🫁 Understanding Chronic Cough in Aspergillosis

What the latest British Thoracic Society statement means for you

🌬️ Why This Matters

If you live with aspergillosis, Allergic Bronchopulmonary Aspergillosis (ABPA), or bronchiectasis, coughing can dominate your life. It’s tiring, painful, and socially awkward — especially when people assume it means infection.

Doctors used to see cough as just a symptom of another problem, but the British Thoracic Society (BTS) Clinical Statement on Chronic Cough in Adults (2023) recognises something new:

For many people, a cough can become a condition in its own right — caused by airway and nerve hypersensitivity, not just infection.

This matters for aspergillosis patients because fungal allergy and inflammation make the airways especially sensitive.

💡 What Is “Chronic Cough”?

A chronic cough is one lasting eight weeks or more.
It may be:

  • Dry – little or no mucus

  • Productive – thick sputum (common in bronchiectasis or chronic aspergillosis)

  • Triggered by dust, cold air, perfume, or strong scents

For people with aspergillosis, several overlapping causes may exist:

  • Fungal colonisation or infection

  • Allergic inflammation (ABPA)

  • Bronchiectasis and mucus retention

  • Reflux or post-nasal drip

  • Nerve hypersensitivity

This is why one treatment rarely fixes everything — different “treatable traits” must be addressed together.

🧬 Why It Happens

1️⃣ The Hypersensitive Cough Reflex

People with aspergillosis often develop overactive airway nerves — so normal irritants like dust, scent, or cold air trigger coughing fits.

This “cough reflex hypersensitivity” happens because:

  • Ongoing inflammation damages the airway lining.

  • Nerve endings in the throat and lungs become over-responsive.

  • Even mild triggers set off powerful reflexes.

This is a real physiological process, not psychological.
It’s why cough can continue even when infection is under control.

2️⃣ Treatable Traits – Finding the Real Drivers

Treatable Trait What It Means What Helps
Airway infection or colonisation Persistent fungi or bacteria Antifungal or antibiotic therapy, sputum tests
Allergic inflammation ABPA or asthma-type airway swelling Corticosteroids, biologics (e.g., mepolizumab, benralizumab)
Cough reflex hypersensitivity Overactive airway nerves Speech therapy, nerve-modulating medication
Airway clearance problems Mucus that’s hard to shift Physiotherapy, saline or mucolytic therapy
Reflux or postnasal drip Acid or sinus drainage irritation Reflux management, ENT care

Identifying these traits helps your clinician personalise treatment.

💊 Medications That Can Cause or Worsen Cough

The BTS statement highlights that some medicines can trigger or amplify chronic cough — especially in people with already-sensitive lungs.

🔹 ACE Inhibitors (Blood pressure or heart disease)

Examples: Ramipril, Lisinopril, Enalapril, Perindopril

  • Can cause a dry, tickly cough due to bradykinin build-up.

  • Happens in ~1 in 5 users, sometimes months after starting.

  • GP can switch to a similar drug (ARB – e.g., losartan) that doesn’t cause cough.

🔹 Beta Blockers (Heart or migraine medicines)

Examples: Atenolol, Propranolol, Bisoprolol

  • May tighten airways, worsening wheeze or cough.

  • Safer “lung-selective” versions exist but should still be monitored.

🔹 Inhalers

Examples: Fluticasone, Budesonide, Salbutamol

  • Can irritate the throat if used without a spacer or if technique is poor.

  • Always rinse or gargle after use, and ask your pharmacist to review inhaler technique.

🔹 Antifungal or Reflux Medicines

  • Antifungals (itraconazole, voriconazole) don’t directly cause cough, but reflux or nausea can trigger coughing indirectly.

  • PPIs (omeprazole, lansoprazole) usually help reflux-related cough, but long-term use should be reviewed regularly.

🔹 Other Drugs

  • Amiodarone, methotrexate, and some biologics can rarely cause cough due to lung inflammation.

  • Nasal sprays or lozenges with menthol/alcohol may irritate already-sensitive airways.

💬 If you suspect a medicine is contributing, don’t stop it suddenly — speak to your doctor or pharmacist first.
They can review interactions using the
👉 BNF Interactions Checker – NICE Medicines Guidance.

🔍 How Doctors Assess Chronic Cough

BTS recommends a structured pathway:

  1. Basic tests: chest X-ray, spirometry, bloods (eosinophils, IgE), FeNO if available.

  2. Further tests: CT scan, allergy or sputum studies if initial tests are abnormal.

  3. Trait-based review: identifying overlapping issues — fungal, allergic, nerve-related, or reflux-related.

  4. Specialist referral: to a Cough Clinic or Aspergillosis Centre if symptoms persist.

🧴 Pharmacists: Your Safety Specialists

Pharmacists — hospital or community — are crucial for managing long-term cough and medication safety:

  • Check for cough-inducing drugs or interactions.

  • Advise on best timing for antifungal and steroid doses.

  • Help switch to fragrance-free personal or cleaning products.

  • Liaise with your GP and consultant to fine-tune treatment.

🧭 Regular medication reviews every few months can prevent small problems becoming major triggers.

💬 How It Feels — and Why It’s Misunderstood

People with aspergillosis often describe:

“A tickle that turns into a spasm I can’t stop.”
“People think I’m ill, but it’s just the air or perfume.”

This happens because your airway nerves and immune cells are already primed.
Coughing doesn’t mean you’re infectious — it’s your body’s protective reflex in overdrive.

🩺 What Helps Most

  • Optimise your aspergillosis and ABPA treatment.

  • Cough-control physiotherapy or speech therapy for nerve-related cough.

  • Airway clearance techniques for mucus.

  • Identify and avoid irritants: perfume, smoke, strong detergents, cold air.

  • Ask about biologics if inflammation remains active despite steroids.

  • Use nerve-modulating medicines only under specialist advice.

🧘 Emotional Health Matters Too

Living with a chronic cough can cause anxiety, embarrassment, and isolation.
Support from counsellors, CBT therapists, or patient groups helps manage this stress — and can actually reduce cough frequency through better relaxation and breathing control.

🌱 Key Takeaway

Chronic cough in aspergillosis isn’t “just a symptom” — it’s often a mix of airway inflammation, fungal allergy, nerve hypersensitivity, and sometimes side effects of medicines.

The good news is that every contributing factor is treatable once identified — and cough can improve significantly with the right combination of medical, physical, and environmental care.

🔗 Trusted Resources

by GAtherton

💼 Aspergillosis, Scent Sensitivity, and the Workplace

Understanding why everyday environments can trigger coughing — and what you can do about it

🌫️ When the Air Itself Feels Unsafe

Many people living with aspergillosis, Allergic Bronchopulmonary Aspergillosis (ABPA), or severe allergies feel anxious about returning to offices or shared spaces.
It isn’t the job that’s difficult — it’s the environment.

Dusty desks, neglected air vents, cold air-conditioning, and strong perfumes can all trigger coughing or wheezing.
Even a few minutes in a scented or dusty room can leave you coughing for hours — and explaining (again) that you’re not contagious.

If this sounds familiar, you’re not being oversensitive — you’re reacting to real biological triggers.

🧬 Why These Reactions Happen

1️⃣ Chemical Irritants and Perfumes

Perfumes, air fresheners, and cleaning sprays release volatile organic compounds (VOCs) such as limonene, linalool, and formaldehyde.
In sensitive lungs, these cause irritation and inflammation of the airways.

  • Research shows VOCs can provoke coughing, wheezing, and chest tightness in people with asthma or allergic airway disease.

  • These chemicals also activate airway nerve endings (trigeminal and vagal nerves) that trigger coughing reflexes — even when no infection or allergy is present.

This is known as neurogenic inflammation — a real, measurable process that makes you cough within seconds of exposure.

2️⃣ Damaged or Sensitive Airways

People with aspergillosis, bronchiectasis, or ABPA already have inflamed, scarred, or hypersensitive airways.
The airway lining (epithelium) is fragile and “leaky,” letting irritants trigger inflammation more easily.
Cough receptors are overactive, so small exposures — to scent, dust, or cold air — produce a big response.

Doctors call this airway hyperreactivity or irritant-induced cough reflex hypersensitivity.
It’s not psychological — it’s your lungs doing too good a job of protecting themselves.

3️⃣ Immune System Over-Response

Because aspergillosis and ABPA involve Type-2 immune inflammation (involving eosinophils and Th2 cytokines), your body’s defence cells are already primed.
When you inhale perfumes, dust, or fungal spores, those same immune pathways may flare up — releasing histamine and other inflammatory chemicals.
That’s why even non-allergic triggers can cause coughing or breathlessness.

4️⃣ Combined Triggers

Reactions are often additive.
Dust, perfume, cold air, and low humidity can act together:

  • VOCs stick to dust particles and linger.

  • Cold air increases nerve sensitivity.

  • Mould fragments or Aspergillus spores amplify inflammation.

So what seems like “just perfume” may actually be a cocktail of irritants acting on already-inflamed lungs.

💬 The Social Challenge

Explaining a chronic cough can feel awkward.
Colleagues often assume it means infection — and that’s stressful when you’re already managing symptoms.
You shouldn’t have to justify your condition, but some people find it helps to have a short, calm explanation ready:

“I have a long-term lung condition that makes me cough when the air is dusty or scented — it’s not infectious.”

If you’re comfortable, let HR or Occupational Health know so they can help set expectations and prevent misunderstandings.

🏥 Your Rights and Reasonable Adjustments (UK)

Under the Equality Act 2010, aspergillosis and severe environmental allergies can qualify as a disability because they substantially affect daily life.
That means employers have a legal duty to make reasonable adjustments, such as:

  • A clean, fragrance-free workspace

  • Portable air purifier or improved ventilation

  • Flexible or hybrid working

  • Adjusting temperature or airflow

  • Asking cleaning teams to use low-VOC products

Occupational Health can formalise these requests confidentially so you’re not seen as a “complainer.”

👉 Equality Act 2010 – Reasonable Adjustments (GOV.UK)
👉 ACAS Guidance on Long-Term Health Conditions

🧴 Pharmacists: The Unsung Safety Specialists

Your hospital or local pharmacist is an important ally.
They can:

  • Review all your medicines for interactions or side effects that might worsen coughing.

  • Advise how to take antifungals (e.g., with food, not with antacids).

  • Suggest fragrance-free personal care or cleaning products.

  • Liaise with your GP or hospital consultant if medication changes are needed.

You can also use the official
👉 BNF Interactions Checker (NICE Medicines Guidance)
to look up possible drug interactions — but always confirm findings with your pharmacist.

🏡 Considering Remote or Hybrid Work

If triggers are unavoidable in your current workplace, remote or hybrid work may be a safe and realistic alternative.
A Fit Note from your consultant or GP can recommend home working as a health adjustment.
When searching for jobs, look for roles described as remote, home-based, or flexible — many NHS, charity, and tech employers are now supportive of this.

🧘 Managing the Emotional Side

Anxiety about returning to work is natural.
Many people find that anticipating exposure — and potential misunderstanding — is almost as stressful as the symptoms themselves.
Talking to your consultant or GP about counselling or CBT for health anxiety can help you build confidence and coping strategies.
Peer support from others with chronic respiratory disease can be just as powerful — you’re not alone in feeling this way.

🌱 Key Takeaways

  • Reactions to perfume, dust, and cold air are real physiological responses, not oversensitivity.

  • They occur because inflamed airways and primed immune systems are hypersensitive to chemical and physical irritants.

  • Simple environmental changes — plus understanding from employers and colleagues — can make a huge difference.

  • Pharmacists, doctors, and occupational-health teams can help you manage medicines and advocate for a safe workspace.

You deserve an environment that helps you stay well — not one that forces you to prove you’re not sick.

Further Reading

  • “Airway Hyperresponsiveness in Asthma: Its Measurement and Clinical Significance” (PMC full-text) — a detailed review of what airway hyper-responsiveness (AHR) is, how it happens, and why it matters. Link

  • “Cough Hypersensitivity” (PDF patient leaflet, UK NHS trust) — explains how the airway nerves become too sensitive, what triggers are, and how the cycle of cough can develop. Link

by GAtherton

⚠️ Omeprazole and PPIs: What’s Behind the Recent Warning?

Recently, several newspapers – including The Mirror – reported that a “BBC doctor” had issued a warning to anyone taking omeprazole, a commonly prescribed drug for acid reflux and heartburn.
So, is this something new, or just another media scare? Let’s look at what the evidence actually says – and what it means if you’re living with aspergillosis, bronchiectasis, or other chronic lung diseases.

💊 What Are PPIs?

Proton Pump Inhibitors (PPIs) such as omeprazole, lansoprazole, and esomeprazole are medicines that reduce stomach acid.
They’re often used to:

  • Treat reflux, indigestion, or stomach ulcers

  • Protect the stomach from irritation caused by anti-inflammatory drugs or steroids

They’re very effective and widely prescribed — millions of people in the UK take them every day.

⚠️ Why the Headlines?

The recent news stories stem from a discussion on BBC Morning Live, where GP Dr Punam Krishan highlighted the potential long-term side effects of PPIs.
Although these aren’t “new discoveries”, they serve as an important reminder that long-term PPI use should be reviewed regularly.

🧠 What the Evidence Shows

Research over the past decade has shown that taking PPIs for a long time or at high doses can lead to several possible side effects:

Possible Issue What Happens Why It Matters
Infections Higher risk of gut infections such as Clostridioides difficile and bacterial overgrowth Stomach acid normally helps kill harmful bacteria; reducing it alters the balance
Changes in gut microbiome Loss of protective “friendly” bacteria May influence digestion, immunity, and inflammation
Reduced absorption of nutrients Low magnesium, iron, or vitamin B12 Can lead to tiredness, cramps, or anaemia
Bone health Slightly higher risk of fractures with very long-term use May relate to calcium absorption
Kidney and heart effects (rare) Observed in some studies Still being researched

Most of these risks are small, and for many people the benefits outweigh them — but it’s still important to make sure you’re taking the lowest effective dose and that your doctor reviews the need for it periodically.

🫁 Why It Matters for Aspergillosis and Lung Conditions

If you have aspergillosis, bronchiectasis, or Primary Ciliary Dyskinesia (PCD), there are extra reasons to think carefully about long-term PPI use:

  • Microbiome connections: The gut and lungs are linked through what’s called the gut–lung axis. Disturbances in gut bacteria can affect immune responses elsewhere in the body — possibly including the lungs.

  • Infection control: PPIs can slightly increase the risk of bacterial or fungal overgrowth in the gut. While this doesn’t directly cause lung infection, it may influence the body’s balance between helpful and harmful microbes.

  • Medication interactions: Some antifungal medicines (like itraconazole or posaconazole) rely on stomach acidity for absorption — so PPIs can reduce their effectiveness. Your specialist will usually time doses or adjust medication accordingly.

  • Reflux and aspiration: On the other hand, reflux itself can worsen lung disease if acid is inhaled into the lungs — so stopping PPIs suddenly can make things worse. Always discuss any change with your doctor first.

🩺 What You Can Do

If you take omeprazole or another PPI:

  1. Check why you’re on it – Is it for reflux, ulcer protection, or another reason?

  2. Review the dose and duration – Many people can step down to a lower dose or switch to on-demand use once symptoms are controlled.

  3. Don’t stop suddenly – Stopping PPIs abruptly can cause a rebound in acid production and make symptoms flare.

  4. Ask about alternatives – Some people can switch to H2-blockers (e.g. ranitidine-type medicines), or use lifestyle changes such as avoiding late meals, raising the bedhead, and reducing caffeine or alcohol.

  5. Discuss with your specialist team – Particularly if you’re also on antifungal or antibiotic treatments, as interactions can occur.

🧩 Key Takeaway

The recent headlines about omeprazole are not new, but they highlight a genuine issue:
PPIs are very useful drugs — but long-term use should always be reviewed to make sure the benefits outweigh the risks.

For most people, there’s no need to panic.
Just make sure you:

  • Use the lowest effective dose

  • Review your need for PPIs at least once a year

  • Discuss any concerns with your respiratory or gastroenterology team

🔗 Useful References

by GAtherton

🏠 Awaab’s Law: What It Means for Social Housing Tenants

Awaab’s Law is one of the most important housing reforms in years.
It aims to protect tenants from damp, mould and unsafe living conditions — problems that can seriously affect health, especially for people with asthma, bronchiectasis or fungal lung disease.

The law starts to take effect in October 2025 and is named in memory of Awaab Ishak, a two-year-old who tragically died from prolonged exposure to damp and mould in a housing association flat in Rochdale.
His case led to new, legally enforceable time limits for social landlords to investigate and repair health hazards in rented homes.

📜 Where the Law Comes From

Awaab’s Law forms part of the Social Housing (Regulation) Act 2023.
It adds a new legal duty (Section 10A) to the Landlord and Tenant Act 1985, requiring every social landlord to comply with “prescribed requirements” about how quickly hazards must be investigated and repaired.

These rules are set out in the Awaab’s Law Regulations, published on GOV.UK, and enforced by the Regulator of Social Housing.

👥 Who the Law Covers

Awaab’s Law applies to:

  • Social landlords in England, such as housing associations and local authorities

  • Tenants living in social housing under secure, assured, or introductory tenancy agreements

Awaab’s Law does not yet apply to:

  • Private landlords or the private rented sector (PRS)

  • Owner-occupiers or leaseholders

The Government has confirmed that lessons from this law will inform future private-rented-sector reforms.
(Official source: GOV.UK – Awaab’s Law Guidance)

🏘️ What Is Social Housing?

Social housing is housing owned or managed by public or not-for-profit organisations and rented out at below-market rates to people in housing need.
It provides secure, long-term homes and is regulated by the Regulator of Social Housing.

(Official source: Regulator of Social Housing – GOV.UK)

🧱 Who Provides It

  • Local authorities (councils) – council housing

  • Housing associations – independent, not-for-profit registered providers

  • Charitable or community landlords – smaller providers that must still meet national standards

These organisations are known as registered providers under the Housing and Regeneration Act 2008.

💰 How Social Housing Differs from Other Tenancies

Feature Social Housing Private Rented Housing Shared Ownership / Leasehold
Who owns it Council / housing association Private landlord / company Part tenant part provider
Rent level Below market (50–80%) Market rate Rent on unsold share + mortgage
Tenancy type Secure / assured (long-term) Assured shorthold (short-term) Leasehold ownership
Regulation Regulator of Social Housing Local authority & housing law Leasehold law
Repair standards Decent Homes Standard + Awaab’s Law General HHSRS duties As defined in lease
Who qualifies Based on housing need Anyone meeting market criteria Specific financial criteria

⚙️ What Landlords Must Do Under Awaab’s Law

Social landlords must:

  1. Investigate reported hazards quickly

  2. Provide written findings after inspection

  3. Repair and make safe within legal deadlines

  4. Offer temporary accommodation if the home cannot be made safe in time

These duties cover damp and mould and any emergency hazard posing serious risk to health or safety.

🕒 Timeframes Landlords Must Follow

Stage Time Allowed Example
Emergency hazard Make safe immediately / within 24 hours Gas leak, severe mould, electrical fault
Significant hazard Investigate within 10 working days Damp, cold, structural issues
Tenant update Written summary within 3 working days Explain findings + repairs
If not safe in time Provide alternative accommodation Until repairs complete

(Source: GOV.UK – Draft Guidance)

💬 Why Mould and Damp Matter

Damp and mould are common and dangerous in UK housing and can worsen or trigger asthma, ABPA, CPA, and COPD.
The English Housing Survey (2023) found 1 in 10 social homes had damp or mould problems.

Mould exposure can cause:

  • Asthma flare-ups and new respiratory infections

  • Worsening of fungal lung disease

  • Eye, throat, and skin irritation

Awaab’s Law recognises that poor building design and ventilation, not “tenant lifestyle,” are usually to blame.

🏘️ Why Shared and Multiple-Occupancy Homes Are Higher Risk

Buildings converted into Houses in Multiple Occupation (HMOs) are prone to damp and mould because they:

  • House many people in small spaces

  • Were often converted without proper ventilation or insulation

  • Rely on multiple tenants to report and manage repairs

HMOs are mainly in the private rented sector and not covered by Awaab’s Law.
They are regulated separately under the Housing Act 2004 and inspected by councils using the Housing Health and Safety Rating System (HHSRS).

These homes frequently house students, low-income workers, and people with chronic illness, making damp-related respiratory illnesses a particular concern.

🧱 Why HMOs Need Stronger Oversight

Local authorities can issue Improvement Notices or prosecute landlords for neglecting repairs, but Awaab’s Law’s fixed deadlines do not yet apply.
Government statements indicate future reforms will extend similar protections to private and HMO tenants.

💬 Why This Matters for Health

For anyone with chronic lung disease (ABPA, CPA, asthma, bronchiectasis), damp and mould can trigger flare-ups and new infections.
Awaab’s Law now forces social landlords to act promptly within set legal time limits.

Tenants can:

  • Use the landlord’s complaints procedure

  • Contact the Housing Ombudsman Service

  • Report serious risks to the Regulator of Social Housing or local council

🏛️ Does Awaab’s Law Apply to MOD, NHS, and Other Service Housing?

No — not directly.
Awaab’s Law covers registered social housing providers in England (local authorities and housing associations).
It does not extend to housing owned or managed by the Ministry of Defence (MOD), NHS Trusts, or other public-service employers, unless they are formally registered social landlords (which is rare).

Housing Type Covered by Awaab’s Law? Notes
Council / Housing Association Homes ✅ Yes Registered providers under the Regulator of Social Housing
Private Rented Sector ❌ No (not yet) May be included in future reforms
MOD (Service Family Accommodation) ❌ No Managed by Defence Infrastructure Organisation; standards set by policy, not law
NHS Staff Accommodation ❌ No Governed by occupational licence terms and health & safety law
University or Key Worker Housing ❌ No Treated as private or institutional housing
Charitable / Supported Housing ⚠️ Sometimes Only if registered with the Regulator of Social Housing

These providers must still maintain safe conditions under Health and Safety law, but they do not yet have the same legal repair timescales as social landlords.
The Government has stated that principles from Awaab’s Law may be used to improve MOD and NHS housing standards in future.

(Sources: legislation.gov.uk, GOV.UK – Awaab’s Law Guidance, Parliament.uk HCWS423)

🧩 Summary

Key Point What It Means
Who it covers Tenants in social housing (England only)
What it covers Damp, mould, and serious health hazards
When it starts From 27 October 2025
Who it excludes Private, MOD, NHS and service housing
Why it matters Protects tenants from unsafe homes and poor health
Who enforces it Regulator of Social Housing / Local Authorities
Official sources GOV.UK / legislation.gov.uk / Parliament.uk

🔗 Official References

by GAtherton

🌿 Aspergillosis in the Sinuses (Allergic Fungal Rhinosinusitis – AFRS)

It’s quite possible for Aspergillus to affect both the lungs and the sinuses.
The sinuses are small air-filled spaces behind the nose, eyes, and cheeks that normally drain mucus freely. When Aspergillus spores become trapped there, they can trigger an allergic or inflammatory reaction — rather like ABPA in the lungs.

This allergic form is called Allergic Fungal Rhinosinusitis (AFRS).
It isn’t a contagious infection — it’s an overreaction of the immune system to fungal spores. Over time, it can lead to thick mucus, nasal blockage, and sometimes nasal polyps.

🩵 Common symptoms

  • Persistent nasal congestion or blockage

  • Thick or sticky mucus (sometimes with brown or dark flecks)

  • Reduced or lost sense of smell

  • Facial pressure, pain, or fullness (especially around the eyes or cheeks)

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

  • Fatigue or worsening asthma symptoms

🔬 Diagnosis

  • CT scan of the sinuses – shows thickened or blocked areas

  • Nasal endoscopy – a tiny camera used to look inside

  • Fungal culture or microscopy from mucus samples

  • Blood tests – sometimes show raised total IgE or Aspergillus-specific IgE

💊 Treatment

  • Topical nasal steroids (sprays or rinses) or short courses of oral steroids to reduce inflammation

  • Saline rinses to help keep the sinuses clear

  • ENT surgery if sinuses are blocked or filled with thick fungal debris

  • Antifungal medication in some cases, especially if fungal growth is confirmed

🌸 The Main Types of Aspergillus Sinus Disease

There are several recognised types of sinus aspergillosis. Most people with ABPA or asthma experience only the allergic form (AFRS).

1️⃣ Allergic Fungal Rhinosinusitis (AFRS)

  • Caused by an allergic reaction to Aspergillus

  • Leads to inflammation, thick mucus, and polyps

  • Non-invasive – the fungus stays on the surface

  • Managed with steroids, nasal rinses, and sometimes surgery
    ✅ This is the type most relevant for ABPA patients.

2️⃣ Fungal Ball (Mycetoma)

  • A clump of fungus (usually A. fumigatus) in a single sinus, often the cheek (maxillary) sinus

  • Common in otherwise healthy people

  • Causes chronic congestion or facial pain

  • Treated surgically – antifungals rarely needed

  • Not allergic and not invasive

3️⃣ Invasive Aspergillus Sinusitis

  • Rare, seen mostly in people with severely weakened immunity (e.g., chemotherapy, bone marrow transplant, uncontrolled diabetes)

  • The fungus invades surrounding tissue and blood vessels

  • Causes severe facial pain, swelling, fever, sometimes affecting the eyes

  • Needs urgent treatment with antifungal drugs and surgery
    ⚠️ Very rare in people with ABPA or CPA.

🤝 Specialist care

If you have lung aspergillosis (such as ABPA or CPA) and start noticing more nasal congestion, sinus pressure, or post-nasal drip, it’s sensible to mention it to your respiratory or mycology team.
At the National Aspergillosis Centre (NAC), sinus disease is often co-managed by ENT surgeons, respiratory physicians, and mycology specialists, ensuring coordinated care.

With the right combination of treatments — and early recognition of symptoms — most people find their sinus symptoms improve, and controlling sinus inflammation can even help with overall breathing and energy.

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

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

Information on Allergic BronchoPulmonary Aspergillosis (ABPA) / SAFS – For Family and Friends

Print out or share electronically

WHAT IT IS
ABPA (Allergic Bronchopulmonary Aspergillosis) and SAFS (Severe Asthma with Fungal Sensitisation) are allergic reactions to a common fungus, Aspergillus. In some people with asthma, the immune system overreacts to spores in the air, causing inflammation, swelling, and mucus plugs in the lungs.

WHAT IT'S NOT

  • Not contagious – you can't catch it.

  • Not poor hygiene – Aspergillus is everywhere in the air.

  • Not the patient's fault – flare-ups happen because of the condition, not something they did or didn't do.

WHY AREN'T OTHERS AFFECTED?
Most people's lungs clear these spores easily. In ABPA/SAFS the immune system reacts too strongly – more likely with long-standing asthma, severe allergies, damaged airways (e.g., bronchiectasis), or a genetic tendency. It's not weakness or lifestyle choices – often just lung history and bad luck.

TYPICAL SYMPTOMS

  • Wheezing, cough (sometimes with mucus plugs)

  • Breathlessness

  • Severe fatigue

  • Sometimes coughing up blood

WORST SYMPTOMS

  • Mucus plugs – thick, sticky clumps blocking airways, making breathing suddenly harder.

  • Intense coughing – can be exhausting, cause chest pain, and disrupt sleep.

TREATMENT

  • Anti-inflammatory medicines (often steroids)

  • Antifungals to reduce Aspergillus in the airways

  • Biologics for severe asthma/allergic inflammation

  • Monitoring with blood tests, breathing tests, and scans

THE REALITY
This condition can dominate daily life. On bad days the person may not be able to do much at all. Energy and breathing can change day-to-day (even hour-to-hour). If plans are cancelled, it isn't a lack of interest – it's the illness. Flare-ups can also make people feel short-tempered – a natural reaction to frustration, not a lack of care. Many people also live with a constant awareness of environmental risks – weighing up every new place or activity for dust, damp, or spores. This can feel exhausting and may lead them to avoid situations that others wouldn’t think twice about.

LOOKING AHEAD

  • With good control – Many people manage their symptoms well, reduce flare-ups, and keep active with the right treatment and avoidance of triggers.

  • Risks – Without good control, repeated flare-ups can slowly damage the lungs and lead to bronchiectasis.

  • Change over time – Some improve and need less treatment; others have ongoing ups and downs. Early action on flare-ups makes a big difference.

ENVIRONMENTAL TRIGGERS & PROTECTION
Some people with ABPA or SAFS have to avoid dust, mould, strong smells, smoke, and damp places – these can trigger flare-ups. Activities like gardening, compost turning, or DIY can be risky because they release fungal spores into the air. Wearing a well-fitting mask (e.g., FFP2/FFP3) can help reduce exposure – it's about staying well, not being antisocial.

HOW FRIENDS AND FAMILY CAN BEST HELP

  • Be flexible with plans – energy and breathing can change suddenly; last-minute cancellations aren't personal.

  • Help avoid triggers – choose low-dust, low-mould venues and activities.

  • Support treatment routines – lifts to appointments, collecting prescriptions, or reminders if welcome.

  • Listen without judgement – let them share symptoms and frustrations.

  • Encourage safe activities – suggest hobbies and outings with low environmental risk.

  • Show affection and reassurance – a hug, a kind message, or checking in can mean a lot.

MORE INFORMATION & SUPPORT
National Aspergillosis Centre (UK): https://mft.nhs.uk/wythenshawe/services/infectious-diseases/national-aspergillosis-centre/
Patient information & community: https://aspergillosis.org

by GAtherton

🧵 Why Am I Getting More “Plugs” This July?

A message for aspergillosis patients

July is often a time when people with aspergillosis feel a bit better — but sometimes, things don’t go quite to plan. If you’ve suddenly started getting more mucus “plugs” or are struggling to clear your chest, here are some possible reasons:

🔍 Common Reasons for More Mucus or Plugs in Summer

Possible Cause Why it might affect you now
Fungal spores are high July and August bring very high outdoor levels of Aspergillus, Cladosporium, and other moulds – especially on dry, windy days or after cutting grass. These can trigger inflammation and more mucus.
Pollen season continues Even though tree pollen has gone, grass, weed, and cereal pollen are still in the air. These can worsen symptoms for people with ABPA or asthma.
Humidity or storms Sudden weather changes, humid air, or storms can make breathing more difficult and mucus harder to shift. Some people call this "thunderstorm asthma."
Air pollution (ozone) Sunny weather increases ozone and air pollution – both can irritate your airways.
Low-level infection or flare-up If your mucus is thicker, darker, or smells different, it might be a sign of a fungal or bacterial flare-up, even without a high temperature.
Hydration or medication changes Less water, skipping nebulisers, or changes in routine can make mucus stickier.
Blocked sinuses Post-nasal drip from fungal sinusitis can make it feel like mucus is always sitting in your throat or upper chest.

✅ What You Can Do

  • Drink more fluids, especially warm water or squash

  • Use saline in your nebuliser to loosen thick mucus

  • Do your chest clearance exercises more often – flutter device, ACBT, or huffing

  • Don’t skip antifungals, inhalers, or mucolytics like carbocisteine

  • Consider a nasal rinse if your sinuses feel blocked

  • Keep windows closed on high spore or high pollen days

  • Speak to your team if things don’t settle – you may need a review or antibiotics

⚠️ When to Get Checked

  • You're coughing up yellow, green or brown mucus

  • Mucus smells bad or has blood in it

  • You feel more breathless or more tired

  • You’ve needed to increase your nebuliser use

💬 You're Not Alone

Many patients with aspergillosis get more mucus at this time of year — even when the sun’s out! Don’t assume it’s “just the weather.” Sometimes it’s a sign that your lungs or sinuses are reacting to invisible spores in the air.

by GAtherton