🫁 “Lung Flush” (Bronchoalveolar Lavage) in ABPA – What It Is and Why It Brings Only Short-Term Relief

A lung flush (also called a bronchoalveolar lavage, or BAL) isn’t a regular treatment for Allergic Bronchopulmonary Aspergillosis (ABPA), but it’s sometimes used selectively in NHS hospitals.

💧 What Happens During a Lung Flush

It’s done during a bronchoscopy, where a thin, flexible tube is passed through the nose or mouth into the lungs.
A small amount of sterile saline is washed into part of the lung and then gently suctioned back out.
The fluid is tested for:

  • Aspergillus growth or DNA

  • Other infections (bacteria, fungi, viruses)

  • Signs of inflammation or allergic activity

You’re given local anaesthetic and light sedation, so you stay comfortable but sleepy. Most people go home the same day.

🧪 Main Purpose – Diagnosis

In most ABPA cases, a lavage is done to find out what’s causing symptoms – whether they’re due to Aspergillus, another infection, or ongoing inflammation.
The results help doctors fine-tune treatment, such as adjusting antifungal doses or deciding if a biologic drug might help.

🫁 Sometimes Used to Clear Mucus

In certain situations – especially when thick mucus plugs are blocking airways or causing part of a lung to collapse – doctors may use lavage as a therapeutic “flush.”
This can wash out sticky secretions and temporarily improve airflow, helping physiotherapy and medication work more effectively.

It’s usually a short, day-case procedure, and most people feel back to normal after a day or two.

⚠️ Why It’s Only Short-Term Relief

Although lavage can clear mucus, ABPA is caused by an allergic immune reaction, not by the mucus itself.
Unless that reaction is controlled with:

  • Corticosteroids (to reduce inflammation),

  • Antifungal drugs (to lower the fungal load), or

  • Biologic injections (to block allergy pathways),

…the lungs will continue to produce thick, sticky mucus, which can re-accumulate within days or weeks.
So while a “lung flush” can make breathing easier in the short term, the effect is temporary – like clearing a blocked drain while the tap is still running.

⚠️ Risks and After-Effects

A bronchoscopy with lavage is generally safe, but it is still an invasive procedure. Possible effects include:

  • Temporary sore throat, cough, or hoarseness (common)

  • Mild bleeding or streaks of blood in sputum for a short time

  • Low oxygen levels during or after the procedure (monitored carefully)

  • Chest tightness, infection, or fever – uncommon but possible

  • Bronchospasm (airway narrowing) in people with very sensitive lungs, which is why it’s done in a hospital with respiratory support available

Because of these small but real risks, the NHS uses lavage only when the benefits outweigh the downsides – for example, when mucus is causing serious blockage or when test results will change management.

💬 In Summary

A “lung flush” can temporarily clear mucus and ease breathing, but it doesn’t stop ABPA’s underlying allergic inflammation.
The mucus often returns unless that inflammation is brought under control with long-term medical treatment.
It’s a useful tool when needed, but not something done regularly or lightly.

by GAtherton

🌿 Why do I get thick, yellow mucus in the morning?

Many people with asthma, ABPA (allergic bronchopulmonary aspergillosis) or sinus problems notice that first thing in the morning they cough up or “hook out” very thick, sticky, yellow mucus from the back of the throat or nose.
It can feel like glue — stringy, rubbery, and slow to move.

The good news is:
👉 This doesn’t automatically mean that Aspergillus fungus is growing in your sinuses.

💧 Why it happens

At night, mucus naturally becomes thicker because:

  • You breathe more through your mouth while sleeping, which dries the nose and throat.

  • Mucus sits still instead of draining, so it concentrates and thickens.

  • If you already have sinus inflammation or allergies, your mucus glands make even more.

  • It often drains down the back of the throat (post-nasal drip), where it collects until morning.

This combination makes for a lumpy, sticky “plug” that only shifts once you’re up and moving around.

🧠 When might fungus be involved?

If the sinuses become colonised with Aspergillus or another fungus, there are usually extra clues, such as:

  • Blocked nose or pressure that doesn’t improve with sprays or rinses

  • One-sided pain or discharge

  • Dark, rubbery, or green-grey plugs rather than yellow mucus

  • Loss of smell

  • CT or endoscopy showing thick debris or “fungal balls”

If these are present, an ENT specialist can look directly into the sinuses and, if needed, take a small sample for fungal culture or order a CT scan.

🩺 What helps most people

You can often manage the morning mucus with simple measures:

  • Saline nasal rinses (like Sterimar, NeilMed, or salt-water sprays) — thin mucus and wash out allergens or fungal dust.

  • Warm fluids or gentle steam to moisten airways.

  • Topical nasal steroid sprays (if prescribed) — reduce swelling and mucus production.

  • Plenty of hydration through the day.

  • Avoid over-using decongestant sprays, which can make congestion worse in the long run.

If mucus stays thick, coloured, or difficult to clear for more than a few weeks — or you develop sinus pressure, pain, or smell loss — ask for a review by your ENT or respiratory team.

🟢 Key message

Thick yellow mucus in the morning is usually a sign of dryness and overnight build-up, not an active fungal infection.

Regular rinsing, good hydration, and controlling sinus inflammation usually keep things under control.

Fungal colonisation is much less common — and when it happens, there are usually other warning signs that your clinician can check.

by GAtherton

Understanding and Controlling Your Immune System

How your immune system works

Your immune system is your body’s built-in defence and repair network.
It protects you from infection, clears away damaged cells, and helps you heal after illness or injury. But it’s also connected to almost every part of the body — your brain, gut, hormones, and even mood.
When finely balanced, it keeps you healthy. When it becomes over- or under-active, it can cause inflammation, allergies, or long-term conditions such as ABPA or asthma.

🧠 1. Brain and nerves

  • Normal role: Immune cells in the brain (called microglia) keep nerve circuits healthy and remove damaged cells.

  • When things go wrong: Too much inflammation can cause fatigue, “brain fog,” anxiety, or depression — feelings many people experience during infection or flare-ups. Long-term inflammation is linked to memory problems and slower recovery after illness.

❤️ 2. Heart and blood vessels

  • Normal role: Immune cells repair vessel walls and help wounds heal.

  • When things go wrong: Chronic inflammation can thicken arteries (atherosclerosis) or cause rare problems like vasculitis, which affects blood flow. Balancing inflammation helps protect heart and circulation health.

🫁 3. Lungs and airways

  • Normal role: The immune system protects your lungs from germs, clears dust, and repairs tissue after irritation.

  • When things go wrong:

    • In asthma or ABPA, the immune system overreacts to harmless triggers such as Aspergillus spores, pollen, or dust, causing airway swelling, mucus build-up, and breathlessness.

    • In CPA, parts of the immune system struggle to clear fungal infection effectively, leading to chronic inflammation and tissue damage.
      Keeping the immune response balanced — not too weak, not too strong — is the key to long-term lung health.

🍽️ 4. Gut and digestion

  • Normal role: About 70% of your immune cells live in the gut, where they keep a healthy balance of bacteria and prevent harmful microbes leaking into the bloodstream.

  • When things go wrong: Stress, poor diet, or antibiotics can disrupt this balance, increasing inflammation.
    A varied, fibre-rich diet and, in some cases, probiotics can help the gut “educate” the immune system.

💪 5. Muscles, joints, and repair

  • Normal role: Immune cells clear damaged tissue and stimulate repair after exercise or illness.

  • When things go wrong: If the immune system stays “switched on,” joints and muscles can ache or feel weak.
    Fatigue in aspergillosis may be partly due to ongoing low-level inflammation.

🧬 6. Hormones and metabolism

  • Normal role: Hormones like cortisol and adrenaline help keep inflammation under control.

  • When things go wrong:

    • Overactive inflammation can worsen insulin resistance, weight changes, and tiredness.

    • Autoimmune problems can affect glands like the thyroid or adrenal glands (Addison’s disease).
      Managing stress, sleep, and diet all help the immune-hormonal balance.

🩸 7. Blood and bone marrow

  • Normal role: The immune system is built in the bone marrow, producing white cells, red cells, and platelets.

  • When things go wrong: Excessive inflammation raises blood markers such as CRP or eosinophils, often seen during ABPA flare-ups or infection.
    Monitoring these levels helps your specialist adjust treatment safely.

🦴 8. Skin and mucous membranes

  • Normal role: Acts as the body’s first barrier, with immune cells ready to seal wounds or fight germs.

  • When things go wrong: Eczema, psoriasis, and slow-healing wounds can occur when immune balance is disturbed — sometimes as side effects of steroids or other medications.

⚖️ 9. The balance between defence and tolerance

The most important job of your immune system is to tell friend from foe — to destroy invaders but leave your own body unharmed.

  • If it overreacts, you get allergies or autoimmune disease.

  • If it underreacts, infections can take hold more easily.

  • In aspergillosis, both problems can occur together: too little defence against fungus, but too much inflammation once the fungus is detected.

🧩 How Medicine Is Learning to Control the Immune System Better

In the past, we only had blunt tools — like steroids — to “calm” inflammation. These saved lives but also caused side effects.
Today, science is learning to control the immune system more precisely, using targeted treatments, cell therapies, and even lifestyle tools that work with your body’s own defences.

🎯 1. Targeted biologic drugs

These are antibodies made in the lab that block one specific immune signal instead of suppressing everything.

Examples used in asthma and ABPA:

  • Mepolizumab and benralizumab block interleukin-5 (IL-5), reducing eosinophil-driven inflammation.

  • Dupilumab blocks IL-4 and IL-13 pathways, calming allergic inflammation.

Other biologics (like infliximab, tocilizumab, and omalizumab) target immune messengers involved in arthritis, eczema, or autoimmune disease.

💉 2. Vaccines and immune training

Vaccines “teach” the immune system to respond safely and efficiently.
New approaches — such as mRNA vaccines — can be updated quickly and may in future be used to retrain the immune system in chronic diseases, allergies, and even cancer.

⚙️ 3. Immune cell therapies and genetic repair

Researchers can now rebuild parts of the immune system:

  • CAR-T cell therapy modifies a patient’s own T cells to find and destroy cancer.

  • T-reg therapy expands the body’s natural “peacekeeping” cells to prevent autoimmune attack.

  • Gene editing (CRISPR) aims to correct inherited immune problems or fine-tune overactive responses.

🧠 4. Neuro-immune and stress control

Because the brain and immune system constantly talk, therapies that reduce stress or stimulate specific nerves can influence inflammation.

  • Vagus nerve stimulation devices can reduce gut and joint inflammation.

  • Mindfulness, relaxation, and gentle exercise lower stress hormones and improve immune balance — especially in asthma or ABPA, where stress can trigger flares.

🌿 5. Microbiome and metabolic balance

Your gut bacteria, diet, and metabolism shape immune health.

  • A high-fibre, plant-based diet produces short-chain fatty acids that calm inflammation.

  • Probiotic and prebiotic therapies are being studied to restore immune tolerance.

  • Metabolic drugs such as metformin are showing anti-inflammatory effects beyond diabetes care.

🧩 6. Re-teaching immune tolerance

The ultimate goal is to re-educate the immune system so it stops attacking harmless things.

  • Allergen immunotherapy exposes the body to small, increasing doses of allergens to reduce sensitivity.

  • Nanoparticle and peptide therapies are being developed to signal to immune cells that “this is safe,” switching off allergic or autoimmune responses without weakening defences.

👤 7. Personalised immune medicine

Every person’s immune system behaves differently.

  • New blood and genetic tests (“immune phenotyping”) help doctors match patients to the best biologic or antifungal treatment.

  • Artificial intelligence is being used to model individual immune systems — predicting who will respond best to certain drugs.

  • In the future, “immune profiles” may be as common as cholesterol or blood pressure checks.

💬 Living with Aspergillosis: What This Means for You

  • You’re not powerless. Understanding your immune system helps you work with your doctors to find the best balance of antifungal, biologic, and anti-inflammatory treatments.

  • Lifestyle still matters. Stress control, exercise, nutrition, and infection avoidance (e.g. clean air, low mould exposure) all influence immune stability.

  • New hope. Research is rapidly advancing — turning immune control from a guessing game into a precise science.
    The same breakthroughs that transformed cancer and autoimmune care are now informing treatments for allergic and fungal lung disease.

🩺 In summary

Your immune system touches every part of your body — lungs, gut, brain, hormones, and skin.
In aspergillosis, it can become both under-protective and over-reactive, creating the delicate balance specialists are trying to restore.
Modern medicine is learning to tune the immune system like an orchestra, not silence it — calming inflammation when it harms you, and strengthening defence when you need it most.

The future of aspergillosis care lies in immune precision — treating not just infection, but the whole system that responds to it.

by GAtherton

🌿 Covid-19 and ABPA / Bronchiectasis: What Patients Need to Know

Many patients with ABPA, bronchiectasis, and asthma ask:

“If I test positive for Covid, am I at higher risk, and do I need antivirals or steroids?”
“Is Covid still a dangerous infection now that everyone has had it many times?”

Here’s what’s important right now.

🎯 Why you may be at higher risk

Having ABPA, bronchiectasis, or asthma doesn’t guarantee severe illness, but it does put you at higher risk compared to the average healthy adult. This means you are more likely to experience:

  1. More severe Covid illness – infections can trigger worse chest symptoms (wheeze, shortness of breath, cough).

  2. Secondary infections – bronchiectasis makes it easier for bacteria to grow in mucus after a viral infection.

  3. Flares of existing disease – Covid can set off asthma attacks or ABPA flare-ups.

  4. Slower recovery – fatigue, breathlessness, and extra sputum can last longer.

⚠️ Important: “Higher risk” does not mean you will definitely become very unwell. Many people with chronic lung disease still have mild Covid and recover fully at home.

✅ Current Covid treatments in the UK (2025)

  1. Antivirals / monoclonal antibodies

    • People with conditions like ABPA, bronchiectasis, or severe asthma may be eligible for medicines such as Paxlovid or Molnupiravir.

    • These must usually be started within 5 days of symptoms or a positive test.

    • Access is through the NHS Covid Medicines Delivery Unit (CMDU), often arranged via NHS 111 or your GP.

  2. Steroids

    • Oral steroids (prednisolone) are not routinely given for Covid unless oxygen levels drop, or you already take them for your lung condition.

    • If your asthma/ABPA flares, follow your specialist’s guidance on when to start rescue steroids.

  3. Antibiotics

    • Covid is viral, so antibiotics don’t treat it directly.

    • But if your doctor suspects a bacterial infection (e.g. in bronchiectasis), they may prescribe something like doxycycline.

🧾 Practical steps if you test positive

  • Call NHS 111 or your GP: Tell them you have ABPA/bronchiectasis/asthma and ask about referral for antivirals.

  • Monitor symptoms closely:

    • Use a pulse oximeter if you have one (seek help if oxygen ≤94%).

    • Watch for worsening breathlessness, chest pain, or confusion.

  • Keep safe at home: Ventilate rooms, use masks if possible, and wash hands often — though once exposed, focus mainly on monitoring and treatment.

🚨 When to seek urgent help

  • Severe shortness of breath

  • Oxygen levels ≤92–94%

  • Chest pain, confusion, or sudden collapse
    → Call 999

❓ Is Covid still dangerous in 2025?

Why it feels less dangerous now

  • Vaccination and immunity: Most people have had jabs and multiple infections, so later bouts are usually milder.

  • Variants: Current strains spread more easily but often cause less pneumonia than the original virus.

  • Better treatments: Antivirals and steroids (when needed) are widely available.

Why it can still be dangerous

  • Vulnerable groups: People with lung disease, weakened immunity, or older age are still more likely to need hospital care.

  • Exacerbations: Even mild Covid can set off asthma or ABPA flares, or worsen bronchiectasis infections.

  • Long Covid: Some people continue to develop fatigue, breathlessness, or brain fog lasting weeks to months.

  • Hospital admissions: Lower than during the pandemic, but NHS hospitals still see severe cases every winter.

👉 In summary: For most healthy people, Covid now feels like a bad cold or flu. For people with ABPA, bronchiectasis, or severe asthma, it can still be a dangerous infection — which is why monitoring and access to antivirals remain important.

✅ Key message

With ABPA and bronchiectasis, you are more vulnerable to complications from Covid. Most people still recover at home, but you may be eligible for antivirals. Steroids are only used if your underlying condition flares or if your oxygen drops. Stay alert, act quickly if symptoms worsen, and reach out for NHS support as soon as you test positive.

by GAtherton

National Aspergillosis Centre Video Recordings

NAC Monthly Patient Meetings

The NAC monthly patient meetings provide a friendly, supportive, and informative space for anyone living with aspergillosis or related conditions. Hosted by the National Aspergillosis Centre (NAC), these sessions bring together patients, carers, and healthcare professionals to:

  • share personal experiences

  • ask questions in a safe environment

  • hear the latest updates on treatments, research, and self-care strategies

🎥 Watch past sessions
Our YouTube channel now has 87 recordings, covering everything from expert talks to personal patient stories. Whatever your stage in the journey — newly diagnosed or managing your condition for years — you’ll find something helpful and relatable.

👉 Browse all recordings here

Recent Highlights

  • September — Explored how Artificial Intelligence can support patients in finding trustworthy information. We also answered community questions about biologic medications, looking at what research tells us about their long-term effectiveness in asthma and ABPA.

  • August — Focused on new biologics for severe asthma, discussing why they don’t always work for everyone, and why some patients see benefits fade over time.

  • July — Shared updates from the British Thoracic Society meeting in Manchester, plus further insights into what the future may hold for biologic treatments.

💡 Whether you want practical advice, the latest medical updates, or simply the chance to connect with others who truly understand your journey, the NAC monthly meetings are here for you.

by GAtherton

💊 Biologics for ABPA & Severe Asthma: How NHS Doctors Choose

Biologics are modern injection or infusion treatments that target the immune system. They can help people with Allergic Bronchopulmonary Aspergillosis (ABPA) by reducing inflammation, cutting down on steroid use, and lowering flare-ups.

In the UK, consultants must follow NICE (National Institute for Health and Care Excellence) guidance, which sets both clinical criteria and cost-effectiveness rules.

🔎 Step 1: Who qualifies?

  • You must already be on high-dose inhalers and still have severe symptoms.

  • Decisions are made by a specialist severe asthma / ABPA clinic team (MDT).

  • Blood tests, flare history, and steroid use are all considered.

🧭 Step 2: Which biologic?

Consultants match the drug to the type of inflammation you have:

Pathway / Clues Possible Biologic Notes
IgE-allergic (allergic tests positive, high IgE) Omalizumab (Xolair) Works best if perennial allergies are driving symptoms.
Eosinophilic (high eosinophil counts, frequent flare-ups, or long-term steroid use) Mepolizumab (Nucala) or Benralizumab (Fasenra) NHS requires doctors to choose the least-expensive if both fit.
Eosinophils ≥400 + frequent flare-ups Reslizumab (Cinqaero, IV drip) Less used, but an option if IV therapy is acceptable.
Still severe after above / not eligible Dupilumab (Dupixent) Also helps if you have eczema or nasal polyps.
Any type, severe with ≥3 flare-ups or on daily steroids Tezepelumab (Tezspire) Works even if blood tests don’t show high eosinophils or IgE.

🛑 Step 3: Stop if no benefit

NICE requires a 12-month review.

  • If your flare-ups or daily steroid dose haven’t fallen enough (usually by ≥50%), treatment should stop.

💷 Why cost matters

  • The NHS only funds biologics judged “cost-effective.”

  • If two drugs are equally suitable, consultants must use the least-expensive one.

  • This doesn’t mean you won’t get the right drug — but sometimes doctors must justify why one biologic is better for you personally.

📌 What this means for ABPA patients

  • ABPA is not directly covered by NICE guidance, but the same biologics are often used if you also meet asthma criteria.

  • Main goals:

    • Reduce oral steroids (prednisolone) and their side-effects.

    • Control flare-ups and lung damage.

  • Evidence supports omalizumab, mepolizumab, benralizumab, and dupilumab in ABPA; tezepelumab has less data so far.

✅ Bottom line:
Biologics can be life-changing for ABPA patients, but the NHS pathway means the choice depends on your blood results, flare history, steroid needs — and cost-efficiency rules. If one option doesn’t work, another may still be possible.

by GAtherton

Other forms of aspergillosis: Aspergillus Pneumonia (Community-Acquired Aspergillus Lung Infection)

What is it?

Aspergillus pneumonia is a rare but serious lung infection caused by breathing in spores of the Aspergillus mould (most often Aspergillus fumigatus). Unlike allergic conditions such as Allergic Bronchopulmonary Aspergillosis (ABPA) or Aspergillus bronchitis, which affect the airways, Aspergillus pneumonia occurs when the fungus actually invades lung tissue. This makes it a more dangerous condition.

How do people catch it?

Most cases are acquired in the community (outside hospital).
You may be at higher risk if you have:

  • A weakened immune system (chemotherapy, transplant, high-dose steroids, uncontrolled diabetes).

  • Chronic lung disease such as COPD or emphysema.

  • A very heavy exposure to fungal spores (compost heaps, rotting bark, mulch, or farming dust).

Almost all cases are due to Aspergillus fumigatus, though other species like A. flavus have also been reported.

How common is it?

  • Aspergillus pneumonia is uncommon, despite Aspergillus spores being everywhere in the environment.

  • It is most often seen in people with weak immune defences, long-term lung disease, or very high exposure.

  • Because it often looks like ordinary bacterial or viral pneumonia, it can be missed or diagnosed late.

Symptoms

The illness may start like a regular chest infection:

  • Cough (dry or with sputum)

  • Shortness of breath

  • Fever or chills

  • Chest pain

  • Fatigue

  • Sometimes coughing up blood

It may progress:

  • Slowly over weeks, with cavities (holes) forming in the lungs.

  • Very quickly, especially after flu, COVID-19, or high spore exposure.

How does it differ from other Aspergillus conditions?

Condition What’s happening Who gets it Key signs
Aspergillus Pneumonia Fungus invades lung tissue (serious infection) Immunocompromised patients, COPD, heavy spore exposure Pneumonia-like illness: fever, cough, breathlessness, chest pain
ABPA Allergy to Aspergillus spores causes airway inflammation People with asthma or cystic fibrosis Wheeze, thick mucus plugs, recurrent asthma attacks
Aspergillus Bronchitis Fungus grows in widened/damaged airways without invading tissue People with bronchiectasis or chronic airway disease Chronic cough, mucus, sometimes blood streaks

👉 In short:

  • Pneumonia = infection inside lung tissue (dangerous, urgent).

  • ABPA = allergic reaction in the lungs.

  • Bronchitis = long-term airway infection.

Is it a type of invasive aspergillosis?

Yes. Aspergillus pneumonia is considered a form of invasive aspergillosis because the fungus invades lung tissue:

  • Acute/severe form: fast, aggressive illness in very vulnerable people (immunocompromised, post-viral, heavy spore exposure).

  • Subacute or “necrotising” form: slower, smouldering infection in people with COPD, diabetes, or long-term steroids, often with cavities.

👉 It is not mild like ABPA or bronchitis — it requires antifungal treatment.

Diagnosis

Doctors may use:

  • Chest X-ray or CT scan – patches, cavities, or diffuse shadowing.

  • Sputum or bronchoscopy samples – to detect Aspergillus in culture or under the microscope.

  • Blood tests – for Aspergillus antibodies, or sometimes antigen (galactomannan).

Treatment

  • Antifungal medicines are the main treatment (voriconazole is most common; sometimes itraconazole or posaconazole).

  • Corticosteroids may be added in severe “pneumonitis-type” illness with overwhelming inflammation.

If treatment begins early, many people respond well. If diagnosis is delayed, the illness can progress rapidly and be life-threatening.

Outlook

  • Without antifungal treatment, Aspergillus pneumonia can be fatal.

  • With modern antifungal drugs, survival and recovery are possible.

  • Some people may develop long-term lung damage, even after successful treatment.

Key message for patients

If you have sudden worsening cough, fever, or chest symptoms that don’t improve with antibiotics — especially if you have COPD, are on steroids, or have had heavy spore exposure — ask your doctor whether Aspergillus pneumonia should be considered. Early diagnosis and treatment make the best outcomes possible.

by GAtherton

Other types of aspergillosis: Allergic Fungal Rhinosinusitis (AFRS)

(Also called Allergic Fungal Sinusitis, Allergic Aspergillus Sinusitis, Allergic Aspergillosis of the sinuses)

What is AFRS?

AFRS is a type of chronic sinus disease caused by an allergic reaction to fungi such as Aspergillus. It mainly affects adolescents and young adults, especially in warm and humid climates. AFRS accounts for about 5–10% of all cases of chronic sinusitis.

Unlike some other forms of fungal sinus disease, AFRS occurs in people with a normal immune system. It is not the same as an invasive fungal infection.

Symptoms

Common symptoms include:

  • Blocked or congested nose

  • Nasal polyps (soft swellings inside the nose)

  • Post-nasal drip (mucus running down the back of the throat)

  • Loss of smell or taste

  • Recurrent sinus infections

  • Headache or facial pressure

Pain is not typical — if severe pain is present, bacterial sinusitis may also be involved. Some people may have more dramatic problems such as worsening eye symptoms, changes in facial appearance, or very severe nasal blockage.

Diagnosis

Doctors may use a combination of:

  • CT scans showing thickened sinuses with “allergic mucin” (thick mucus mixed with fungal debris).

  • Nasal endoscopy to look for polyps and mucus.

  • Laboratory tests for raised IgE (allergy antibody) or specific IgE against fungi.

  • Biopsy or mucus samples, which sometimes show fungal filaments (though not always).

The diagnosis is sometimes difficult, as not every laboratory can reliably detect fungi in mucus.

Causes

AFRS is caused by an overactive immune response to fungi in the sinuses.

  • The most common fungi are Aspergillus (especially A. flavus), Alternaria, and Curvularia.

  • People with allergies, asthma, or nasal polyps are at higher risk.

Treatment

Treatment usually combines surgery and medical therapy.

  • Surgery: Performed using an endoscope through the nose. The aims are to:

    1. Remove thick mucus and fungal debris.

    2. Improve drainage and ventilation of the sinuses.

    3. Allow future cleaning and access if disease comes back.

  • Steroids: Corticosteroids are used to control inflammation and prevent relapse. These may be:

    • Tablets (short or long courses depending on severity)

    • Nasal steroid sprays or rinses (usually long-term)

  • Other treatments:

    • Antifungal medicines are not clearly proven to help but may be tried in some cases.

    • Immunotherapy (allergy desensitisation) may help reduce recurrence.

    • Antibiotics such as azithromycin are occasionally added if bacteria are thought to play a role.

Despite treatment, recurrence is common. Many patients need repeat surgery or ongoing medical therapy.

Link with ABPA (Allergic Bronchopulmonary Aspergillosis)

AFRS affects the sinuses, while ABPA affects the lungs, but both are caused by an allergic reaction to Aspergillus and have many similarities.

  • Some patients develop both AFRS and ABPA, sometimes called “sinobronchial allergic mycosis syndrome.”

  • If you have AFRS and also develop asthma, persistent cough, or changes on a lung scan, your doctor may check for ABPA.

  • Likewise, people with ABPA and severe sinus symptoms may be assessed for AFRS.

  • If there is concern, your doctors may refer you to the National Aspergillosis Centre (NAC) in Manchester for specialist advice.

Key points for patients

  • AFRS is not a dangerous invasive infection, but it is long-lasting and tends to come back.

  • Surgery plus steroid treatment is the main approach.

  • Ongoing follow-up is important because relapse is common.

  • AFRS and ABPA can sometimes occur together, so chest symptoms should always be discussed with your doctor.

by GAtherton

Other forms of aspergillosis: Chronic Aspergillus Sinusitis

(Chronic invasive and granulomatous forms)

Chronic sinus problems are very common, but in a small number of people they are caused by fungal infection, especially Aspergillus. This type of infection is different from the usual bacterial sinusitis and needs different treatment.

What is chronic Aspergillus sinusitis?

  • Chronic rhinosinusitis (CRS) is long-term inflammation of the sinuses (lasting more than 12 weeks).

  • In about 6–12% of CRS cases, fungi are the cause — with Aspergillus being the most common.

  • There are two important invasive forms that are rare but serious:

    • Chronic invasive Aspergillus sinusitis – the fungus grows slowly into the lining of the sinuses and nearby tissues.

    • Chronic granulomatous Aspergillus sinusitis – the immune system forms a hard granuloma (lump of immune cells and fungus), usually caused by Aspergillus flavus.

These conditions progress slowly but can cause long-term damage if not treated.

Who gets it?

  • Chronic invasive Aspergillus sinusitis is more common in Western countries and Japan.

  • Granulomatous sinusitis is more often seen in parts of Africa, South Asia (India, Pakistan), the Middle East, and occasionally the southern United States.

  • People at risk include:

    • Those with diabetes, on long-term steroids, or with HIV infection.

    • Sometimes people with no obvious immune problems can still develop it.

  • Aspergillus fumigatus usually causes chronic invasive sinusitis.

  • Aspergillus flavus is the main cause of granulomatous sinusitis.

Symptoms

Because these forms progress slowly, symptoms are often missed or mistaken for “ordinary sinus problems.” They may include:

  • Blocked or congested nose that doesn’t improve with usual treatments

  • Facial pain or pressure, especially around the eyes, cheeks, or forehead

  • Headaches

  • Nasal discharge, sometimes blood-stained

  • Bleeding from the nose (epistaxis)

  • Facial swelling or numbness

  • Bulging eye (proptosis) or reduced vision if the infection spreads to the orbit

  • Rarely: brain involvement (abscess, meningitis, stroke-like symptoms)

Granulomatous sinusitis often causes a slowly enlarging mass in the nose, cheek, or orbit, and may be mistaken for a tumour.

How is it diagnosed?

  • Scans (CT or MRI): show a mass in the sinuses, sometimes with bone damage. MRI is useful if the eye or brain are involved.

  • Endoscopy and biopsy: tissue samples are taken from the sinus lining.

  • Laboratory tests:

    • Special stains and fungal culture help identify Aspergillus.

    • Blood tests (Aspergillus IgG antibodies) can support the diagnosis.

  • Diagnosis can be delayed because the condition is uncommon and mimics other sinus problems.

Treatment

Prompt treatment is essential to prevent serious complications. Management usually involves:

  1. Surgery

    • To remove infected tissue and improve sinus drainage.

    • Surgery also allows biopsy to confirm diagnosis.

  2. Antifungal medication

    • Long-term antifungal tablets (usually itraconazole or voriconazole).

    • Sometimes intravenous antifungals (e.g. amphotericin B or posaconazole) are used in severe cases.

    • Treatment usually lasts at least 6 months, often longer (sometimes up to a year).

  3. Managing risk factors

    • Good control of diabetes.

    • Reducing or stopping steroid medicines if possible.

Outlook (prognosis)

  • With early diagnosis and combined treatment (surgery + antifungals), many patients do well.

  • Granulomatous sinusitis tends to relapse more often but generally has a better long-term outlook than invasive sinusitis.

  • Regular follow-up is essential because recurrence is common.

    • Follow-up usually includes scans every few months and nasal endoscopy to check for regrowth.

    • Ongoing monitoring may be needed for up to 5 years.

Key points for patients

  • Chronic Aspergillus sinusitis is rare, but important to recognise because it needs different treatment than ordinary sinus infections.

  • Symptoms can mimic chronic sinusitis or even cancer, so biopsy and specialist review are essential.

  • Surgery plus antifungal medication is the main treatment.

  • Long-term follow-up is needed to monitor for relapse.

  • If you have risk factors like diabetes or steroid use, controlling these is important.

✅ Summary:
Chronic invasive and granulomatous Aspergillus sinusitis are rare but serious fungal infections of the sinuses. They progress slowly, can cause damage to the eyes or brain if untreated, and are sometimes mistaken for tumours. With specialist care, surgery, antifungal therapy, and long-term follow-up, most patients can achieve good control of the disease.

by GAtherton

Other forms of aspergillosis: Aspergilloma (Fungal Ball in the Lung)

Aspergilloma (Fungal Ball in the Lung)

An aspergilloma is a clump of fungus (usually Aspergillus) that grows inside an old cavity in the lung. These cavities often form after conditions like tuberculosis (TB), other lung infections, or lung disease. The fungus does not usually invade healthy lung tissue, but it uses the cavity as a space to grow.

How common is aspergilloma?

  • Aspergillomas are uncommon overall, but they are more likely to appear in people who have had tuberculosis in the past.

  • In some countries where TB is (or was) common, aspergillomas are found quite frequently.

  • In countries like the UK, they are rare, but can still happen in people with conditions such as COPD, sarcoidosis, or after lung surgery.

  • Doctors often describe aspergilloma as part of the wider group of conditions called chronic pulmonary aspergillosis (CPA).

What are the symptoms?

  • Many people with an aspergilloma have very few symptoms at first – sometimes only a cough.

  • The most serious problem is bleeding from the lungs (haemoptysis). This can range from small streaks of blood in the sputum to heavy, life-threatening bleeding.

  • Some people may also have chest infections, breathlessness, or tiredness if other lung problems are present.

How is it found?

  • An aspergilloma usually shows up on a chest scan (X-ray or CT).

  • It often looks like a round “ball” inside a cavity in the upper part of the lung.

  • Sometimes it can move around a little inside the space.

  • Important note: Aspergillomas are not cancer, but they can sometimes be mistaken for cancer on scans. For this reason, doctors may arrange extra tests (such as blood tests, repeat scans, or sometimes biopsy) and may refer patients to the National Aspergillosis Centre (NAC) to be certain of the diagnosis.

Who looks after you?

  • At your local hospital, aspergillomas are usually managed by a respiratory (chest) specialist doctor.

  • Depending on your situation, they may also work with:

    • Thoracic surgeons (for possible surgery)

    • Radiologists (for scans or embolisation)

    • Infectious diseases doctors (for antifungal treatment)

  • If your case is complex, unclear, or high-risk, your local team can refer you to the National Aspergillosis Centre (NAC) at Wythenshawe Hospital, Manchester. NAC is the UK’s only NHS specialist centre for aspergillosis and provides expert diagnosis, advanced testing, and treatment advice, often working alongside your local hospital team.

What is the outlook (prognosis)?

  • Some aspergillomas remain stable for years and cause very few problems.

  • A small number may even disappear on their own, although this is unusual.

  • The main risk is serious bleeding, which can be sudden. This is why regular check-ups are important.

  • Surgery to remove the part of lung with the aspergilloma is usually the most effective treatment and can be curative in suitable patients.

  • For people who cannot have surgery, treatments such as blocking bleeding vessels (embolisation) or instilling antifungal medicine into the cavity can sometimes help, but problems may return.

🚨 Emergency: If you cough up blood 🚨

  • Small streaks of blood (mild):

    • Stay calm – these often stop by themselves.

    • Contact your hospital team promptly to let them know.

    • Keep a record of how much and how often it happens.

  • More than a few teaspoons, clots, or ongoing bleeding (moderate to heavy):

    • Call 999 (UK) or go to A&E immediately.

    • Sit upright to help protect the other lung.

    • Take this leaflet or your aspergillosis care details with you.

  • Very heavy bleeding (life-threatening):

    • Treat this as an emergency.

    • Emergency doctors may use medicine to help blood clot, a procedure to block the bleeding vessel (embolisation), or surgery if possible.

⚠️ Always report any bleeding to your doctor, even if it seems small.

Treatment options

  • No treatment may be needed if the aspergilloma is small, not causing bleeding, and the person feels well. Regular monitoring is important.

  • Surgery is the most effective treatment if the fungal ball is causing repeated or heavy bleeding.

  • Antifungal tablets are sometimes used before or after surgery, but on their own they are usually not very effective.

  • Tranexamic acid – a medicine that helps the blood clot – is sometimes prescribed to reduce or control bleeding. It can be taken by mouth or given in hospital if bleeding is significant. It does not remove the aspergilloma but can help keep bleeding under control.

  • Other treatments for people who cannot have surgery include:

    • Blocking the bleeding blood vessels (embolisation) – this can stop bleeding, but the effect may not last.

    • Instilling antifungal medicine directly into the cavity – less common, results vary.

Key points for patients

  • An aspergilloma is not cancer, but because it can sometimes look like cancer on scans, careful checks and sometimes referral to the NAC are needed.

  • The main risk is bleeding, which may require urgent treatment.

  • Surgery offers the best chance of cure, but only if lung function allows.

  • If you have an aspergilloma, you should:

    • Attend regular hospital check-ups.

    • Report any coughing up of blood immediately.

    • Take tranexamic acid if prescribed for bleeding, but also inform your doctor if bleeds occur.

    • Avoid blood-thinning medicines (like aspirin, ibuprofen, or some herbal remedies) unless your doctor prescribes them.

by GAtherton