Medical infographic explaining how smoking damages the lungs, increases COPD risk and contributes to Chronic Pulmonary Aspergillosis (CPA), including smoking cessation and vaping advice.

Smoking, COPD and Chronic Pulmonary Aspergillosis (CPA)

Medical infographic explaining how smoking damages the lungs, increases COPD risk and contributes to Chronic Pulmonary Aspergillosis (CPA), including smoking cessation and vaping advice.
Smoking damages the lungs, increases the risk of COPD and can contribute to Chronic Pulmonary Aspergillosis (CPA). Stopping smoking may help preserve remaining lung function and improve long-term health.

Many people diagnosed with Chronic Pulmonary Aspergillosis (CPA) also have Chronic Obstructive Pulmonary Disease (COPD). One of the strongest shared risk factors between the two conditions is cigarette smoking.

Smoking does not directly “cause” Aspergillus infection in the same way a virus or bacteria causes disease. However, it can create the lung damage and immune dysfunction that make CPA more likely to develop and harder to control.

Why smoking matters in CPA and COPD

Smoking damages the lungs over many years by:

  • Destroying normal lung tissue and airways
  • Causing chronic inflammation
  • Reducing the lungs’ ability to clear mucus, dust and fungal spores
  • Damaging the tiny hair-like structures called cilia that normally sweep organisms out of the airways
  • Weakening local immune defence inside the lungs
  • Increasing emphysema, cavities, scarring and bronchiectasis — all environments where Aspergillus can grow more easily

People breathe in Aspergillus spores every day. Healthy lungs usually remove them without difficulty. Damaged lungs are different. In COPD, especially severe COPD, spores can remain trapped in damaged airways and cavities, increasing the risk of long-term fungal colonisation or infection.

Is smoking causal?

The relationship is complex, but in many patients smoking is likely to be an important contributing cause.

Smoking contributes to:

  • COPD development
  • Structural lung damage
  • Reduced immune clearance
  • Increased infection risk
  • Faster lung decline

All of these increase vulnerability to CPA.

Smoking is therefore not simply an associated factor. In many patients it is part of the chain of events that eventually leads to CPA developing.

Not every smoker develops CPA, and not every person with CPA has smoked. Some people develop CPA after tuberculosis, severe pneumonia, sarcoidosis, asthma, bronchiectasis, lung surgery or other lung diseases. However, smoking substantially increases risk because it accelerates lung injury and reduces the lungs’ resilience.

Why continuing to smoke after CPA diagnosis is dangerous

Once CPA is established, continuing to smoke can make management much harder.

Smoking may:

  • Accelerate further lung destruction
  • Worsen breathlessness and cough
  • Increase mucus production
  • Increase flare-ups and infections
  • Reduce physical fitness and oxygen levels
  • Reduce quality of life
  • Increase hospital admissions
  • Make COPD progression faster
  • Increase risk of lung cancer alongside CPA
  • Make recovery from infections slower

Many patients with CPA already have limited lung reserve. Continuing to smoke can progressively reduce the remaining healthy lung tissue.

“The damage is already done” — is stopping still worthwhile?

Yes. This is one of the commonest and most understandable feelings among long-term smokers with lung disease. However, stopping smoking can still help, even after significant lung damage has already occurred.

Within days to weeks

  • Carbon monoxide levels fall
  • Oxygen delivery improves
  • Airways may become less irritated
  • Some coughing and mucus clearance may improve

Within months

  • COPD flare-ups may reduce
  • Circulation improves
  • Physical activity may become easier
  • Inflammation begins to reduce

Over years

  • Lung function decline slows
  • Risk of heart disease and stroke falls
  • Risk of lung cancer gradually decreases
  • Survival improves compared with continued smoking

For people with CPA, preserving remaining lung function is critical. Slowing further structural damage may help stabilise disease, and antifungal treatment works best in lungs that are not being continually injured by smoke.

Is vaping a safer alternative?

Many patients ask whether vaping, or using e-cigarettes, is a safer option than smoking cigarettes.

Current evidence suggests that vaping is likely to be substantially less harmful than smoking tobacco cigarettes because vaping avoids the combustion process that produces tar, carbon monoxide and many toxic chemicals found in cigarette smoke.

For smokers who are unable to stop nicotine completely, switching entirely from smoking to vaping may reduce harm.

However, vaping is not risk-free.

Vaping aerosols can still irritate the lungs and may contain:

  • Fine particles
  • Flavouring chemicals
  • Heating by-products
  • Nicotine
  • Other airway irritants

Some people with CPA, COPD, asthma or bronchiectasis report:

  • Increased cough
  • Throat irritation
  • Chest tightness
  • Wheeze
  • Increased mucus symptoms

Long-term effects of vaping are still being studied.

For patients with CPA, the safest option for lung health is probably:

  1. Stop smoking cigarettes completely
  2. Use vaping only if it helps avoid returning to smoking
  3. Gradually reduce vaping if possible

A common problem is “dual use” — continuing to smoke while also vaping. This usually provides much less benefit than stopping cigarettes completely.

While nicotine itself is addictive, most of the major smoking-related lung damage comes from the toxic products created by burning tobacco.

For many patients, switching from smoking to vaping may still represent an important positive step if it helps them move away from cigarettes permanently.

Nicotine addiction is powerful

Many people with CPA and COPD have smoked for decades. Stopping is rarely simply a matter of willpower. Nicotine is strongly addictive, and smoking often becomes linked to stress relief, routine, anxiety management and social habits.

Patients should not feel ashamed if stopping is difficult. Repeated attempts are normal. Many successful quitters tried several times before succeeding permanently.

What can help?

Support works better than trying alone.

Options include:

  • NHS stop smoking services
  • Nicotine replacement therapy, such as patches, gum, sprays or lozenges
  • Prescription medicines such as varenicline or cytisine, if suitable
  • Behavioural support and counselling
  • Gradual reduction plans
  • Vape or e-cigarette transition strategies in selected patients
  • Family and peer support

For many people with severe lung disease, stopping smoking is one of the most important treatments available — alongside inhalers, oxygen, physiotherapy and antifungal medication.

A realistic but important message

Patients with CPA often already live with fatigue, cough, breathlessness and anxiety about the future. Smoking may feel comforting in the short term, but it usually continues the cycle of lung injury that helped create the problem in the first place.

Stopping smoking cannot reverse established CPA, but it may:

  • Slow further lung decline
  • Improve day-to-day symptoms
  • Improve response to treatment
  • Preserve independence longer
  • Reduce complications
  • Improve long-term survival

Even small improvements in lung health can matter enormously when lung reserve is limited.

When to seek medical advice

Patients with CPA, COPD or other lung disease should seek medical advice if they:

  • Become significantly more breathless
  • Develop chest pain
  • Cough up increasing amounts of blood
  • Notice worsening wheeze or mucus production
  • Develop fevers or signs of infection
  • Feel unable to cope with smoking withdrawal symptoms alone

Stopping smoking is often difficult, but healthcare professionals can offer support and treatment options that improve the chances of success.

by GAtherton

Patient comparing blue reliever inhaler and combination AIR MART inhaler for asthma and aspergillosis

Blue inhalers, combination inhalers and aspergillosis: what patients need to know

Recent news about “blue inhalers” has caused understandable concern for people with asthma, ABPA and other aspergillosis-related lung conditions. The key message is: do not panic and do not stop any prescribed inhaler suddenly.

Blue reliever inhalers, such as salbutamol or Ventolin, remain important medicines and can be lifesaving during asthma symptoms or an asthma attack. However, asthma guidelines have changed because doctors now recognise that relying too heavily on a blue inhaler can be a sign that the underlying airway inflammation is not being well controlled.

What is a blue inhaler?

A blue inhaler usually contains a medicine called a short-acting beta2 agonist, often shortened to SABA. Salbutamol is the best-known example.

These inhalers work quickly by relaxing the muscles around the airways. This can relieve wheeze, chest tightness and breathlessness within minutes. However, a blue inhaler does not treat the airway inflammation that often drives asthma symptoms.

You can read more about reliever inhalers from Asthma + Lung UK.

Why are asthma guidelines changing?

Asthma is not just a condition of narrowed airways. It is also an inflammatory condition. A reliever inhaler may make breathing feel easier for a short time, but if inflammation is not treated, asthma may remain poorly controlled.

Frequent use of a blue reliever inhaler can therefore be a warning sign. It may mean that asthma treatment needs reviewing, especially if someone is needing their reliever often, waking at night, having flare-ups, or finding their normal activities limited.

The updated NICE/BTS/SIGN asthma guideline supports greater use of treatment plans that combine symptom relief with anti-inflammatory treatment.

What are AIR and MART inhalers?

Some patients are now prescribed a combination inhaler that contains:

  • a fast-acting reliever medicine to open the airways
  • an inhaled corticosteroid to reduce inflammation

These approaches are known as:

  • AIR – Anti-Inflammatory Reliever
  • MART – Maintenance and Reliever Therapy

With these plans, the combination inhaler may be used when symptoms occur. In MART, it is also used regularly every day as maintenance treatment.

The important difference is that when symptoms increase, the patient receives more anti-inflammatory treatment as well as more reliever medicine. This aims to reduce the cycle of worsening symptoms, repeated blue inhaler use, and untreated inflammation.

Useful patient information is available from Asthma + Lung UK on AIR inhalers and MART inhalers.

Does this mean everyone should stop using their blue inhaler?

No. This is the most important point.

The new guidance does not mean that every patient must immediately stop using a blue inhaler. It also does not mean that blue inhalers are “bad” or banned.

For many people, nothing will change straight away. Some patients will remain on their current inhalers. Others may be changed to an AIR or MART plan after review by their GP, asthma nurse or respiratory specialist.

Will some patients have their blue inhaler taken away?

Sometimes, but not always.

If a patient is moved onto an AIR or MART plan, their combination inhaler may become both their preventer and their reliever. In that situation, they may no longer routinely need a separate blue inhaler.

However, some patients may still keep a blue inhaler as backup, and others may continue with separate preventer and reliever inhalers. This depends on the individual patient, their diagnosis, their inhalers, and their asthma action plan.

Not all combination inhalers can be used as relievers. Only specific inhalers containing a fast-acting medicine such as formoterol are suitable for AIR or MART use. Patients should only use inhalers in this way if they have been specifically prescribed and instructed to do so.

Why this is more complicated for aspergillosis patients

People with aspergillosis-related lung disease often have more complex respiratory problems than standard asthma alone.

This may include:

For these patients, breathlessness is not always caused by asthma-type inflammation alone. It may also be related to mucus, infection, bronchiectasis, fungal activity, or structural lung damage.

This means that simply taking more inhaler may not always address the real cause of worsening symptoms.

Steroids: useful but needing balance

Inhaled corticosteroids can be very helpful in asthma and ABPA because they reduce airway inflammation. Good control of inflammation may reduce symptoms, flare-ups and the need for oral steroid courses.

However, steroid exposure also needs careful management in aspergillosis patients. Higher steroid doses may increase the risk of side effects such as oral thrush and, in some situations, may affect the balance between inflammation control and fungal growth.

This does not mean patients should avoid inhaled steroids. It means that treatment should be individualised and reviewed by a clinician who understands the patient’s full lung condition.

What should aspergillosis patients do?

  • Do not stop your blue inhaler suddenly if it has been prescribed for you.
  • Do not change your preventer or steroid inhaler without medical advice.
  • Check your own asthma action plan. Make sure you know which inhaler is for daily prevention and which one is for symptoms.
  • Ask whether your combination inhaler is suitable for AIR or MART use. Do not assume that all combination inhalers can be used this way.
  • Request a review if you are using your reliever inhaler frequently, symptoms are worsening, or you are unsure what to do.

When to seek urgent help

Seek urgent medical help if your breathlessness is severe, your reliever is not helping as expected, you are struggling to speak in full sentences, your lips or fingers look blue, or your symptoms are rapidly worsening.

Follow your personal asthma action plan. If you think you are having an asthma attack, do not delay seeking emergency help.

The key message

The new guidance is not simply about “taking away blue inhalers”. It is about recognising that asthma symptoms often reflect airway inflammation, and that some patients do better when symptom relief and anti-inflammatory treatment are given together.

For people with aspergillosis, the message is especially important: inhaler treatment should be reviewed in the context of the whole lung condition, not changed because of a headline.

If you are unsure about your inhalers, speak to your GP, asthma nurse, respiratory consultant or aspergillosis team.

Further reading

by GAtherton

Houseplants and aspergillosis risk showing how soil and moisture can expose people with ABPA to Aspergillus spores and how to reduce risk

Houseplants and Aspergillosis: Do You Need to Get Rid of Them?

Houseplants and aspergillosis risk showing how soil and moisture can expose people with ABPA to Aspergillus spores and how to reduce risk
Houseplants can be kept safely with ABPA in many cases—focus on soil management, hygiene, and ventilation to reduce Aspergillus exposure.
Last reviewed: May 2026
Audience: Patients with aspergillosis (including Allergic Bronchopulmonary Aspergillosis), carers, and non-specialist cliniciansHouseplants are a common concern for people with
aspergillosis, particularly those with
Allergic Bronchopulmonary Aspergillosis (ABPA).If you’ve asked this question, you’re not alone—many patients raise it in our
patient questions and discussions.

🔑 Key Points

  • Houseplants can be a source of Aspergillus spores, mainly from soil.
  • Most people with ABPA do not need to remove all plants.
  • The main risk comes from damp soil and disturbance.
  • Simple precautions can significantly reduce exposure.
  • How plants are cared for matters more than the type of plant.

Contents

🌱 Why can houseplants be a problem?

Aspergillus is a common environmental mould found in:

  • Soil and compost
  • Decaying plant material
  • Damp indoor environments

For people with Allergic Bronchopulmonary Aspergillosis (ABPA), inhaling spores can trigger airway inflammation, wheeze, cough, and breathlessness.

The main risk comes from soil rather than the plant itself.

⚖️ How big is the risk?

The risk varies depending on:

  • How stable your condition is
  • The number of plants
  • Ventilation in your home
  • How plants are maintained

Specialist centres such as the National Aspergillosis Centre (NAC) recommend a
risk reduction approach rather than complete avoidance.
You can read more in our guide to
reducing mould exposure.

Important: There is limited direct research linking houseplants to worsening ABPA. Advice is based on environmental studies and clinical experience.

🌿 Do houseplants clean the air?

You may have heard that houseplants “clean the air.” This idea comes from laboratory studies, including research by
:contentReference[oaicite:0]{index=0}, conducted in sealed environments.

In real homes, the effect is minimal.

  • Very large numbers of plants would be needed
  • Ventilation has a much greater impact
  • Soil may introduce Aspergillus spores

For a broader explanation, see our
aspergillosis overview.

Bottom line: Plants may improve wellbeing, but they are not an effective air-cleaning strategy.

🌿 Can I safely keep my houseplants?

In many cases, yes.

Many people with ABPA keep houseplants without problems when their condition is stable and plants are well maintained.

However, some individuals are more sensitive, so a personalised approach is important.

✅ How to reduce your risk

1. Manage the soil carefully

  • Avoid constantly damp compost
  • Allow the top layer to dry between watering
  • Consider lower-organic substrates (e.g. clay pebbles)

Tip from patients: Adding a layer of stones or gravel on top of the soil can reduce disturbance during watering and may help limit release of fungal spores.

2. Avoid disturbing soil indoors

  • Repot plants outside if possible
  • Wear a well-fitted mask (FFP2 or FFP3)

3. Maintain good plant hygiene

  • Remove dead leaves promptly
  • Avoid visible mould growth
  • Do not allow stagnant water

4. Choose locations carefully

  • Keep plants out of bedrooms
  • Ensure good ventilation

5. Personal hygiene after handling plants

  • Wash hands after handling soil or compost
  • Avoid touching your face before cleaning hands
  • Consider changing clothes after heavy gardening
  • Ventilate the area after indoor plant work

These steps form part of a wider approach to
reducing environmental exposure.

🌿 Are some plants lower risk for ABPA?

There is no strong evidence that specific plants are “safe” or “unsafe.” The main risk comes from soil and moisture.

Some setups may be lower risk in practice:

  • Hydroponic or semi-hydroponic plants
  • Plants that prefer drier conditions (e.g. succulents)
  • Well-maintained plants with minimal decaying material

Important: Any plant can become higher risk if soil becomes damp or mouldy.

If unsure, you may wish to review
clinical guidance or discuss with your care team.

🚩 When should I consider removing plants?

  • Symptoms worsen after watering or handling plants
  • Visible mould in soil
  • Frequent flare-ups
  • Clinical advice recommends stricter avoidance

Some people remove plants temporarily during unstable periods and reintroduce them later.

❓ Common questions

Are leaves dangerous?

No—the main risk comes from soil and decaying material.

Is outdoor gardening riskier?

Yes, due to higher exposure. Wearing a mask is recommended.

Do air purifiers help?

HEPA filters may reduce airborne particles, but evidence specific to ABPA is limited.

⚠️ When to seek medical advice

  • Increasing breathlessness or wheeze
  • Worsening cough or mucus
  • Reduced peak flow
  • Symptoms linked to specific environments

Do not change treatment without medical advice.

📚 References & Further Reading

👩‍⚕️ Author & Review

Developed for patient education in line with UK specialist practice (National Aspergillosis Centre, Manchester).
This information is general and does not replace individual medical advice.

Looking for more answers? Visit our
patient questions hub.

by GAtherton

Diagram showing inflamed airway with mucus and narrowing compared to improved airway with clearer airflow and better lung function

Can Lung Function Improve After Infection or Treatment?

Diagram showing inflamed airway with mucus and narrowing compared to improved airway with clearer airflow and better lung function
Airways can become narrowed by inflammation and mucus after infection or treatment. With time and the right support, airflow can improve and symptoms may ease.

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?

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:

  1. Breathe in slowly through your nose (about 2 seconds)
  2. Purse your lips (as if whistling)
  3. Breathe out slowly through your lips (about 4 seconds)
  4. 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:

  1. Sit or lie comfortably
  2. Place one hand on your chest, one on your abdomen
  3. Breathe in through your nose and allow your abdomen to rise
  4. 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.

by GAtherton

Infographic showing causes of weight loss and weakness in aspergillosis including inflammation, reduced appetite, medication effects and muscle loss, with stages of recovery.

Weight Loss and Weakness in Aspergillosis: Why It Happens, How It Feels, and What Helps Recovery

Infographic showing causes of weight loss and weakness in aspergillosis including inflammation, reduced appetite, medication effects and muscle loss, with stages of recovery.
Weight loss and weakness in aspergillosis are usually caused by a combination of inflammation, increased energy use, reduced appetite, and muscle loss. Recovery is often gradual and happens in stages.

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.

---

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

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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:

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.

---

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

---

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.

---

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.

---

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

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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.

by GAtherton

Fermented foods gut lung axis diagram showing microbiome, lungs, reflux and aspiration risks in chronic lung disease

Fermented Foods & Lung Health: Safety, Infection Risk and Aspergillosis

Last reviewed: April 2026

Many people with lung conditions ask whether foods like kefir, yoghurt or cider vinegar could trigger infections. This article explains what we know — and what we don’t — based on current evidence and patient experience.

 

Fermented foods gut lung axis diagram showing microbiome, lungs, reflux and aspiration risks in chronic lung disease
How fermented foods may influence health: most effects are indirect, via the gut–lung axis, reflux, or aspiration rather than direct lung infection

Can fermented foods cause lung infections?

No. There is no strong evidence that fermented foods cause lung infections such as pneumonia. Any effects on the lungs are more likely indirect, for example through reflux or aspiration rather than direct infection.

Quick answer: fermented foods are generally safe, but individual responses vary.

Key Points

  • Fermented foods contain live microorganisms, usually beneficial bacteria and yeasts
  • For most people, these foods are safe and part of a healthy diet
  • There is no strong evidence linking fermented foods to lung infections
  • Some people with lung disease may be affected by reflux or aspiration
  • If symptoms worsen after certain foods, it is reasonable to avoid them

Table of Contents

What are fermented foods?

Fermented foods are made using microorganisms (such as bacteria or yeast) to transform food. Examples include yoghurt, kefir, sauerkraut, kimchi, cheese and cider vinegar (including those containing the “mother”).

These microorganisms are generally considered non-harmful or beneficial.

Are fermented foods safe?

For most people, including many with chronic lung conditions, fermented foods are considered safe.

They may support gut health, although evidence varies depending on the product and individual.

You can read more in our

diet and aspergillosis guide
.

Can they cause infections?

There is no clear evidence that eating fermented foods causes lung infections such as pneumonia.

Lung infections usually arise from:

  • Microorganisms already present in the airways
  • Inhaled organisms from the environment

This is explored further in our article:

Why antibiotics do not always work
.

Why do concerns arise in lung conditions?

People with aspergillosis, bronchiectasis or chronic lung disease may be more sensitive to changes affecting the lungs.

1. Aspiration

If small amounts of food or liquid enter the airway, this can contribute to infection.

2. Reflux

Reflux can reach the upper airway and may play a role in lung irritation.

3. Lung microbiome

The lungs contain their own microbial environment, which can shift during illness.

4. Coincidence vs causation

An infection occurring after a dietary change does not necessarily mean the food caused it.

Evidence in this area is still developing, and most studies focus on gut health rather than direct lung effects.

Who might need to be more cautious?

  • Frequent lung infections
  • Significant bronchiectasis
  • Swallowing difficulties
  • Severe reflux
  • Weakened immune systems

At specialist centres such as the National Aspergillosis Centre, these factors are considered alongside overall lung health.

Practical considerations

  • Avoid foods that appear to worsen symptoms
  • Introduce new foods gradually
  • Be cautious with unpasteurised products
  • Keep a simple symptom diary

Common questions

Are probiotics the same as fermented foods?

No. Probiotics are specific strains studied for health benefits, while fermented foods vary widely.

Should people with aspergillosis avoid fermented foods?

There is no general recommendation to avoid them. Most people tolerate them well.

Can fermented foods affect the lungs directly?

Not usually. Effects, if present, are more likely indirect.

When to seek medical advice

  • New or worsening breathlessness
  • Persistent cough or sputum changes
  • Fever or infection symptoms
  • Repeated infections

Summary

Fermented foods are generally safe, but individual responses vary. There is no strong evidence linking them to lung infections, but factors such as reflux or aspiration may be relevant in some people.

Balancing general evidence with personal experience is key.

References

Author & Review

This article has been prepared by the National Aspergillosis Centre CARES team for patients and non-specialists.

It is intended for general education and should not replace individual medical advice.

by GAtherton

Help us understand how damp homes affect health

We are supporting a UK research project looking at how damp homes may affect health, including respiratory health and conditions such as aspergillosis.

This study is being led by the National Aspergillosis Centre at Manchester University NHS Foundation Trust, and is being shared through aspergillosis.org to support research into damp homes and health.

We are currently inviting people across the UK to register their interest in taking part.

Registering your interest should take less than one minute and does not commit you to taking part.


Register your interest now

Why this matters

Damp and mould are often linked to health problems, but there is still limited real-world evidence from people’s homes across the UK.

This project aims to help improve understanding of how home environments may affect health by gathering information from people living in a wide range of housing conditions.

Who can register interest?

We would like to hear from people living in the UK, including:

  • people with lung or respiratory conditions
  • people without any known lung or breathing condition
  • people who have experienced damp or mould at home
  • people who have not experienced damp or mould at home
  • members of the general public who would like to contribute to the research

We are keen to hear from people with different health backgrounds and a wide range of home environments.

What is the study about?

This research is exploring how damp homes may affect health. The aim is to improve understanding of the relationship between home environments and health symptoms in real-world settings.

This project is for research purposes only and does not provide medical advice or diagnosis.

What might taking part involve later?

If the study opens, some people who register interest may later be invited to:

  • complete a short questionnaire about their home and health symptoms
  • receive a simple home sampling kit by post
  • collect and return a small household sample, for example dust from the home, for research purposes

The home sampling part is intended to be simple and practical. Full instructions would be provided.

Registering your interest now does not commit you to taking part later.

Important information

  • Registering interest is voluntary.
  • You do not have to take part in the full study later.
  • Your details will only be used to contact you about this project.
  • Your data will be handled in line with UK data protection regulations.
  • You can decide later whether or not to take part.

Frequently asked questions

Am I signing up to take part in the study now?

No. At this stage, you are only registering your interest in hearing more about the study.

Do I need to have a lung condition to register interest?

No. We would like to hear from people with and without lung conditions.

Do I need to have damp or mould in my home?

No. We are interested in hearing from people with a wide range of home environments and experiences.

Will I definitely receive a kit?

Not necessarily. Registering interest helps the research team understand the level of interest and contact people if the study opens.

Will I get personal results about my home or health?

At this stage, no individual results are being promised. More information would be provided if the study proceeds.

What happens after I register interest?

You do not need to do anything further straight away. If the study opens, you may be contacted with more information so you can decide whether you would like to take part.

Register your interest

Ready to help? Complete the form below.

This secure form should take less than one minute to complete.

If the form does not load, you can open it here:

Open the form in a new window

by GAtherton

Kefir and aspergillosis infographic

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.

by GAtherton

Allergy, Intolerance and Wheat Reactions: What Is Actually Going On?

Key points

  • You can have real and sometimes severe symptoms without having a classic allergy.
  • Allergy, intolerance, and non-IgE reactions involve different biological pathways.
  • Similar symptoms (such as wheeze or mucus) do not always mean the same cause.
  • The term “intolerance” is often used as a catch-all, which can be confusing.
  • For people with lung conditions, triggers may still worsen symptoms even when allergy tests are negative.

This article is general educational information for patients and carers. If you are new to this topic, you may wish to start with our overview of what is aspergillosis or explore common symptoms affecting the lungs and airways.

Contents

Why this is so confusing

Many people use the word “allergy” to describe any reaction to food or environmental triggers. This is understandable, because the symptoms can feel very similar.

For example:

However, similar symptoms do not always mean the same biological cause. This is where confusion begins.

What is a true allergy?

A true allergy usually refers to an IgE-mediated immune reaction.

This means the immune system reacts quickly to a substance, often within minutes to a couple of hours. Symptoms may include:

This type of reaction is what most allergy clinics are designed to detect, because it can be serious and is usually testable.

What is an intolerance?

An intolerance is a broader term used when symptoms do not follow the classic IgE allergy pathway.

It may involve:

  • digestive processes
  • food chemicals such as histamine or salicylates
  • gut–immune interactions
  • non-specific inflammation

Importantly: intolerance does not mean “mild” or “unimportant”. It simply means the mechanism is different and often harder to measure.

For guidance on managing food-related symptoms, see our diet and nutrition hub.

The grey area: non-IgE reactions

Not all immune reactions involve IgE.

Some reactions involve other parts of the immune system and may be:

  • delayed
  • longer lasting
  • harder to detect with standard tests

This creates a grey area between “allergy” and “intolerance”.

This is why the statement:

“Same symptoms but no IgE = intolerance”

is often an oversimplification.

Wheat as an example

Wheat reactions are often used to illustrate this complexity:

  • Wheat allergy → IgE reaction to wheat proteins
  • Coeliac disease → autoimmune condition (see NICE guidance)
  • Non-coeliac wheat sensitivity → unclear mechanism
  • Carbohydrate intolerance → reaction to fructans (FODMAPs)

All of these may cause symptoms, but they require different ways of understanding and managing.

Why “downgraded” feels upsetting

Patients are sometimes told they have been “downgraded” from allergy to intolerance.

In reality, what has usually happened is:

  • a classic IgE allergy has been considered unlikely
  • testing is unlikely to add further information
  • the reaction falls into a less clearly defined category

This is a change in classification, not a judgement about importance or severity.

Why this matters in asthma and aspergillosis

For people with asthma, Allergic Bronchopulmonary Aspergillosis (ABPA), or chronic pulmonary aspergillosis (CPA):

  • airways are often more sensitive
  • inflammation may already be present

This means that triggers do not always need to be classic allergens to cause problems.

Symptoms such as wheeze, mucus and chest tightness may worsen even when allergy tests are negative.

You may also find it helpful to read why antibiotics do not always work, which explains how non-bacterial causes can drive ongoing symptoms.

Why testing is often limited

Allergy testing works best for IgE-mediated conditions.

For many other reactions:

  • there are no simple validated tests
  • diagnosis relies more on clinical history and patterns

Further detail for clinicians and advanced readers is available in our information section for patients.

What usually happens next?

After a classic allergy has been ruled out, the process does not stop—it changes direction.

Understanding patterns

The focus often shifts to identifying:

  • what triggers symptoms
  • how quickly symptoms occur
  • whether effects are delayed or cumulative

Identifying the main system involved

  • Gut-related → bloating, pain, bowel symptoms
  • Airway-related → wheeze, mucus, chest tightness
  • Mixed/systemic → fatigue and general symptoms

Different types of support

Depending on the pattern, support may involve:

This stage is often less clear-cut but can still lead to meaningful improvements over time.

Take-home message

  • Allergy and intolerance are not the same.
  • “Intolerance” is often used as a broad label.
  • Symptoms may be similar, but the underlying pathways differ.
  • This affects how conditions are understood and managed.
  • Even without a clear label, symptoms remain real and important.

When to seek medical advice

Seek urgent help if you develop:

  • sudden breathing difficulty
  • swelling of the lips, tongue or throat
  • collapse or severe dizziness

Arrange medical review if you have:

  • persistent or worsening symptoms
  • repeated reactions to foods or triggers
  • worsening respiratory symptoms

Related topics

References

  1. NHS – Food allergy and intolerance
  2. BSACI – Food allergy guidance
  3. NICE NG20 – Coeliac disease

Last reviewed: April 2026

Author: Aspergillosis Website Team

Review status: Educational content for patients and carers

by GAtherton

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 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.

by GAtherton