For: patients, carers, general practitioners, specialist nurses and other non-specialists

Key points

• Eating difficulties are common in aspergillosis, especially in chronic pulmonary aspergillosis (CPA) and in people who also have other lung disease.
• The problem is often not simply “poor appetite”. Breathlessness, cough, fatigue, reflux, nausea, altered taste and medicine side effects can all make eating difficult.
• Some people gradually cut out more and more foods because eating feels uncomfortable or because they have been told certain foods are “bad” for lung symptoms.
• For many patients, the main nutritional goal is not a “perfect” diet. It is getting enough energy, protein and fluids in ways that feel manageable.
• “Little and often”, food fortification and nourishing drinks are often more realistic than trying to eat three large meals a day.
• Ongoing weight loss, a very restricted diet, persistent nausea, reflux or difficulty eating most days should be discussed with a doctor, specialist team or dietitian.

Why diet can become a major problem in aspergillosis

Many people living with aspergillosis find that eating becomes much harder than it used to be. This is particularly important in chronic pulmonary aspergillosis (CPA), where weight loss, fatigue and general ill health are common features of the illness. In practical terms, the body may need more energy while the person is less able to eat comfortably.

Several problems can overlap:

• Breathing takes more effort, which can increase energy needs.
• Coughing or breathlessness can interrupt meals.
• Tiredness can make shopping, cooking and eating feel like hard work.
• Inflammation and chronic illness can reduce appetite and contribute to muscle loss.
• Antifungal treatment and other medicines can cause nausea, altered taste, indigestion or poor appetite.
• Reflux, bloating or early fullness may mean that even small meals feel uncomfortable.

For some patients this creates a vicious circle: eating becomes unpleasant, intake falls, weight drops, strength falls, and eating may then feel even more difficult.

Who is most affected?

Not every patient with aspergillosis has major nutritional problems, but some groups are more likely to struggle. This includes people with:

• Chronic pulmonary aspergillosis (CPA)
• pre-existing lung disease such as chronic obstructive pulmonary disease (COPD), bronchiectasis or previous tuberculosis
• long-term fatigue, breathlessness or coughing
• persistent nausea or reflux symptoms
• a history of recent unplanned weight loss
• side effects from antifungal or other medicines
• anxiety around eating because meals repeatedly trigger symptoms

Some people with allergic bronchopulmonary aspergillosis (ABPA) also report poor intake or nutritional difficulties, although the pattern may differ from CPA. In ABPA, steroid treatment, asthma burden, medicine effects and general symptom load may all influence diet.

How eating can become difficult

People often describe eating problems in ways that do not sound like a classic “nutrition” issue. They may say things like:

• “I get full after a few mouthfuls.”
• “I cannot face a proper meal.”
• “Eating makes me cough.”
• “I feel uncomfortable after food.”
• “Some foods seem to sit badly.”
• “I only eat a few safe foods now.”

These experiences are important. They suggest that the real problem may be a mixture of breathlessness, upper gastrointestinal symptoms, medicine effects and learned food avoidance, not simply a lack of willpower or poor food choices.

When eating shrinks into a “minimal diet”

Some patients end up eating very little, often because that feels safer or more manageable than trying to eat normally. A “minimal diet” may look like:

• very small amounts of food only once or twice a day
• mostly soft or liquid foods
• reliance on tea, toast, soup or yoghurt
• long gaps without eating
• skipping meals because eating feels exhausting

This is understandable, but it can become a serious problem. Small intake over time may lead to:

• weight loss
• loss of muscle mass
• greater weakness and fatigue
• slower recovery from illness
• reduced ability to cope with infections or treatment

If a patient is managing only tiny amounts of food, the first goal is often not to rebuild a “normal” diet immediately. It is to make intake easier, more comfortable and more nourishing.

Avoiding many food types

Another common pattern is gradual food restriction. Patients may stop eating several food groups because they believe these foods worsen mucus, cough, reflux, nausea or fungal disease.

Examples include avoiding:

• dairy products
• sweet foods
• bread or dry foods
• meat
• acidic foods
• foods linked in the mind to a previous bad episode

Sometimes there is a genuine reason for avoiding a particular food. For example, reflux may make acidic or very fatty foods uncomfortable, and a dry crumbly food may clearly trigger coughing. The difficulty is that repeated bad experiences can also lead to over-restriction, where more and more foods are cut out than is really necessary.

That can leave the diet low in calories, low in protein and very repetitive. In practice, the aim is usually to adapt foods rather than cut out whole food groups unless there is a clear reason to avoid them.

Could the stomach or gut be part of the problem?

Yes. This is often overlooked.

Some patients with aspergillosis describe symptoms that sound mainly digestive rather than respiratory, for example:

• nausea
• heartburn or reflux
• bloating
• feeling full very quickly
• upper abdominal discomfort
• reduced appetite after starting or changing medication
• alternating diarrhoea and constipation

There are several possible reasons:

• Medicine side effects, including antifungals
• Gastro-oesophageal reflux disease (GORD), which can also worsen cough
• reduced activity levels and chronic illness
• constipation, especially when intake is poor or medicines contribute
• co-existing gastrointestinal disease that is separate from aspergillosis

If eating repeatedly causes upper abdominal or chest discomfort, or if reflux and nausea are prominent, it is reasonable to think of this as a symptom needing review rather than simply a “fussy eating” problem.

Practical ways to make eating easier

Different things help different people, but these approaches are often more realistic than trying to push through large meals.

1. Think “little and often”

Many people do better with five or six small eating opportunities through the day instead of three big meals. That may mean a small breakfast, a mid-morning snack, a light lunch, a nourishing drink, an evening meal and a supper snack.

2. Lower the effort of eating

Soft, moist foods are often easier than dry, chewy or crumbly foods. Examples include:

• porridge
• yoghurt
• custard or rice pudding
• mashed potato with added butter or cheese
• scrambled eggs
• soup with cream or grated cheese
• stews, casseroles or sauced dishes

3. Use drinks as nutrition

For some patients, drinks are easier to manage than food. Nourishing options can include:

• milky drinks
• smoothies
• milkshakes
• fortified hot drinks
• commercial oral nutritional supplements if prescribed or advised

4. Rest before eating

If fatigue or breathlessness are major barriers, it can help to eat after a rest rather than after exertion. Some people find breakfast or lunch easier than an evening meal.

5. Sit upright and stay upright afterwards

This can be especially helpful when reflux, coughing or chest discomfort are part of the picture.

6. Slow the pace

It is acceptable to eat slowly and pause often. Some patients benefit from smaller mouthfuls and short breathing pauses between them.

7. Look for manageable variety

If the diet has become very narrow, widening it gently may be more successful than trying to overhaul everything at once.

How to support weight maintenance

When keeping weight on is difficult, the most useful approach is often to increase the energy and protein content of what is already being tolerated.

Food-first ideas

• Add butter, cream, cheese, yoghurt, milk powder or olive oil to foods where suitable.
• Choose full-fat products rather than “diet” versions if weight loss is a concern.
• Add grated cheese to soup, mashed potato, scrambled eggs or vegetables.
• Make porridge with milk rather than water.
• Keep easy snacks available, such as yoghurts, cheese and crackers, peanut butter, hummus, custard, rice pudding or milky desserts.

Protein matters

Protein helps preserve muscle. Good sources include:

• milk, yoghurt and cheese
• eggs
• meat, fish and poultry if tolerated
• beans, lentils and other pulses
• nut butters where suitable

Oral nutritional supplements

When food alone is not enough, a doctor or dietitian may suggest oral nutritional supplements. These are often used between meals rather than instead of meals. They can be particularly helpful when appetite is low or meal size is very limited.

In general UK nutrition practice, a “food first” approach is usually tried first where appropriate, but oral nutritional supplements are commonly used when someone is at higher risk of malnutrition or is unable to meet needs from food alone.

Food and medicine issues to remember

Food and medicine can interact in two main ways.

1. Medicines can affect eating

Antifungal treatment and other medicines may contribute to:

• nausea
• indigestion
• altered taste
• poor appetite
• bowel upset

If these symptoms started after a medicine was introduced or changed, it is worth discussing that with the prescribing team.

2. Food can affect medicines

Some antifungal medicines have specific instructions about when to take them in relation to food. For example:

• Itraconazole capsules are generally taken with or just after food, while itraconazole liquid is generally taken on an empty stomach.
• Voriconazole is usually taken on an empty stomach.
• Some medicines also have important interactions with antacids or acid-suppressing medicines.

Because formulations differ, and because other medicines may also interact, patients should follow the instructions they have been given for their exact preparation and check with a pharmacist or clinical team if unsure.

Grapefruit and other food interactions: some medicines have clinically important food interactions. Patients should check current advice for each medicine rather than relying on memory or online generalisations.

Common diet myths

Dairy always makes mucus worse

This is a very common belief. Current evidence does not show that dairy routinely increases lung mucus production for most people. Some people do notice a thicker mouth or throat feeling after milk, which may relate to texture rather than extra mucus. If dairy is well tolerated, it can be a useful source of calories and protein.

Sugar “feeds” aspergillosis, so it should be cut out completely

Patients often hear this online, but strict self-imposed restriction can be more harmful than helpful when someone is already struggling to maintain intake. For many patients with weight loss, the immediate nutritional priority is adequate calories and protein, not aggressive dietary exclusion.

There is a special anti-aspergillosis diet

There is no widely accepted specialist diet that treats aspergillosis itself. In routine practice, nutrition advice usually focuses on preventing or treating malnutrition, easing symptoms and managing medicine-related issues.

If eating is difficult, I should just avoid more foods

Sometimes a food really is hard to tolerate, but repeated restriction can shrink the diet too far. Often it is more useful to ask, “Can this be made easier to eat?” rather than “Should I cut this out altogether?”

When to seek medical help

Patients should speak to their doctor, specialist team or another qualified healthcare professional if they have any of the following:

• ongoing unplanned weight loss
• clothes, rings or dentures becoming looser
• difficulty eating most days
• a very narrow diet with only a few “safe” foods
• persistent nausea, reflux, bloating or abdominal discomfort
• increasing weakness or fatigue
• concerns that medicines are worsening appetite or stomach symptoms

It may be appropriate to ask about a dietitian referral, especially if intake has been poor for some time or there are signs of malnutrition.

Seek urgent medical advice if:

• food or fluids are being kept down very poorly
• there are signs of dehydration
• weight loss is rapid or severe
• pain, vomiting, swallowing difficulty or other worrying symptoms are developing

Common questions

Should I force myself to eat full meals?

Usually not. If full meals are consistently overwhelming, smaller and more frequent intake is often more successful.

Are liquid calories “cheating”?

No. For some people, nourishing drinks are one of the most practical ways to protect weight and strength.

What if I only manage a few foods?

That is still worth discussing. A restricted diet may be understandable, but it can increase nutritional risk over time.

What if dairy feels unpleasant?

Individual experience matters. If a food clearly feels uncomfortable, it may help to try alternatives or use smaller amounts in different forms. But many people do not need to exclude dairy automatically.

Could reflux be making my cough worse?

Yes, it can in some people. Reflux can irritate the upper airway and may contribute to cough or discomfort around meals.

When to seek medical advice

Ask for medical advice if you are losing weight, struggling to eat most days, developing a very restricted diet, or think nausea, reflux or medication side effects are affecting your intake. Ask urgently if you are becoming dehydrated, vomiting repeatedly, or your intake has become extremely poor.

Author and review information

Prepared for: aspergillosis.org

Purpose: general educational information for patients and non-specialists

Review note: Because medicine instructions can change between formulations and brands, patients should always check the current advice supplied with their own prescription and confirm uncertainties with a pharmacist or clinical team.

References and further reading

1. Carter C, Muldoon EG, Kosmidis C. Chronic pulmonary aspergillosis - a guide for the general physician. 2024.
   PubMed
2. Tashiro M, Takazono T, Izumikawa K. Chronic pulmonary aspergillosis: comprehensive insights into epidemiology, diagnosis, treatment, and unresolved challenges. 2024.
   Free full text
3. Roboubi A, et al. Allergic bronchopulmonary aspergillosis. 2023.
   PubMed
4. Sunman B, et al. Current approach in the diagnosis and management of allergic bronchopulmonary aspergillosis in children with cystic fibrosis. 2020.
   Free full text
5. Madhavan V, et al. Malnutrition in allergic bronchopulmonary aspergillosis complicating asthma. 2023.
   Free full text
6. British Dietetic Association. Spotting and treating malnutrition.
   BDA resource
7. BAPEN. Food first / food enrichment.
   BAPEN resource
8. BAPEN / Malnutrition Pathway. Managing malnutrition in COPD.
   PDF
9. NICE. Managing malnutrition in COPD, The Malnutrition Pathway.
   NICE shared learning resource
10. NHS. Heartburn and acid reflux.
    NHS advice
11. Cambridge University Hospitals NHS Foundation Trust. Dietary and lifestyle advice for adults with gastro-oesophageal reflux disease (GORD).
    CUH advice
12. NICE BNF. Itraconazole.
    BNF drug monograph
13. Manchester University NHS Foundation Trust, National Aspergillosis Centre. Patient Information: Itraconazole.
    PDF
14. Manchester University NHS Foundation Trust, National Aspergillosis Centre. Patient Information: Voriconazole.
    PDF
15. Oxford University Hospitals NHS Foundation Trust. Advice about antifungals.
    PDF
16. Balfour-Lynn IM. Milk, mucus and myths. Archives of Disease in Childhood. 2019.
    Article
17. Pinnock CB, Graham NM, Mylvaganam A. Relationship between milk intake and mucus production in adult volunteers challenged with rhinovirus-2. 1990.
    PubMed
18. ASCIA. Milk, mucus and cough.
    Patient resource