⚠️ Flu Season Warning: UK Flu Cases Are Now Surging — Dominated by a Drifted H3N2 Strain

The UK flu season has begun much earlier and much faster than usual, and cases are now surging across the country. The UK Health Security Agency (UKHSA) confirms that the dominant strain this year is a drifted influenza A(H3N2) variant (sub-clade K). This strain now accounts for the vast majority of flu cases in people tested.

🔥 Why this flu season is different

  • Almost all flu cases are influenza A, and around 84% of typed cases are H3N2.
    This pattern is consistent across community, GP and hospital surveillance.

  • The H3N2 strain circulating is genetically drifted, meaning it has evolved away somewhat from the reference vaccine strain.
    UKHSA has publicly confirmed this drift.

  • This increases the risk of infection spreading rapidly — which is exactly what is happening now.

🛡️ Does the flu vaccine still work?

Yes — despite the drift, UKHSA reports that the 2025–26 flu vaccine still provides important protection, including:

  • ~70–75% effectiveness in children

  • ~30–40% effectiveness in adults

This means vaccination dramatically reduces severity, even if it does not fully prevent infection.

⚠️ Why this matters for people with lung conditions

If you have:

  • ABPA (Allergic Bronchopulmonary Aspergillosis)

  • Bronchiectasis

  • Asthma

  • Chronic lung disease
    …you are at higher risk of:

  • pneumonia

  • severe chest infections

  • hospitalisation

  • long recovery times

H3N2 seasons are historically worse for adults and people with underlying respiratory disease.

🔺 What you should do now

1. Get vaccinated immediately

If you haven’t had your flu jab yet, do not wait.
The season is already surging and accelerating earlier than usual.

2. Be extremely cautious in high-risk environments

  • Schools

  • Public transport

  • Healthcare settings

  • Large indoor gatherings

  • Poorly ventilated rooms

3. Use winter protection behaviours

  • Ventilate indoor spaces

  • Consider wearing a mask in crowded indoor areas

  • Wash hands frequently

  • Avoid contact with people who are unwell

4. If you become ill — act fast

For anyone with ABPA, bronchiectasis or asthma:

  • A sudden fever

  • A sharp rise in cough

  • Change in sputum

  • Chest tightness

  • Breathing changes

…should be treated as early warning signs.
Contact your GP or respiratory team quickly, as secondary pneumonia is more likely in H3N2 seasons.

Summary

Flu is now surging across the UK, driven by a drifted H3N2 strain, and people with underlying lung disease should take this season particularly seriously.
Vaccination remains strongly protective, but additional precautions are vital during this rapid upswing in cases.

by GAtherton

💙 The NHS Is Changing: What “Value-Based Healthcare” Means for People with Aspergillosis

The NHS is beginning to look not just at how many people it treats, but how well those treatments work — and whether every pound spent makes the biggest difference to patients’ lives.
This idea is called value-based healthcare (VBHC).

🧭 What “value” means

In simple terms, value =

Better health and quality of life for patients ➗ the resources and effort used to achieve it.

It’s not about cutting care.
It’s about making sure time, money, and medicines are used where they bring the greatest benefit — especially for people with long-term or complex conditions like aspergillosis.

⚙️ From “productivity” to “value”

Until now, the NHS has mostly measured productivity — how many people are seen, how many tests or treatments are delivered, and how quickly.

That approach works for short-term or simple care (like hip replacements or cataract surgery), but it doesn’t tell the full story for complex, long-term conditions such as aspergillosis, where the real goal is to stay well, avoid hospital admissions, and maintain a good quality of life.

So, over the next few years, these older productivity measures will gradually be replaced or balanced with value-based measures that ask:

“Did this care actually help patients live better and longer — and was it a good use of NHS resources?”

This means success will be judged more on outcomes and experience than on numbers and speed.

🌿 Why this matters for people with aspergillosis

Aspergillosis, whether Allergic Bronchopulmonary Aspergillosis (ABPA) or Chronic Pulmonary Aspergillosis (CPA), is often complicated and different for every patient.
Traditional NHS targets — such as waiting times or the number of appointments — don’t always show whether patients are breathing easier, feeling stronger, or coping better at home.

Value-based care changes that by focusing on:

  • Real health outcomes – fewer flare-ups, better lung function, reduced fatigue

  • Patient experience – how well care fits your needs, and how supported you feel

  • Sensible use of treatments – balancing benefit, side effects, and cost

  • Joined-up care – making sure specialists, GPs, and community teams work together smoothly

🏥 How the National Aspergillosis Centre (NAC) fits in

The National Aspergillosis Centre (NAC) already works in a value-based way:

  • It tracks outcomes such as infection control, hospital admissions, and steroid use

  • It listens to patients through groups, surveys, and education sessions

  • It combines research, expert treatment, and patient partnership to improve care

  • It shares learning with hospitals across the UK

As the NHS moves further toward value-based care, NAC’s approach — measuring what really matters to patients — is exactly the kind of model the health service wants to grow.

🔄 What might change over the next few years

You may start to notice:

  • More focus on your experience and progress: you might be asked to fill in short questionnaires about symptoms and quality of life (called Patient-Reported Outcome Measures or PROMs).

  • Better coordination between hospital, GP, and community teams — digital health records will help your care stay connected.

  • New measures of success: NAC may report things like “flare-ups prevented” or “improvement in wellbeing” rather than only how many people were seen.

  • More evidence about what works: shared data will help identify which treatments or combinations give the most benefit.

⚠️ What it does not mean

  • It doesn’t mean fewer services or reduced access for people with complex lung disease.

  • Rare conditions like aspergillosis will continue to need specialist national centres because they provide expert care that general services can’t.

  • The goal is to show that centres like NAC deliver high value — preventing complications, reducing hospital stays, and improving lives.

💬 What you can do

  • Give feedback about your health and care — this helps measure real outcomes.

  • Take part in surveys or PROMs if asked — these are how value is proven.

  • Stay involved in patient groups and discussions — your voice helps shape what “value” means for people living with aspergillosis.

🌱 In summary

The NHS is moving from counting treatments to counting outcomes.
For people with aspergillosis, that means care that’s more personalised, joined-up, and focused on what really matters — your health, comfort, and quality of life.

The National Aspergillosis Centre is well placed to lead this change and to show how specialist, patient-centred care can deliver real value for people with complex lung disease.

by GAtherton

🌧️ Damp Homes and Aspergillosis: Why This Matters

If you live with aspergillosis, asthma, or other chronic lung conditions, your home environment plays a vital role in how well you stay.
Dampness, mould, and poor ventilation allow fungi — including Aspergillus — to grow and release spores into the air. Breathing in these spores can irritate airways, trigger allergic reactions, or worsen infection risk.

That’s why the NAC CARES team has gathered the latest UK policy, research, and practical guidance on this issue — all now available on our new information hub:
👉 Damp Homes – UK Policy and Research

🏠 What’s New on the Aspergillosis.org Damp Homes Page

Over the past week, the NAC CARES team has published a series of new articles and updates that help you:

1. Understand the Health Risks

  • How damp and mould can worsen breathing symptoms or trigger flare-ups in conditions like Chronic Pulmonary Aspergillosis (CPA) and Allergic Bronchopulmonary Aspergillosis (ABPA).

  • Why people with weakened lungs or immune systems are especially at risk.

  • The hidden signs of mould exposure — condensation, musty odours, or discoloured walls — even when no visible black mould is seen.

2. Learn About Your Rights and What to Do

  • What to check if you rent your home and find damp or mould.

  • Step-by-step guidance on how to report problems, who is responsible for fixing them, and what help is available if landlords or councils don’t act.

  • Links to official UK guidance, including the Awaab’s Law updates, which strengthen tenants’ rights to safe housing.

3. Keep Up with the Latest Research and Policy

  • Summaries of recent UK housing and health studies connecting damp homes to respiratory illness.

  • Insights into national policy changes — including new housing safety standards and public health responses.

  • Easy-to-read summaries of scientific studies showing how mould affects airways and immune response in vulnerable patients.

🧰 How to Use the New Page

  1. Start with the main hub: Damp Homes – UK Policy and Research.
    This gathers all the latest NAC CARES articles, research links, and resources in one place.

  2. Explore by topic:

    • Health & Risk – what damp means for your lungs.

    • Practical Advice – how to spot and deal with mould.

    • Policy & Research – what the UK government and researchers are doing to address the problem.

  3. Take action:
    Use the linked materials when talking with your GP, local council, or housing officer. Having official NHS and government evidence can help you get faster results.

💬 Key Takeaways for Aspergillosis Patients

  • Keep your home dry, warm, and well-ventilated.

  • Report damp or mould promptly to landlords or housing providers — and keep written records.

  • If your symptoms worsen and you suspect environmental triggers, speak with your care team at NAC or your respiratory specialist.

  • Use the NAC CARES Damp Homes page as a trusted, evidence-based guide to understanding your risks and your rights.

 

by GAtherton

🧩 NAC Aspergillosis Research Digest Aspergillosis (October 2025: week 43)

Highlights

  • Post‑transplant GVHD & IFI risk: In paediatric liver transplant recipients with GVHD, invasive fungal infection (aspergillosis/candidiasis) was the dominant cause of death; paper advocates PK‑guided monitoring of JAK inhibitors and tacrolimus for safer immunosuppression. (Pediatr Transplant; free full text) PMID: 41039701 | PMCID: PMC12491760
  • Inhaled opelconazole: In‑vitro + clinical data suggest negligible drug–drug interaction (DDI) risk for the investigational inhaled triazole opelconazole, supporting development for pulmonary aspergillosis. (JAC) PMID: 41105437
  • Isavuconazole DDI mapping: PBPK modelling compares isavuconazole with other azoles and proposes model‑informed dosing for anticancer drugs—useful in haem‑onc co‑prescribing. (CPT:PSP) PMID: 41104611
  • CAR‑T fungal infections: Registry analysis after CD19 CAR‑T for B‑cell lymphoma reports invasive aspergillosis as the commonest mould IFI (11/32). (CMI) PMID: 41109429
  • Air pollution & IPA: Two multicentre cohorts link higher fine particulate (PM2.5) exposure before admission with invasive pulmonary aspergillosis in severe pneumonia. (EBioMedicine) PMID: 41106023
  • Mechanisms of resistance/virulence: A bioRxiv preprint identifies a long non‑coding RNA (afu‑182) that modulates triazole susceptibility and virulence in A. fumigatus. (Preprint) PPR: PPR1101933
  • Burden estimates (Poland): National modelling updates burden for IA, CPA, ABPA, SAFS—useful for service planning and advocacy. (Sci Rep; open) PMID: 41087447 | Full text

Diagnostics

  • Dental/ENT interface: In a retrospective implant‑centred series, chronic sinusitis and aspergillosis were histopathologically confirmed in a subset of sinus augmentation candidates; authors discuss when 3D imaging is warranted pre‑procedure. (Int J Oral Maxillofac Implants) PMID: 41105467
  • Environmental surveillance: Post‑hurricane housing study identified Aspergillus spp. in water‑impacted homes, contextualising environmental exposure risk for ABPA/CPA. (Sci Rep; open) PMID: 41087584

Therapeutics & stewardship

  • Opelconazole (inhaled triazole) DDI profile appears favourable (see above). Consider future role for adjunct/targeted lung delivery once efficacy data mature. PMID: 41105437
  • Isavuconazole PBPK‑based recommendations may aid co‑administration with anticancer agents; still requires centre‑specific DDI checks and, where available, TDM. PMID: 41104611
  • Novel antifungal target: A selective acetyl‑CoA synthetase inhibitor shows antifungal activity in Nat Commun—early‑stage discovery but potentially relevant to future azole‑resistant IA/CPA. (Nat Commun; open) PMID: 41087359

Epidemiology & special populations

  • CAR‑T recipients: IA predominance among mould IFIs underscores the need for surveillance, rapid diagnostics (GM/PCR), and early therapy in post‑CAR‑T care pathways. PMID: 41109429
  • Air quality: Association between PM2.5 and IPA suggests including environmental history in risk assessments for severe pneumonia patients. PMID: 41106023
  • Veterinary reservoir: Review from Turkey highlights aspergillosis as a major poultry disease—relevance for occupational exposures and broader One‑Health messaging. (Vet Med Sci; open) PMID: 40988581

Surgery & case‑based learning

  • CPA with infected bulla: Case report supports surgical resection as an option in selected CPA phenotypes with localised disease. (Clin Case Rep; open) PMID: 41103592

Guidance / practice notes

  • For post‑transplant GVHD, ensure PK monitoring (tacrolimus, JAK inhibitors) and early IFI screening (GM/LFA ± PCR) to balance GVHD control against infection risk. PMID: 41039701
  • In CAR‑T and severe pneumonia pathways, include combined diagnostics (BAL GM, Aspergillus PCR ± culture) and rapid initiation of active triazoles where IA is probable.
  • Consider air quality and environmental exposures (post‑disaster housing, poultry) in patient education and prevention.

References & links

  • Sawada K et al. PK Monitoring of JAK Inhibitor and Tacrolimus in post‑LT GVHD. Pediatr Transplant. 2025. PMID: 41039701 | PMCID: PMC12491760
  • Cass LMR et al. Opelconazole DDIs. J Antimicrob Chemother. 2025. PMID: 41105437
  • Goosen TC et al. Isavuconazole DDI PBPK. CPT: Pharmacometrics Syst Pharmacol. 2025. PMID: 41104611
  • Bouvier A et al. IFIs after CD19 CAR‑T. Clin Microbiol Infect. 2025. PMID: 41109429
  • Zhou H et al. PM2.5 & IPA. EBioMedicine. 2025. PMID: 41106023
  • Poudyal NR et al. lncRNA afu‑182 & azole susceptibility. bioRxiv. 2025. Preprint
  • Tamagawa K et al. Lung resection in CPA with infected bulla. Clin Case Rep. 2025. PMID: 41103592
  • Vélez‑Torres LN et al. Aspergillus in water‑impacted homes. Sci Rep. 2025. PMID: 41087584
  • Krzyściak PM et al. Burden of serious mycoses in Poland. Sci Rep. 2025. PMID: 41087447
  • Alhassani ANA et al. Aspergillosis in poultry (Turkey). Vet Med Sci. 2025. PMID: 40988581

 

by GAtherton

 Share your feedback about your care at the National Aspergillosis Centre

There’s now a new way to read and share patient feedback about local NHS hospitals online. All comments come directly from patients and carers.
If you’ve been seen by the National Aspergillosis Centre (NAC) at Wythenshawe Hospital and would like to tell us about your experience, please visit the feedback page for North Manchester General Hospital.

That’s because NAC sits within the Infectious Diseases service, which is managed through North Manchester as part of the new Manchester University NHS Foundation Trust (MFT) structure.
You might even be the first person to leave a comment!
We know the route is a little indirect, and we really appreciate you taking the time to share your thoughts — your feedback helps us improve care for everyone.
👉 Leave your feedback on Care Opinion

by GAtherton

💬 Healthwatch: Your Local Voice in the NHS

Living with a long-term lung condition such as aspergillosis, asthma, or bronchiectasis often means regular contact with hospitals, GPs, and community clinics.
Sometimes things work well — and sometimes they don’t.
That’s where Healthwatch comes in.

Healthwatch is an independent organisation that represents patients and the public.
It exists to make sure your experiences help shape the way NHS and social-care services are delivered.

🏛️ What is Healthwatch?

Healthwatch was set up by law to be the official voice of patients and the public in health and social care.

There are two levels:

  • Healthwatch England – works nationally to influence NHS and government policy

  • Local Healthwatch – works in every local authority area across England, gathering feedback from people using local services

Healthwatch is not part of the NHS, and it’s not a complaints service, but it does have statutory powers to:

  • Listen to people’s experiences of care

  • Report issues and make recommendations to the NHS, local councils, and care providers

  • Request responses from organisations it investigates

  • Escalate serious concerns to the Care Quality Commission (CQC)

Learn more on the Healthwatch website.

🌿 Why Healthwatch matters to aspergillosis patients

People living with chronic lung disease often face delays, limited understanding, or difficulties accessing ongoing support.
Healthwatch helps make sure those experiences aren’t ignored.

1. Raising the patient voice

You can share your experience of healthcare — good or bad — with your local Healthwatch.
They collect stories from across the community and use them to:

  • Identify patterns (for example, problems with accessing respiratory clinics or antifungal monitoring)

  • Produce reports and recommendations for local NHS decision-makers

  • Push for improvements to long-term care pathways and community support

2. Helping to improve new neighbourhood health hubs

As NHS care moves into the community, Healthwatch plays a key role in making sure new Neighbourhood Health Hubs are:

  • Accessible for people with limited mobility or oxygen needs

  • Located where public transport and parking work for patients

  • Designed with chronic-illness patients in mind, not just short-term care

You can feed in your ideas through Healthwatch about what’s working and what isn’t in new NHS community models.

3. Providing information and signposting

If you’re unsure where to go for care — GP, hospital, or new health hub — or how to complain or appeal a service decision, Healthwatch can point you in the right direction.
They offer clear, local information about:

  • NHS patient transport

  • The Healthcare Travel Costs Scheme (HTCS)

  • Local support groups and community services

4. Supporting patient involvement

Healthwatch works with NHS organisations to include patients and carers in planning and reviewing services.
If you’d like to get involved as a patient representative or share your experience of aspergillosis services, Healthwatch can help you join local working groups or consultations.

5. Spotlighting inequalities

Healthwatch highlights where certain groups are left behind — for example:

  • People with rare or complex conditions

  • Patients in rural or deprived areas

  • Those unable to use digital appointment systems
    This helps ensure people with chronic lung conditions are not overlooked when new community-care models are designed.

⚖️ What Healthwatch can — and can’t — do

✅ Healthwatch can 🚫 Healthwatch can’t
Collect and report your experience to NHS leaders Fix individual clinical problems directly
Influence NHS and council decisions Guarantee faster treatment or appointments
Provide advice on local services and support Replace legal or complaints services
Escalate major safety concerns to the CQC Act as your personal advocate in disputes

Even so, their influence can be powerful — many improvements in NHS access and transport have started with patient stories collected by Healthwatch.

📍 How to contact your local Healthwatch

Every local area has its own Healthwatch website and phone number.
You can find yours at:
👉 Find your local Healthwatch

When you contact them, you can:

  • Fill in a short online form to share your story

  • Ask to join a focus group or consultation

  • Request accessible information or help finding services

  • Subscribe to local updates and reports

If you’d like support from the aspergillosis community, NAC CARES can also help you write or submit your feedback.

💬 Why this matters

“Nothing about us without us.”
Healthwatch exists so that patients — including those with rare and chronic conditions like aspergillosis — can make their experiences count.

By telling your story and feeding back to Healthwatch, you help shape better care for yourself and for others who will face similar challenges in future.

by GAtherton

🏥 NHS Neighbourhood Health Hubs: How Community Care Will Work for People with Aspergillosis and Asthma

The NHS is changing how healthcare is delivered — with more care moving closer to home and fewer hospital visits.
A new model called Neighbourhood Health Services (or Neighbourhood Health Hubs) is being rolled out across England from late 2025, and it could make a real difference for people living with aspergillosis, asthma, bronchiectasis, and other long-term respiratory conditions.

🌍 Why care is moving into the community

The goal is to:

  • Bring care to where people live, not just in large hospitals

  • Reduce waiting times by shifting routine tests and reviews out of hospital clinics

  • Join up GPs, nurses, pharmacists, and hospital specialists into one local team

  • Focus on prevention, self-management, and early support

These reforms come from the government’s Healthcare on Your Doorstep announcement (September 2025), supported initially by £10 million across 43 pilot areas in England.

🧑‍⚕️ What a “Neighbourhood Health Hub” looks like

A one-stop local health centre bringing together:

  • GPs and practice nurses

  • Respiratory nurses, physiotherapists, and pharmacists

  • Mental-health and wellbeing workers

  • Dietitians, occupational therapists, and social-prescribing link staff

  • Voluntary and community organisations (e.g. NAC CARES, Asthma + Lung UK)

Some hubs will connect directly to Community Diagnostic Centres (CDCs) – local sites providing CT, MRI, X-ray, lung-function and blood tests through the NHS England diagnostics programme.
The aim is for one joined-up team to share your records and plan your care locally.

🩺 How hubs work with your GP and A&E

The new hubs are designed to fill the gap between GP surgeries and hospitals – giving extra support when you’re too unwell to manage alone but don’t need emergency care.

Home → GP Practice → Neighbourhood Health Hub → Hospital / A&E

🏠 Your GP surgery

You’ll stay registered with your usual GP. They remain in charge of your prescriptions, results, and overall care.
Your GP can now refer you to a Neighbourhood Health Hub for things that need a wider team – for example:

  • Antifungal monitoring or blood tests

  • Lung-function or CT scans

  • Flare-up review by respiratory nurses

  • Fatigue or wellbeing support

🧑‍⚕️ The Neighbourhood Health Hub

You might go here instead of hospital for:

  • Same-day assessment of an infection or flare-up

  • Bloods, ECGs, or scans ordered by your GP

  • Physiotherapy, airway-clearance or rehabilitation

  • Medication reviews with a pharmacist

  • Appointments with dietitians or mental-health staff

  • Practical help from link workers (see below)

🚨 A&E (Emergency Department)

Still essential for serious problems such as:

  • Sudden or severe breathlessness not relieved by treatment

  • Coughing up blood

  • Chest pain, fainting, or collapse

  • High fever with confusion
    If unsure, call NHS 111 or 999 in an emergency.

🔁 When to use which service

Situation Who decides Where you’ll be seen
Routine check-up or repeat prescription You / GP GP surgery
Specialist review or complex medication GP / consultant Neighbourhood Hub
Mild flare-up needing same-day care NHS 111 / GP Hub or GP
Emergency or life-threatening symptoms NHS 111 / 999 A&E / hospital
Diagnostic tests GP / hospital referral Community Diagnostic Centre

All sites will share your digital care record so results and updates reach your GP and hospital team automatically.

🧑‍🤝‍🧑 Link workers and care coordinators – local help through your GP

Every GP practice and neighbourhood team now has link workers (also called care coordinators or social prescribers).
They’re there to help you navigate healthcare and community support. They can:

  • Arrange or advise on transport for appointments

  • Help complete travel cost reimbursement or benefit forms

  • Connect you with volunteer driver schemes or local charities

  • Find exercise, wellbeing, or peer-support groups

  • Support with fatigue, isolation, or anxiety

Ask your GP reception or Neighbourhood Hub to refer you to the link worker, or request a call-back via the NHS App.

🚗 Transport and accessibility

🚐 NHS Patient Transport Service (PTS)

If you can’t use public transport for medical reasons (for example, oxygen use, mobility difficulties, or severe fatigue), you may qualify for free NHS transport.
Your GP, link worker, or hospital can book this for you through the regional PTS (for example, NWAS in the North West).

💷 Healthcare Travel Costs Scheme (HTCS)

If you’re on a low income or certain benefits, you can reclaim travel expenses under the HTCS.
Bring your appointment letter and proof of eligibility, or ask your link worker to help with the form.

🚙 Community & volunteer transport

Each Integrated Care System (ICS) works with local councils and charities such as Age UK, Mind, or Good Neighbour schemes to run community minibuses and volunteer driver services.
Ask your link worker or hub team for local options.

🅿️ Accessibility

All new and refurbished hubs must include:

  • Blue Badge parking and drop-off zones

  • Wheelchair-friendly entrances and toilets

  • Seating and oxygen-safe waiting areas

  • Negotiated free or reduced parking in shared sites

🧭 At a glance

Issue What’s planned What to do now
Public transport Sites chosen to be local, but not always central Check routes before your visit
NHS Patient Transport Still available for medical need Ask GP or link worker to book
Travel-cost reimbursement Continue via HTCS Keep proof of benefit
Community / volunteer drivers Expanding under ICB–VCS partnerships Request info via link worker
Disabled parking / drop-off Required at new sites Confirm when booking

🪶 A message from the aspergillosis community

For many people with lung disease, “local care” only works if it’s accessible care.
Groups such as NAC CARES, Asthma + Lung UK, and Healthwatch are urging NHS leaders to:

  • Design transport and parking into every new site

  • Ask about mobility and oxygen needs when booking

  • Fund local volunteer schemes

  • Provide dedicated link workers at every hub and GP practice

If you struggle to reach appointments, tell your clinic or Healthwatch — your feedback shapes how services develop.

🧾 Questions to ask before your first visit

  1. 🚗 Is there Blue Badge or patient parking on site?

  2. 🚌 What public-transport links serve the hub?

  3. 🚐 Can the clinic arrange NHS Patient Transport?

  4. 💷 Can I claim travel costs under the HTCS scheme?

  5. ♿ Is the building accessible for wheelchairs or oxygen users?

  6. 💨 Are there rest areas for people who get breathless?

  7. 🧑‍🤝‍🧑 Can my carer or partner attend with me?

  8. 👩‍💼 Is there a link worker who can help with transport or forms?

  9. 🕓 Are there quiet waiting spaces to reduce infection risk?

Having these answers before your appointment makes your visit smoother and safer.

💬 Final thought

“Neighbourhood care” isn’t about replacing your GP or A&E — it’s about bridging the gap.
The new hubs aim to bring together your GP, hospital specialists, and community teams in one local setting, providing earlier help, fewer hospital journeys, and care designed around your life, not your postcode.

🔎 Behind the Headlines: Is this an NHS Expansion or a Shift?

Many people wonder whether this is new investment or a reshuffle of existing NHS services.

🧱 What’s really happening

  • The Neighbourhood Health Service is not a new tier of the NHS, but a redesign of how GP, hospital, and community teams work together.

  • The focus is on moving care out of hospitals and into local clinics, using the same staff and budgets more effectively.

  • Hospitals will still handle emergencies and complex cases, but routine tests, reviews, and education will move into the hubs.

⚖️ Expansion or movement?

Area Expansion Reorganisation
Buildings Some new or refurbished hubs and diagnostics centres Many reusing existing GP or community facilities
Staffing Some new link workers, pharmacists, and AHPs Most existing NHS staff redeployed across neighbourhoods
Funding £10m pilot investment + diagnostic capital No major long-term new funding yet announced
Patient benefit Easier access, joined-up records May reduce hospital appointments rather than add capacity

💬 What this means

For patients, it should feel like an expansion — more care, closer to home —
but in reality it’s a shift of where and how NHS services are delivered, not a large-scale increase in total NHS resources.

⚠️ Risks and opportunities

Opportunities Risks
Easier local access Risk of hospital clinics closing before hubs fully staffed
Joined-up records Depends on IT integration
Focus on prevention May feel like hospital services are being reduced
Better continuity Needs clear accountability (GP vs hub)

🧩 Summary

The new neighbourhood model is a reorganisation within the NHS, not a separate expansion.
It aims to use existing staff, buildings, and budgets more efficiently — giving patients with chronic conditions like aspergillosis and asthma easier access to care and support in their own communities.

by GAtherton

🧩 NAC Aspergillosis Research Digest — Focus: Chronic Aspergillosis (October 2025: week 42)

🧬 Focus Review — Chronic Aspergillosis (October 2025)

Here are peer-reviewed papers on chronic aspergillosis published in the last month:

1. Improving Diagnostic Sensitivity Using Species-Specific IgG (Sep 2025)

  • This study investigated better blood tests to diagnose CPA by measuring IgG antibodies not just to Aspergillus fumigatus but also to other common Aspergillus species.

  • They found adding antibodies against non-fumigatus species identified more CPA cases that would have been missed by the standard A. fumigatus test alone.

  • The treatment results were similar regardless of which Aspergillus species was involved.

  • This means broader antibody testing improves diagnosis without changing expected outcomes.

  • Read full paper on PubMed

2. Prevalence and Impact of Bacterial Co-infections in CPA (April 2025)

  • This study looked at how often bacterial infections occur alongside CPA and their effect on patients.

  • About 21% of CPA patients had bacterial co-infections.

  • However, having a bacterial co-infection did not significantly change mortality rates compared to those without.

  • This highlights the need to assess for bacteria but suggests it may not worsen long-term outcomes.

  • Read full paper on PMC

3. Non-invasive Monitoring Using Serology and HRCT Imaging (June 2025)

  • Researchers combined blood antibody tests and high-resolution chest CT scans to identify active Aspergillus infections in chronic lung disease patients.

  • This method distinguished active infections from colonization without invasive procedures.

  • It supports using combined non-invasive tests to decide who needs further invasive diagnostics or antifungal treatment.

  • This approach helps avoid unnecessary treatments and invasive tests.

  • Read full paper on Frontiers

In short: these studies improve how doctors diagnose and monitor CPA — by expanding antibody testing beyond classic targets, recognizing the role but limited impact of bacterial co-infections, and using combined non-invasive testing strategies to guide management safely and effectively.

by GAtherton

🔍 Aspergillosis: Recent Highlights & Key Publications October 2025 (Week 41)

Revised ISHAM-ABPA working group guidelines (2024)

  • Scope & criteria: Codifies ABPA diagnosis around mandatory Aspergillus sensitisation (specific IgE or SPT) plus total IgE ≥ 500 IU/mL, with supporting features (Aspergillus-specific IgG/precipitins, eosinophilia, imaging with central bronchiectasis/mucus plugging). Distinguishes ABPA vs. ABPM (other fungi) and sets clinical states (acute, response, exacerbation, remission).

  • Treatment pathways: For acute ABPA, permits oral corticosteroids or itraconazole as first-line; combination is reasonable in severe disease or frequent relapsers. Provides steroid-sparing strategies (itraconazole/voriconazole/posaconazole) and practical taper schedules.

  • Biologics & monitoring: Positions omalizumab/mepolizumab/dupilumab for recurrent/exacerbation-prone ABPA. Recommends multidimensional response criteria (symptoms, exacerbations, lung function, IgE kinetics, radiology) rather than IgE alone.

  • Paper (Eur Respir J) · PubMed · OA summary (PMC).

BTS Clinical Statement on Aspergillus-Related Chronic Lung Disease (2025)

  • Who it’s for: UK-focused guidance to help respiratory teams manage CPA, aspergilloma, chronic airway disease with Aspergillus, and allergic phenotypes in secondary care.

  • CPA approach: Emphasises radiology over time (HRCT), microbiology/Aspergillus-IgG, and exclusion of mimics (NTM, malignancy). Advises long-term azoles (with TDM & LFTs), and when to consider surgery (haemoptysis/aspergilloma).

  • Service model: Encourages early referral/MDT (radiology, mycology, thoracic surgery, interventional radiology), signposts NAC pathways, and sets pragmatic follow-up intervals (clinical, radiology, serology).

  • BTS page · News item · (access via Thorax from BTS page).

Consensus guidelines for invasive aspergillosis (ECMM/ISHAM CAPA; 2021)

  • Definitions: Introduces proven/probable/possible CAPA using clinical + mycological evidence (BAL/TA culture or PCR, GM thresholds, imaging).

  • ICU nuance: Acknowledges non-neutropenic ICU patients (COVID/influenza) can develop IA with atypical imaging and lower fungal burdens; endorses combined biomarker strategies (BAL GM/PCR ± serum GM).

  • Therapy: Positions voriconazole/isavuconazole as first-line; L-AmB where resistance or intolerance suspected. Flags early initiation on high suspicion to improve outcomes.

  • Paper (Lancet Infect Dis) · PubMed · ECMM guideline hub.

Epidemiology & Clinical Cohorts

Marseille 2-year retrospective cohort — CPA & ABPA insights (2025)

  • Design: Single-centre retrospective study applying ESCMID CPA criteria and modified ISHAM ABPA criteria to consecutive referrals.

  • Findings: High rate of diagnostic overlap (allergy + chronic infection features). Delays to diagnosis common, especially where IgG negative/indeterminate but GM/BAL/PCR positive.

  • Implication: Supports multimodal testing (serology, GM/PCR, serial imaging) and repeat sampling in indeterminate cases; highlights value of centre-based MDT.

  • PubMed · (preprint/alt copies if needed: SSRN/other listing, ResearchGate record).

Invasive aspergillosis in ICU settings (2025 review)

  • Epidemiology: IA increasingly reported in severe viral pneumonias (COVID, influenza); mortality ~40–50% depending on definition and antifungal timing.

  • Diagnostics: BAL GM outperforms serum GM in non-neutropenic ICU; PCR adds sensitivity but needs pre-test probability framing to avoid over-calling colonisation.

  • Care points: Advocate protocolised screening (e.g., twice-weekly BAL GM/PCR in high-risk ventilated patients) and earlier empiric therapy when criteria met.

  • Open access review (Frontiers, 2025) · (alt listing: ResearchGate record).

Review: Invasive aspergillosis — scope & new species (2024)

  • Landscape: Expands on non-fumigatus Aspergillus species, cryptic species with distinct susceptibility patterns, and emerging hosts (advanced COPD, cirrhosis, ICU).

  • Resistance: Summarises azole resistance mechanisms (cyp51A variants, TR34/L98H, TR46/Y121F/T289A) and notes environmental selection via triazole fungicides.

  • Practice: Reinforces susceptibility testing and situational use of L-AmB or isavuconazole where resistance is likely.

  • Review (ScienceDirect).

Diagnostics: Biomarkers, Molecular, Imaging & Novel Methods

GM antigen & Aspergillus IgG negative “escape” cases

  • Problem: In suspected CPA/airway disease, Aspergillus-IgG can be false-negative early or in immunomodulated hosts.

  • Finding: High GM titres (especially BAL) can help “rescue” such cases, prompting treatment or further invasive sampling.

  • Clinical use: In IgG-negative but high-suspicion scenarios, pair BAL GM + PCR and repeat serology; avoid reliance on single negative IgG.

  • OA study (2025) · PubMed. (See also general GM/BDG performance review: Medicine 2024).

Molecular diagnosis, qPCR & NGS advances (2025 review)

  • Performance: qPCR improves sensitivity vs culture/microscopy; specificity hinges on contamination control and clinical context.

  • Best practice: Combine qPCR with GM/BDG in high-risk patients; consider cycle thresholds and duplicate positivity to support true infection.

  • NGS: Useful for broad pathogen screens or resistant/cryptic species; needs standardisation and careful interpretation.

  • OA review (Front Cell Infect Microbiol, 2025). British Thoracic Society

Microscopy, GM, PCR comparative pilot (2025)

  • Design: Head-to-head assay comparison across serum/BAL/sputum against a composite clinical reference.

  • Takeaway: No single test is definitive; dual-modality (e.g., BAL GM + PCR) yields best balance. Microscopy remains specific but insensitive.

  • Study (ScienceDirect). ERS Publications

Emerging spectroscopy / imaging techniques (TERS)

  • What it is: Tip-enhanced Raman spectroscopy mapping conidial wall components (melanin, polysaccharides, proteins) at nanoscale.

  • Why it matters: Potential to differentiate strains or track resistance-linked wall changes; currently preclinical, not diagnostic.

  • AIP Applied Physics Letters (2025) · arXiv preprint.

Therapeutics, Resistance & New Drugs

Olorofim (F901318) — Phase IIb results (2025)

  • Population: Refractory invasive mould disease (including azole-resistant Aspergillus), many salvage scenarios.

  • Efficacy: Global response ~29% (D42) and ~27% (D84); when counting stable disease, success rises to ~75% (D42) and ~63% (D84).

  • Safety: Transaminase elevations ~10%, mostly reversible with dose interruption/adjustment; no treatment-related deaths reported.

  • Use case: Salvage/compassionate therapy where standard options fail or resistance limits choices; monitor LFTs and DDIs.

  • PubMed · Lancet Infect Dis abstract. (Trial record: NCT03583164).

Review of olorofim in aspergillosis

  • MoA: Inhibits dihydroorotate dehydrogenase (DHODH), blocking de novo pyrimidine synthesis (novel class, no cross-resistance with azoles/echnocandins/AmB).

  • Signals: Case series in azole-resistant disease (incl. CGD) report clinical/radiologic remission; combination strategies under study.

  • Caveats: Access via trials/managed access; need phase III data and resistance surveillance under use pressure.

  • epocrates.com

Pipeline and alternative antifungals

  • Fosmanogepix (Gwt1 inhibitor): Oral/IV; activity against Candida/Aspergillus; CNS penetration promising; phase II positive signals.

  • Rezafungin (long-acting echinocandin): Weekly IV dosing enables OPAT; emerging real-world data in invasive disease and step-down.

  • Ibrexafungerp (tricohalose class/β-glucan): Oral; Aspergillus data limited (better for Candida), but combinations explored.

  • New azoles (isavuconazole real-world/TDM): Use where voriconazole intolerance or QT issues exist.

  • (See contemporary reviews; real-world rezafungin data below.)

Rezafungin (real-world, 2025) — OPAT-friendly weekly echinocandin; emerging safety/utility data.

Azole resistance & clinical implications

  • Drivers: Agricultural triazoles select environmental cyp51A mutations; patients can acquire primary resistant strains.

  • Practice changes: Where resistance prevalence is ≥10%, consider empiric L-AmB or isavuconazole until susceptibility known; always request AFST when feasible.

  • Nature Communications 2024 · Review PubMed.

Therapeutic drug monitoring & combination strategies

  • TDM: Essential for voriconazole/posaconazole (target troughs, avoid toxicity). Isavuconazole TDM less routine, but consider in extremes.

  • Combinations: Azole + echinocandin in refractory disease or high burden IA; AmB-based combos when resistance suspected. Evidence heterogeneous—use in expert-guided salvage.

  • (Covered within recent IA/therapy reviews above.)

Immunology, Host Responses & Biologics

Immunopathogenesis review (2023)

  • Pathways: Th2-skewed responses drive ABPA/SAFS (IgE/eosinophilia); defects in phagocyte function (neutropenia, CGD, high-dose steroids) predispose to invasive disease.

  • Mediators: Roles for IFN-γ, IL-5/IL-13, mucus hypersecretion, and airway remodelling; supports biologic targeting in allergic phenotypes.

  • OA review (Front Immunol 2023).

Biologics in ABPA / severe asthma

  • When to use: Relapsing ABPA, frequent steroid bursts, or steroid toxicity despite azole therapy.

  • Agents & effects: Omalizumab (anti-IgE) reduces exacerbations/steroid need; mepolizumab/benralizumab (anti-IL-5/IL-5R) tackle eosinophilia; dupilumab (anti-IL-4Rα) addresses Th2 axis and mucus/plugging.

  • Integration: Keep antifungal therapy for fungal burden; use biologics to control inflammation/exacerbations and spare steroids; monitor IgE dynamics and radiology.

  • ISHAM ABPA paper · PubMed.

by GAtherton

Living Healthier with Aspergillosis: Small Steps That Can Make Life Easier

Living with aspergillosis, whether it is allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), or another form, often means dealing with fatigue, coughing, breathlessness, repeated infections, and the side effects of treatment. Medicines such as antifungals and biologics are central to care, but everyday choices around food, activity, rest, and stress can also make a real difference.

This isn’t about strict rules or being told what you “should” do. It’s about finding small, realistic steps that help you feel stronger and more in control of daily life.

Why healthy habits can feel hard

Many people know what’s “healthy” but still find it difficult to change routines. That’s normal. Habits stick for lots of reasons:

  • Familiar routines feel safe, even if they’re unhelpful.

  • Stress, tiredness, or sadness can make comfort eating or smoking feel like a quick fix.

  • Friends, family, and culture shape our patterns.

  • Healthy food or exercise can seem expensive or time-consuming.

  • Mood and motivation play a huge part — especially if you’re already coping with illness.

Understanding why change is tough is the first step. You’re not failing — you’re human.

The potential benefits of living a little healthier

  • Easier breathing → avoiding smoke and doing gentle activity can help your lungs cope better.

  • Fewer flare-ups and infections → nourishing food, better sleep, and stress control support your immune system.

  • More energy → balanced eating and regular movement often boost stamina and reduce fatigue.

  • Treatments working better → some habits (like smoking or alcohol) interfere with antifungals; avoiding these can make medicines more effective.

  • Improved mood → routines such as exercise, cooking, or group activities can ease anxiety and give a sense of connection.

Diet and weight: it’s about health, not the scales

When weight feels like the focus

Many people are told to lose weight, but strict weight-loss diets rarely succeed in the long term. They can leave people frustrated or feeling worse. For aspergillosis, the aim is not chasing numbers on the scales — it’s about supporting your body so you can feel and function better.

Why diets often fail:

  • Cutting things out makes us crave them more.

  • The body resists weight loss by slowing metabolism.

  • Diets feel temporary, not sustainable.

  • One slip can feel like failure.

  • Stress and emotions drive food choices as much as hunger.

Breaking that cycle

Some people find it more helpful to:

  • Focus on health gains (more stamina, fewer infections, better mood) instead of weight loss.

  • Make small, sustainable swaps they can keep for years.

  • Add nourishing foods (protein, fruit, vegetables) instead of strict restriction.

  • Notice and celebrate everyday wins — walking further, coughing less, sleeping better.

When the struggle is keeping weight on

Not everyone has weight to lose. For some, infections, inflammation, and the effort of breathing can burn through calories, making it hard to maintain weight. In that case, the goal shifts to adding in extra energy and protein:

  • Eat smaller portions more often.

  • Fortify food with milk powder, cheese, cream, nut butters, or olive oil.

  • Keep calorie-rich snacks handy (flapjacks, trail mix, smoothies).

  • Try nutritional drinks (Fortisip, Ensure, or homemade shakes).

  • Ask your team for dietitian support if weight keeps dropping.

When to seek specialist help

General lifestyle tips are a useful starting point, but some people face severe or complex dietary problems. These can include:

  • Ongoing or severe weight loss / malnutrition

  • Difficulty swallowing or digesting food

  • Drug–food interactions (e.g. antifungals with certain juices or stomach acid medicines)

  • Other health conditions (diabetes, coeliac disease, kidney problems)

  • Persistent nausea, diarrhoea, or appetite loss from treatment

If this sounds familiar, the best step is to ask for a referral to a registered dietitian. A dietitian can:

  • Create a personalised nutrition plan to match your energy and protein needs

  • Suggest practical adjustments if eating is difficult

  • Ensure your plan is safe alongside antifungal or steroid treatment

  • Provide access to prescription nutritional supplements if needed

  • Monitor progress and adjust over time

What works for one patient may not be safe for another — professional advice ensures the plan is right for you.

Gut health and the microbiome

There’s growing interest in the link between the gut and the lungs — sometimes called the gut–lung axis. A healthy gut microbiome (the community of bacteria and other microbes in the digestive system) can support overall immunity and help regulate inflammation, which matters in conditions like ABPA and CPA.

  • Fibre feeds healthy gut bacteria → fruits, vegetables, oats, beans, and nuts help your gut produce anti-inflammatory compounds.

  • Probiotics (live “friendly bacteria” in yoghurts or supplements) may help some people, especially after antibiotics, but the evidence in aspergillosis is still limited.

  • Balance is key → too much fibre all at once can cause bloating; start gradually and pair fibre with calorie-rich foods if you struggle with weight.

  • Hydration matters → fibre works best when you’re drinking enough fluids.

  • Check before supplements → always discuss probiotic products with your team, especially if you are immunocompromised.

Small steps — like adding an extra piece of fruit or trying a yoghurt with live cultures — can gently support gut balance without overloading.

Starting small (and letting it grow)

Big lifestyle overhauls are rarely realistic. A more helpful approach is:

  • Pick one tiny change — a 10-minute walk, one less sugary drink, or a piece of fruit with breakfast.

  • Celebrate the success — each small step builds confidence and momentum.

  • Notice the ripple effect — walking more may improve sleep; better sleep may give more energy for cooking.

  • Climb the ladder slowly — the first step is hardest, but it makes the next ones easier.

Finding support

  • Share your goals with your medical team — they can suggest safe exercise, eating tips, or referrals.

  • Join pulmonary rehab, exercise groups, or online communities — peer encouragement makes a big difference.

  • Explore local schemes — social prescribing, community cooking, or walking groups can be free and welcoming.

  • Remember: mental health matters too. If low mood or anxiety makes change feel impossible, speaking with a GP or counsellor can help unlock progress.

The bottom line

Treatments like itraconazole and benralizumab are essential in controlling aspergillosis, but they work best when supported by healthy routines.

Living healthier means different things for different people:

  • For some, it’s cutting down alcohol or moving a little more.

  • For others, it’s eating enough to keep strength up.

  • For everyone, it’s about supporting your lungs, your body, your gut, and your wellbeing, not chasing numbers or perfection.

Even small, steady steps — chosen by you, at your pace — can add up to meaningful improvements and make daily life with aspergillosis a little easier.

by GAtherton