
- the microbiome
If you are interested in the wider role of food and nutrition in lung health, see our article on diet and aspergillosis: what helps, what doesn’t, and what matters most.
Why Does This Question Come Up in Aspergillosis?
Different forms of aspergillosis have different risk profiles
It is important not to group all forms of aspergillosis together.
- Invasive aspergillosis usually affects people with very weakened immune systems. In that setting, clinicians are often more cautious about foods or products containing live microorganisms.
- Chronic pulmonary aspergillosis (CPA) usually affects people with underlying lung damage or structural lung disease. Many patients are not severely immunocompromised in the same way.
- Allergic bronchopulmonary aspergillosis (ABPA) and related allergic conditions raise slightly different questions again, because symptom flares may relate more to sensitivity and inflammation than to infection risk.
That distinction matters, because advice that is appropriate for one group may not automatically apply to another.
Chronic vs Invasive Aspergillosis: Why It Matters
For people with chronic pulmonary aspergillosis, the question is usually less about needing to avoid kefir as a rule, and more about recognising that there is no established role for it in treatment. In other words, kefir is not a treatment for CPA, but nor is it routinely listed as something that every patient with CPA must avoid.
For people with ABPA, the picture is slightly different again. Some patients are very aware of foods that seem to trigger symptoms, but that still does not create a universal rule that fermented foods should always be avoided.
What Does the Evidence Say?
At present, there is no strong evidence showing that kefir has a specific benefit for aspergillosis, and there is also no clear evidence that it is harmful in most people with chronic aspergillosis.
Most discussion around kefir and probiotics comes from broader research on:
- the gut microbiome
- antibiotic-associated bowel symptoms
- general digestive health
That is not the same as proving benefit for lung symptoms, fungal disease, or long-term respiratory outcomes.
For related discussion about how antibiotics affect symptoms, infections, and the microbiome, you may also find this helpful: why antibiotics do not always work.
Probiotics and the Gut–Lung Connection
Research into the gut–lung axis suggests that the gut microbiome may influence immune responses elsewhere in the body, including the lungs. This is an active area of research, but it is still early, and it does not yet mean that fermented foods or probiotic supplements should be seen as treatments for aspergillosis.
Some people are interested in probiotics because of repeated antibiotic courses, bowel side effects, or a general wish to support gut health. Those are understandable reasons, but the evidence for a direct lung benefit in chronic aspergillosis remains limited.
Why Do People React Differently?
The main reasons for caution are usually not “aspergillosis” on its own, but the wider clinical picture.
For example, extra caution may be more relevant in people who are:
- severely immunocompromised
- taking high-dose steroids or other immunosuppressive treatment
- acutely unwell
- known to react poorly to fermented foods or probiotic products
In some people, symptoms after kefir may be more about tolerance than infection risk. Patients sometimes describe:
- bloating
- nausea
- abdominal discomfort
- a sense that fermented foods do not suit them
Others report no obvious problems at all. This is one reason it is safer to frame kefir as an individual tolerance issue rather than something routinely recommended or routinely banned.
Kefir in Chronic Pulmonary Aspergillosis (CPA)
For people with CPA, the question is usually less about fungal exposure from kefir and more about whether it suits the individual patient. Many people with CPA have damaged lungs rather than profound immune suppression, so the same dietary warnings used in invasive fungal disease do not automatically apply.
- kefir is not a standard treatment for CPA
- it is not routinely listed as something that must be avoided in all patients with CPA
- individual circumstances, treatments, and tolerance still matter
If you are newly diagnosed or want a broader overview, see our CPA information page.
What About ABPA and Other Allergic Conditions?
In ABPA and related conditions, some people are understandably more alert to foods that seem to trigger symptoms. Fermented products may not suit everyone, but there is not a clear universal rule that they should be avoided.
As with many food-related questions in chronic lung disease, experiences are mixed and difficult to generalise. If you would like a fuller explanation of ABPA itself, visit our ABPA information page.
Homemade vs Shop-Bought Products
Some people also ask whether homemade kefir is different from commercial products. In general terms, homemade fermented products may be less standardised than commercially prepared ones, but that does not automatically mean they will cause a problem. It simply adds another layer of variability.
This is another reason why broad, one-size-fits-all advice is difficult.
How Should This Be Framed for Patients?
A cautious and balanced way to put it is:
Kefir is a fermented drink containing live bacteria and yeasts. Questions about it often come up in aspergillosis because advice is sometimes stricter for people who are severely immunocompromised. For people with chronic conditions such as CPA or ABPA, there is no clear evidence that kefir is either beneficial or harmful for aspergillosis itself. People’s experiences vary, so it is best thought of as an individual tolerance issue rather than something routinely recommended or routinely banned.
When Extra Caution May Be Needed
Extra caution may be more relevant if someone is:
- severely immunocompromised
- on significant immunosuppressive treatment
- recovering from serious illness
- already experiencing ongoing gut symptoms or unexplained food intolerance
In those situations, questions about probiotics, supplements, or fermented foods are often best discussed with a clinician who understands the wider medical picture.
When to Seek Medical Advice
It is sensible to discuss diet or probiotic questions with a clinician or specialist team if:
- you are severely immunocompromised
- you are on significant immunosuppressive treatment
- you develop persistent gut symptoms after using a probiotic product
- you are unsure how advice applies to your particular diagnosis or treatment
Healthcare professionals looking for more formal clinical material can visit our Information for Professionals page.
Common Questions
Can kefir treat aspergillosis?
No. There is no evidence that kefir treats aspergillosis.
Is kefir dangerous with chronic pulmonary aspergillosis?
There is no clear evidence that kefir is harmful in most people with chronic pulmonary aspergillosis, but there is also no evidence that it is beneficial for the condition itself. Tolerance varies between individuals.
Should people with ABPA avoid fermented foods?
Not necessarily. Some people feel certain foods do not suit them, but there is no universal rule that all fermented foods should be avoided in ABPA.
Summary
- Kefir is a fermented probiotic drink containing live bacteria and yeasts
- Advice that applies to invasive aspergillosis does not always apply in the same way to chronic pulmonary aspergillosis or allergic bronchopulmonary aspergillosis
- There is no strong evidence that kefir treats or worsens chronic aspergillosis
- The safest educational position is a neutral one: not a recommendation, not a blanket prohibition
- Individual circumstances, treatments, and tolerance matter
Last reviewed: April 2026
Reviewed by: National Aspergillosis Centre patient information team perspective
Please note: This article is for general education and should not be used as individual medical advice.
Could diarrhoea on itraconazole be C. diff?
Last reviewed: 20 April 2026
Understanding the difference for people with aspergillosis
Key points
- Clostridioides difficile (C. diff) is a bowel infection most often linked to antibiotic use, not antifungal treatment.
- Itraconazole can cause diarrhoea and stomach upset as a recognised side effect, but that is not the same as having C. diff.
- People with aspergillosis may still be at higher risk of C. diff because many have had recent antibiotics, repeated antibiotic courses, hospital care, or other illnesses.
- Persistent watery diarrhoea, tummy pain, fever, bleeding, dehydration, or diarrhoea lasting more than a few days should not be ignored.
- Probiotics may help some people reduce antibiotic-associated diarrhoea, but they are not suitable for everyone and are not a treatment for C. diff.
Contents
- Why this question comes up so often
- What is C. diff?
- Is itraconazole a usual cause of C. diff?
- Why people with aspergillosis may still worry about C. diff
- Side effect or infection?
- What do NHS sources advise?
- Do probiotics help?
- Common questions
- Why this matters in aspergillosis
- When to seek medical advice
- Take-home message
- Suggested internal links
- References
Why this question comes up so often
If you live with aspergillosis, it can be hard to work out why new symptoms have appeared. Many patients have had antibiotics at some point for chest infections, have been in hospital, or take several medicines at once. So when diarrhoea develops while on itraconazole, it is understandable to wonder whether the antifungal is to blame, whether it is a simple side effect, or whether something more important is going on.
That confusion is common, because several different problems can cause similar gut symptoms.
What is C. diff?
Clostridioides difficile (C. diff) is a bacterium that can infect the bowel and cause diarrhoea, abdominal pain and sometimes much more severe illness. It often affects people whose usual gut bacteria have been disrupted, especially after antibiotic use.
Some people carry C. diff without symptoms, but when the balance of the gut changes, the bacteria can multiply and produce toxins that irritate and inflame the bowel. That is why C. diff is more than “just diarrhoea”. It is a specific infection with recognised causes and recognised risks.
Is itraconazole a usual cause of C. diff?
In general, no. Itraconazole is an antifungal, not an antibiotic, and it is not recognised as a typical trigger for C. diff. Most guidance links C. diff mainly to antibiotics, especially in people who are older, frailer, recently hospitalised, or otherwise vulnerable.
That said, itraconazole can cause gastrointestinal side effects, including diarrhoea. So someone may genuinely develop bowel symptoms while taking itraconazole without having C. diff.
The important point is this: diarrhoea on itraconazole does not automatically mean C. diff, but it should not automatically be dismissed as “just the antifungal” either.
Why people with aspergillosis may still worry about C. diff
Even if itraconazole is not the usual cause, people with aspergillosis may still face a real risk of C. diff because many have had one or more recognised risk factors:
- recent or repeated antibiotic courses
- recent hospital stay or healthcare exposure
- older age
- other illnesses or frailty
- sometimes medicines such as proton pump inhibitors have also been associated with increased risk
So in practice, a patient may be taking itraconazole when diarrhoea starts, but the bigger driver may actually be a recent antibiotic course or hospital admission rather than the antifungal itself.
Side effect or infection?
Here is the distinction many patients find helpful.
Diarrhoea more suggestive of a medicine side effect
A simple side effect from itraconazole may cause:
- looser stools
- nausea
- abdominal discomfort
- symptoms that are unpleasant but relatively mild and not rapidly worsening
Diarrhoea more concerning for C. diff or another bowel infection
Symptoms that deserve proper attention include:
- frequent watery diarrhoea
- tummy pain or cramping
- fever
- blood in the stool or bleeding from the bottom
- dehydration, such as very dry mouth, dizziness, or passing very little urine
- diarrhoea lasting more than 7 days
- feeling generally very unwell
| More suggestive of side effect | More concerning for infection such as C. diff |
|---|---|
| Mild diarrhoea or looser stools | Frequent watery diarrhoea |
| Mild nausea or stomach discomfort | Tummy pain, cramping, fever |
| Symptoms remain mild | Symptoms worsening or lasting several days |
| No bleeding or dehydration | Bleeding, dehydration, or feeling very unwell |
In other words, the pattern and severity matter. Mild stomach upset can happen with many medicines. Persistent watery diarrhoea, pain, fever or bleeding should not simply be written off as “one of those things”.
What do NHS sources advise?
NHS advice is to seek urgent help if diarrhoea happens while taking, or after recently taking, antibiotics, if there is blood in the diarrhoea, or if it lasts more than 7 days. Severe pain, fever, or signs of dehydration are also warning signs.
This matters because true C. diff is a recognised medical problem with specific treatment pathways.
Do probiotics help?
Probiotics are products that contain live microorganisms (usually bacteria or yeast) intended to support the balance of the gut microbiome. They are often sold as capsules, powders, or drinks.
They are widely available, but their role in preventing or managing diarrhoea is still being studied, and product quality varies considerably.
What does the evidence suggest?
- Some studies suggest probiotics may help reduce antibiotic-associated diarrhoea.
- There is some evidence they may reduce the risk of C. diff in certain situations, particularly when started early during antibiotic treatment.
- However, results are inconsistent, and benefits are usually modest.
Are probiotics a treatment for C. diff?
No. Probiotics are not a standard treatment for confirmed C. diff infection. Medical treatment is required for confirmed cases.
How to recognise a higher-quality probiotic
If people are considering probiotics, it can be helpful to understand what distinguishes more credible products from less reliable ones.
- Clearly labelled strains – for example Lactobacillus rhamnosus GG rather than just “Lactobacillus”. Evidence is strain-specific.
- CFU count (colony forming units) – this indicates the number of live organisms. Typical products range from millions to billions of CFU.
- Expiry-date guarantee – reputable products state the number of live organisms at the end of shelf life, not just “at manufacture”.
- Storage instructions – some require refrigeration; unclear instructions may suggest lower quality control.
- Evidence transparency – more reliable manufacturers refer to published studies rather than making vague claims.
Common red flags to be cautious about
- Claims to “cure” or “prevent” serious conditions such as C. diff
- Very long lists of ingredients without clear strain identification
- No CFU count or unclear labelling
- Heavy marketing language such as “miracle”, “detox”, or “boosts immunity dramatically”
- Products sold only through social media or unverified online sources
Are probiotics safe for everyone?
Probiotics are often well tolerated, but they are not suitable for everyone.
- People who are immunocompromised or seriously unwell may be at risk of rare infections linked to probiotic organisms.
- This includes some patients with complex lung disease, those on immunosuppressive treatment, or those with central lines.
- Because of this, probiotics should be discussed with a healthcare professional before use in these groups.
What is the practical take?
- Probiotics may help some people reduce diarrhoea associated with antibiotics.
- They are not routinely recommended for everyone.
- They are not a treatment for C. diff.
- Product quality varies, so understanding labels is important.
- For people with long-term conditions such as aspergillosis, it is sensible to check before using them.
As research into the gut microbiome develops, understanding of probiotics may improve. For now, they are best seen as a possible supportive option in some situations, rather than a standard part of care.
Common questions
Can antifungals cause C. diff?
Not usually. The main recognised trigger is antibiotic exposure, not antifungal therapy. But antifungals such as itraconazole can cause diarrhoea as a side effect, which can create understandable confusion.
Could I get C. diff if I have not had antibiotics recently?
Yes, it is possible, but antibiotics are the classic and most important risk factor. Recent hospital contact and other vulnerabilities can matter too.
If my diarrhoea started after itraconazole, does that prove itraconazole caused it?
No. Timing can be a clue, but it does not prove the cause. A side effect is possible, but so are other explanations, including infection, recent antibiotics, other medicines, or unrelated bowel problems.
Could acid-suppressing tablets increase risk?
Possibly. Proton pump inhibitors have been associated with C. diff risk in some studies, but that does not prove they directly cause it.
Why this matters in aspergillosis
For aspergillosis patients, this topic matters for two reasons.
First, gut symptoms are common, especially when treatment is complex. That makes it easy to mislabel symptoms. Second, many patients have also needed antibiotics for chest infections or have had hospital admissions, which means true C. diff risk may be more relevant than it first appears.
The safest message is not “itraconazole causes C. diff” and not “it is definitely nothing serious”, but rather: know the difference, notice the red flags, and get persistent symptoms checked.
When to seek medical advice
Seek medical advice promptly if diarrhoea is:
- frequent and watery
- continuing rather than settling
- happening after recent antibiotics
- accompanied by tummy pain, fever, bleeding, or dehydration
- making you feel significantly unwell
Take-home message
Long-term itraconazole use is not a typical direct cause of C. diff. However, itraconazole can cause diarrhoea, and people with aspergillosis may still be at risk of C. diff because of recent antibiotics, hospital exposure, and other health factors.
The key is not to jump to conclusions either way: mild diarrhoea can be a medicine side effect, but persistent watery diarrhoea, pain, fever, bleeding or dehydration should be taken seriously.
Suggested internal links
- Antifungal treatment hub
- Why antibiotics do not always work
- Chronic Pulmonary Aspergillosis
- Allergic Bronchopulmonary Aspergillosis (ABPA)
- Information for professionals
References
- NHS. Clostridioides difficile (C. diff) infection.
- NICE. Clostridioides difficile infection: antimicrobial prescribing (NG199).
- BNF. Itraconazole.
- UK Health Security Agency. Clostridioides difficile guidance, data and analysis.
- UK Health Security Agency. Increase in Clostridioides difficile infections: current epidemiology data and investigations.
Author: National Aspergillosis Centre CARES Team
What if you can’t tolerate azole antifungal medicines?
Key points
- Azole antifungals are commonly used to treat aspergillosis, but not everyone tolerates them well.
- “Azole intolerance” means the body reacts badly to the medication, even if it is otherwise effective.
- Symptoms can include fatigue, flushing, shaking, nausea, and discomfort around the liver area.
- In some cases, blood tests show changes in liver function.
- If azoles are not tolerated, there are often alternative approaches your clinical team can consider.
Contents
- What are azole antifungals?
- What is azole intolerance?
- Why does azole intolerance happen?
- Common symptoms to look out for
- The role of the liver
- What can be done if azoles are not tolerated?
- Why monitoring is important
- Common questions
- When to seek medical advice
What are azole antifungals?
Azole antifungals are a group of medicines used to treat fungal infections such as aspergillosis. They work by interfering with the fungal cell membrane, helping to stop the fungus growing.
Common examples include:
- Fluconazole
- Itraconazole
- Voriconazole
- Posaconazole
They are often used long-term in conditions like chronic pulmonary aspergillosis (CPA) or allergic bronchopulmonary aspergillosis (ABPA).
What is azole intolerance?
Azole intolerance means that a person develops unpleasant or harmful side effects when taking these medications, even at standard doses.
This is different from:
- Allergy – an immune reaction (e.g. rash, swelling, breathing difficulty)
- Resistance – when the fungus is not affected by the drug
With intolerance, the drug may still work against the fungus—but the body cannot tolerate its effects.
Why does azole intolerance happen?
There is no single cause. Instead, several factors can contribute:
1. How the body processes the drug
Azoles are broken down in the liver. People vary in how efficiently this happens, which can lead to higher levels of the drug in the body.
2. Effects on liver enzymes
Azoles affect enzymes (called cytochrome P450 enzymes) that are involved in processing many medications. This can:
- Increase drug levels
- Cause interactions with other medications
- Put strain on the liver
3. Individual sensitivity
Some people are simply more sensitive to these drugs, even when blood levels are within the expected range.
4. Other health factors
- Existing liver conditions
- Age
- Other medications
- Nutritional status
Common symptoms to look out for
Patients describe a range of symptoms when azoles are not well tolerated, including:
- Flushed or hot cheeks
- Shaking or tremor
- Severe fatigue
- Nausea or reduced appetite
- Discomfort or pain in the upper abdomen, back, or sides (where the liver sits)
- General feeling of being unwell
These symptoms can appear soon after starting treatment or develop over time.
The role of the liver
The liver plays a central role in processing azole antifungals.
In some cases, this can lead to:
- Raised liver enzymes on blood tests
- Inflammation or irritation of the liver
It is important to note that:
- Some people have abnormal blood tests without symptoms
- Others feel unwell even when tests are only mildly changed
This is why both symptoms and blood tests are considered together.
What can be done if azoles are not tolerated?
If azole intolerance is suspected, your clinical team may consider several approaches:
Adjusting treatment
- Reducing the dose
- Changing how the medication is taken (e.g. with food)
Switching to another azole
Some people tolerate one azole better than another.
Therapeutic drug monitoring (TDM)
Blood tests can measure drug levels to help ensure they are not too high or too low.
Considering non-azole treatments
In some cases, different classes of antifungal medication may be considered.
The best approach depends on the individual, the condition being treated, and how severe the side effects are.
Why monitoring is important
Because azoles affect the liver and interact with other medications, monitoring is a routine part of care.
This may include:
- Regular liver function blood tests
- Drug level monitoring (for some azoles)
- Review of other medications
Monitoring helps detect problems early and allows treatment to be adjusted safely.
Common questions
Does intolerance mean I cannot take any antifungal treatment?
No. Many patients who cannot tolerate one medication can use another, or a different approach may be possible.
Will the symptoms settle if I continue?
In some cases mild symptoms improve, but persistent or worsening symptoms should always be reviewed.
Is this common?
Most people tolerate azoles reasonably well, but intolerance is recognised and not rare in specialist clinics.
When to seek medical advice
You should contact your healthcare team if you experience:
- Persistent or worsening fatigue
- Pain in the upper abdomen, back, or sides
- Nausea affecting eating or drinking
- New or unusual symptoms after starting medication
Seek urgent medical attention if you notice:
- Yellowing of the skin or eyes (jaundice)
- Dark urine or pale stools
- Severe abdominal pain
Summary
Azole antifungals are an important part of treating aspergillosis, but some people experience intolerance.
This is usually related to how the body processes the medication—particularly in the liver—and varies from person to person.
If intolerance occurs, it does not mean that treatment options have run out. With careful monitoring and specialist input, alternative strategies can often be found.
Further reading
- Chronic pulmonary aspergillosis (CPA)
- Allergic bronchopulmonary aspergillosis (ABPA)
- Information for healthcare professionals
Author & review
This article has been prepared for patients and carers using information aligned with UK specialist practice, including the National Aspergillosis Centre (Manchester, UK).
Important: This content is for general educational purposes only and is not a substitute for medical advice. Always speak to your healthcare team about your own situation.
Tremor (Shaking) in Aspergillosis, Asthma, COPD and TB: Causes, Meaning and When to Seek Help
Last reviewed: 16 April 2026
For: Patients, carers, general practitioners, nurses and non-specialists
Topic: Tremor (shaking) in aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) and tuberculosis (TB)
Shaking or tremor can feel alarming, but in most people with lung conditions it has a clear and manageable cause.
Key points
- A tremor is a shaking movement, usually affecting the hands.
- In people with aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB), tremor is usually not caused by the lung condition itself.
- The most common causes are medications, breathlessness, stress, fatigue, weakness, or an unrelated tremor condition such as essential tremor.
- Reliever inhalers such as salbutamol commonly cause a fine shaking of the hands.
- Antifungal medicines can sometimes contribute to tremor directly or through drug interactions.
- Biologic treatments used for severe asthma are not usually a cause of tremor and may sometimes reduce tremor indirectly by lowering steroid or reliever inhaler use.
- Most tremors in this setting do not mean the underlying disease is worsening.
- A new tremor should still be mentioned to a healthcare professional, especially if it is worsening, happens at rest, or comes with stiffness, slowness or balance problems.
Contents
- What is a tremor?
- Why can it happen in lung conditions?
- What sort of tremor might it be?
- What is essential tremor?
- Is it Parkinson’s disease?
- Do biologics play a part?
- Will it get worse?
- What can help?
- When to seek medical advice
- Common questions
- References
If you are newly diagnosed, you may find it helpful to start with our overview of what aspergillosis is and how it affects the lungs, as well as our broader guide to information for patients and carers.
What is a tremor?
A tremor is an involuntary shaking movement. It most often affects the hands, but it can also affect the head, jaw or voice. People may notice it when holding a cup, using cutlery, writing, typing, or holding their arms out in front of them.
Tremor can be worrying, especially if it is new. Some people fear it means their infection is spreading, their lungs are failing, or they are developing Parkinson’s disease. In most people with respiratory conditions, that is not the case.
Why can it happen in lung conditions?
For most people with aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB), tremor is usually explained by one or more of the following:
1. Medications
This is the most common explanation. Reliever inhalers such as salbutamol are well known to cause a fine tremor, especially in the hands. Steroids can also make people feel shaky, wired, weak or restless. In people with aspergillosis, antifungal medicines such as itraconazole or voriconazole may sometimes contribute to tremor or make it more noticeable, particularly if they interact with other medicines.
If you are taking antifungal medication, you may also find it helpful to read our guide to antifungal treatments and side effects, including how different drugs can interact with each other.
2. Breathlessness, stress and adrenaline
When the body is under strain, trembling can become more noticeable. Breathlessness, anxiety, poor sleep, infection, inflammation and exhaustion can all amplify the body’s normal background tremor.
3. Fatigue and muscle weakness
Muscles that are tired or weakened tend to shake more easily. This can happen in chronic respiratory disease, after infections, during recovery, or after long periods of reduced activity.
People living with long-term conditions such as Chronic Pulmonary Aspergillosis (CPA) may experience fatigue and reduced muscle strength, both of which can make tremor more noticeable.
4. An unrelated tremor condition
Some people have a separate condition such as essential tremor. This may have been mild for years and only become noticeable during a period of illness, stress, treatment changes or increased reliever inhaler use.
5. Less common neurological causes
Less commonly, tremor may be due to a neurological condition such as Parkinson’s disease or to another medical problem such as thyroid disease, low blood sugar, or medication side effects from medicines unrelated to the lungs. This is why a new tremor should not be ignored, even though the cause is often straightforward.
What sort of tremor might it be?
The type of tremor can give useful clues.
Action or postural tremor
This is the most common type in people with lung disease. It appears when using the hands or holding them in a position, such as lifting a drink, eating, writing, or stretching the arms out. This pattern often fits tremor linked to salbutamol, stress, fatigue, steroids, or essential tremor.
Enhanced physiological tremor
Everyone has a tiny natural tremor. Illness, adrenaline, fatigue, caffeine, poor sleep, fever, pain and some medicines can make it much more obvious. This often causes a fine, fast, variable shakiness.
Essential tremor
This is a common neurological condition that usually causes shaking during movement or when holding a posture. It often affects both hands and may slowly become more noticeable over time.
Rest tremor
This happens when the hand is fully relaxed and not being used. A true rest tremor is less typical of inhaler- or stress-related shaking, so it deserves more careful assessment.
What is essential tremor?
Essential tremor is one of the most common movement disorders. It usually affects both hands, although one side can be worse than the other. It tends to happen during action rather than complete rest. Some people also notice tremor of the head or voice.
Essential tremor is not caused by aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB). However, illness, tiredness, anxiety, reliever inhalers and medication changes can all make an underlying essential tremor more obvious.
For many people, essential tremor remains mild for years. It can slowly worsen over time, but it does not usually turn into Parkinson’s disease.
Is it Parkinson’s disease?
Most tremor in respiratory patients is not Parkinson’s disease. Parkinson’s disease usually causes a different pattern, often with tremor at rest, stiffness, slowness, reduced arm swing, or changes in walking. A tremor that only happens after inhaler use or when someone is tired, anxious or unwell is less suggestive of Parkinson’s disease.
That said, not every tremor in a person with lung disease should be blamed on medications. If the tremor is clearly happening at rest, is becoming more obvious over time, or is linked with stiffness or slowed movement, it should be assessed properly.
Do biologics play a part?
Biologic treatments used for severe asthma and some cases of Allergic Bronchopulmonary Aspergillosis (ABPA), such as omalizumab, mepolizumab, benralizumab and dupilumab, are not usually associated with tremor. They are much less likely to cause shaking than reliever inhalers or steroids.
If you are receiving advanced asthma treatments, you can read more in our guide to biologic therapies for asthma and ABPA, which explains how these treatments work and what side effects to expect.
In practice, biologics may sometimes help indirectly. If they improve asthma control, reduce flare-ups, lower oral steroid use, or reduce the need for frequent salbutamol, tremor may improve rather than worsen.
If someone develops shaking while on a biologic, it is usually sensible to look first at the broader picture: reliever inhaler use, steroid dose, antifungal treatment, other medicines, fatigue, anxiety, and whether the tremor started after a different medication change.
Will it get worse?
Often, the answer is reassuring: not necessarily.
If the tremor is linked to salbutamol or another medicine
It may improve once the dose is reduced, the timing is adjusted, the medicine is changed, or the underlying breathing problem is better controlled. Some medication-related tremors fluctuate rather than steadily worsening.
If the tremor is linked to illness, fatigue or stress
It often comes and goes. It may be worse during flare-ups, infections, poor sleep, low mood, pain or periods of worry, and better on good days.
If it is essential tremor
Essential tremor can slowly progress over time, but this usually happens over years rather than days or weeks. Many people remain stable for long periods.
If it is Parkinson’s disease or another neurological cause
That requires separate assessment. It is much less common than action tremor related to medicines or illness in respiratory patients, but it should be considered when the pattern fits.
Overall, a tremor does not usually mean aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB) is worsening in the lungs.
If your symptoms have been difficult to control, it may also help to read why chest infections do not always improve with antibiotics, particularly in conditions such as aspergillosis.
What can help?
- Notice when the tremor happens: after inhalers, when tired, during stress, or all the time.
- Keep a note of recent treatment changes, including inhalers, steroids, antifungals and any new tablets.
- Check whether the tremor happens during action, at rest, or both.
- Try to reduce obvious triggers where possible, such as exhaustion, missed meals, dehydration and excess caffeine.
- Ask for a medication review if the tremor is new or troublesome.
- If you have asthma or Chronic Obstructive Pulmonary Disease (COPD), discuss whether frequent reliever inhaler use means your maintenance treatment needs reviewing.
When to seek medical advice
Speak to your healthcare team if:
- the tremor is new, persistent, or getting worse
- it started after a change in medication
- it is affecting eating, drinking, writing or daily activities
- it happens when your hands are fully at rest
- you also notice stiffness, slowed movement, poor balance, falls, or changes in walking
- you feel generally unwell, confused, very weak, or have other new neurological symptoms
Reassurance for patients and carers
Tremor can be unsettling, but it is common and often explainable. In people living with aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB), the cause is usually medication effects, body stress, fatigue, or an unrelated essential tremor rather than the lung condition itself damaging the nervous system.
That means there is often room to improve things: inhalers can be reviewed, other medicines checked, triggers reduced, and the tremor pattern assessed properly. Most importantly, a tremor does not automatically mean the worst.
Related topics:
Common questions
Does aspergillosis itself cause tremor?
Usually no. Tremor in people with aspergillosis is much more likely to be related to medication, fatigue, illness, anxiety, or a separate tremor condition.
Can salbutamol make you shake?
Yes. This is a very well recognised side effect. It usually causes a fine tremor in the hands.
Can antifungal treatment cause tremor?
It can in some people, either directly or through interactions with other medicines. If tremor appears after starting or changing antifungal treatment, it is worth raising.
Do biologics usually cause tremor?
No. Biologics are not a common cause of tremor and may sometimes reduce tremor indirectly by improving control and reducing the need for steroids or frequent reliever inhalers.
Will this definitely get worse?
No. Many tremors stay mild, fluctuate, or improve when the cause is identified and managed.
References
- British National Formulary (BNF) – Salbutamol
Describes common side effects of beta-2 agonists, including tremor and shakiness.
https://bnf.nice.org.uk/drugs/salbutamol/ - NHS – Tremor
Overview of tremor types, causes, and when to seek medical advice.
https://www.nhs.uk/conditions/tremor/ - NHS / Neurology Guidance – Essential Tremor
Clinical overview of essential tremor, including action/postural tremor characteristics and distinction from Parkinson’s disease.
https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/gp-factsheets/essential-tremor/ - Electronic Medicines Compendium (eMC) – Voriconazole (Vfend) Summary of Product Characteristics
Details neurological side effects and drug interaction potential of voriconazole.
https://www.medicines.org.uk/emc/product/7981/smpc - Electronic Medicines Compendium (eMC) – Itraconazole Summary of Product Characteristics
Provides prescribing information, including neurological effects and interactions.
https://www.medicines.org.uk/emc/search?q=itraconazole - NICE Guidance – Asthma (NG80)
Covers pharmacological management of asthma, including use of bronchodilators and biologics.
https://www.nice.org.uk/guidance/ng80 - NICE Technology Appraisals – Biologic therapies for severe asthma
Includes guidance on omalizumab, mepolizumab, benralizumab and dupilumab.
https://www.nice.org.uk/guidance/ta278 - NHS – Parkinson’s Disease
Overview of symptoms including resting tremor, stiffness and slowed movement.
https://www.nhs.uk/conditions/parkinsons-disease/
Author note: This article is for general education and is not a substitute for individual medical advice. People with new, worsening or unexplained tremor should discuss it with their usual healthcare professional.
You can explore more topics like this in our latest patient questions and answers, where we regularly explain common symptoms and concerns raised by people living with aspergillosis and other lung conditions.
Inflammation and Aspergillosis: Understanding “Stable”, “Flare”, and “Improving” Disease
Last reviewed: April 2026
Key points
- Inflammation is part of the body’s response to Aspergillus, but it does not always mean damage is actively worsening.
- “Stable” disease means no clear progression over time, not that the condition has disappeared.
- Symptoms in aspergillosis often vary because of other infections, especially in the lungs.
- Test results (such as IgE or CRP) can change without symptoms changing.
- Doctors make decisions based on the overall pattern over time, not a single test result.
Table of contents
- What is inflammation and why does it matter?
- Inflammation in different types of aspergillosis
- Clear definitions: active, flare, stable, improving, remission
- What does “stable disease” mean in practice?
- Why other infections cause flare-ups
- Understanding test results (CRP, IgE, scans)
- When test results worsen but symptoms do not
- How doctors decide what is happening
- Common patient questions
- When to seek medical advice
What is inflammation and why does it matter?
Inflammation is the body’s way of responding to something it sees as harmful. In aspergillosis, this is usually the fungus Aspergillus.
This response involves immune cells, chemicals, and changes in the lungs that aim to control the fungus. However, if inflammation continues over a long period (chronic inflammation), it can also contribute to:
- Ongoing symptoms (cough, breathlessness, fatigue)
- Mucus production
- Damage to lung tissue over time
Important: inflammation can be present at a low level without causing active damage. This is common in chronic conditions.
Inflammation in different types of aspergillosis
The type of inflammation depends on the form of aspergillosis:
- Allergic Bronchopulmonary Aspergillosis (ABPA): driven by an overactive allergic response. Blood markers such as IgE and eosinophils are often used to monitor this.
- Chronic Pulmonary Aspergillosis (CPA): caused by long-term infection in damaged lung tissue, leading to ongoing inflammation and structural changes.
- Aspergillus bronchitis: persistent infection with inflammation, often causing chronic cough and sputum.
In all cases, inflammation may improve with treatment but often does not disappear completely.
Clear definitions: disease states
Doctors use the following terms to describe how the disease is behaving:
- Active disease: symptoms, tests, or scans are getting worse over time
- Flare-up: a short-term worsening, often triggered by infection or another stress on the body
- Stable: no clear overall change over time
- Improving / responding to treatment: symptoms and/or tests are getting better
- Remission: minimal or no signs of active disease (used more often in ABPA)
Key point: these states are not fixed — patients may move between them.
What does “stable disease” mean in practice?
“Stable” means that, over a period of time (weeks to months), there is no clear evidence that the disease is progressing.
This usually includes:
- No worsening of key symptoms
- No new complications (e.g. haemoptysis, significant weight loss)
- Imaging (CT scans) showing no progression
- No need to increase treatment
What stable does NOT mean:
- It does not mean symptoms are absent
- It does not mean inflammation is zero
- It does not mean you will feel the same every day
Many patients with stable disease still experience day-to-day variation in symptoms.
Why other infections cause flare-ups
People with aspergillosis are more vulnerable to other lung infections (bacterial or viral).
This is because:
- Lung structure may already be damaged
- Mucus clearance is less effective
- The immune system is already active
When another infection occurs, it can trigger a flare-up, causing:
- Increased cough and breathlessness
- More or thicker sputum
- Fatigue and feeling unwell
- Raised inflammatory markers (e.g. CRP)
Crucial point: this does not necessarily mean the aspergillosis itself is worsening. It is often a temporary additional problem.
Understanding test results
Doctors use several types of tests to monitor inflammation and disease activity:
- CRP / ESR: general markers of inflammation
- IgE: particularly important in ABPA
- Eosinophils: linked to allergic inflammation
- CT scans: show structural changes in the lungs
- Sputum cultures: detect infection
Important limitations:
- No single test gives a complete picture
- Results can fluctuate for many reasons
- Changes must be interpreted over time
When test results worsen but symptoms do not
This situation is common, especially in ABPA.
For example, IgE levels may rise without any noticeable change in symptoms.
This may happen because of:
- Natural biological variation
- Exposure to allergens
- A mild or early flare that has not yet caused symptoms
Key point: a change in a single test result does not automatically mean the disease is worsening.
Doctors will usually:
- Repeat tests
- Look for consistent trends
- Assess symptoms and scans
If symptoms remain stable and no other changes are seen, the condition may still be considered stable — but monitored more closely.
How doctors decide what is happening
Clinicians do not rely on a single result. Instead, they assess the pattern over time:
- Are symptoms changing?
- Are test results consistently rising or falling?
- Are scans stable or changing?
- Is the patient responding to treatment?
This combined assessment is called the clinical picture.
Common questions
If I feel better, what is that called?
This is usually described as improving or responding to treatment. In some cases (especially ABPA), it may be called remission.
Does inflammation always mean damage?
No. Low-level inflammation can persist without causing further harm.
Why do my symptoms change from day to day?
This is common and often relates to infections, environment, or general health rather than disease progression.
Can aspergillosis affect the whole body?
It can have wider effects, but it mainly affects the lungs in most patients.
When to seek medical advice
Seek medical advice if you notice:
- Persistent worsening of symptoms
- New haemoptysis (coughing up blood)
- Significant weight loss
- Symptoms not improving after a suspected infection
- Concerns about test results
Author and review
Author: Aspergillosis Patient Education Team
Reviewed by: National Aspergillosis Centre (UK)
References
- Denning DW et al. Chronic pulmonary aspergillosis guidelines
- ISHAM ABPA guidelines
This article is for general information only and is not a substitute for medical advice.