Potential respiratory hazards of fungal exposure in the residential indoor environment: a systematic review (2025)

Summary of the 2025 Systematic Review for Non-Specialists & Patients

Read full paper here: Potential respiratory hazards of fungal exposure in the residential indoor environment: a systematic review - ScienceDirect

What was this review about?

This review looked at all the scientific evidence from 1990–2025 on how indoor fungi (moulds) in homes affect people’s breathing and general respiratory health. It examined 94 studies, mapping out where fungi come from, which species appear most often, and how they affect the lungs, nose, throat, and immune system.

Key Findings in Plain Language

1. The biggest sources of indoor mould are dampness and building damage

Homes with water leaks, damp walls, damaged materials and poor ventilation are the most common sources of fungi—especially Aspergillus and Penicillium. These thrive in wet building materials, bathrooms, kitchens, drains, air-conditioning systems and even water dispensers.

2. Indoor fungi are strongly linked to a wide range of respiratory symptoms

Across many countries, indoor fungal exposure was associated with:

  • Asthma and asthma flare-ups

  • Allergic rhinitis (blocked or runny nose)

  • Chronic cough and throat irritation

  • Adenoid enlargement in children

  • Hypersensitivity pneumonitis (allergic inflammation of the lungs)

  • Reduced lung function

  • Even pulmonary haemorrhage in rare cases

The review shows that even everyday exposure—not just visibly mouldy homes—can worsen respiratory health.

3. Some fungi are more strongly associated with illness

Important associations include:

  • Aspergillus → asthma symptoms, COPD exacerbations, throat irritation, hypersensitivity reactions

  • Penicillium → asthma, allergic rhinitis, hypersensitivity pneumonitis

  • Alternaria → childhood asthma risk

  • Candida & Fusarium → present in wet areas such as bathrooms and may affect vulnerable individuals

4. The geographic picture is uneven

Most research comes from high-income, temperate countries. There are major evidence gaps in tropical and subtropical regions, where humidity is high and fungal exposure is likely worse. This limits current global understanding of risk.

5. Prevention works — but public awareness is low

Simple actions (cleaning, improved ventilation, addressing leaks, correct humidity ranges) can radically reduce fungal burden. One study showed 80–90% reduction in airborne mould counts after residents were given basic remediation advice.

What’s New or Important in This 2025 Review?

1. A fully integrated “source → species → disease → location” map

The review is the first to link fungal sources, the exact fungi found, the diseases they cause, and where the evidence comes from, creating a multi-layered evidence map. This helps identify:

  • Which household features pose the highest risk

  • Which fungi are clinically most important

  • Where research gaps exist

2. Highlights the major global research imbalance

It emphasises that very little evidence exists from low-income and tropical areas—where exposure may be far more severe. This is a call for equity and better global surveillance.

3. Shows that fungi may affect more than the lungs

The review notes new evidence that fungal exposure may also influence neurological and immune-mediated symptoms, suggesting mould exposure could have broader health effects than traditionally recognised.

4. Identifies major gaps in identifying which fungal species cause harm

Many studies only measure “mould level” without identifying the fungus. The review argues for better fungal detection technologies, such as:

  • Portable real-time samplers

  • Multi-omics (DNA, RNA, metabolites)

  • Long-term cohort studies

These tools could finally clarify which fungi cause which illnesses.

5. Strong emphasis on emerging technologies for prevention

Including:

  • UV and photocatalytic TiO₂ devices

  • Improved antifungal cleaning agents

  • Building materials designed to resist mould growth

  • Volcanic minerals and clays that absorb harmful compounds

Why This Review Matters (for Patients, Carers, and Clinicians)

1. It shows mould is not “just an allergy problem”

Indoor fungi can worsen or trigger asthma, COPD, hypersensitivity pneumonitis, chronic sinus issues, and may even influence immune and neurological health. This validates patient experiences where damp homes worsen symptoms.

2. It provides strong evidence for housing-related health advocacy

Patients can use this to:

  • Request landlord repairs

  • Support home assessments

  • Advocate for rehousing if severe mould is present

  • Justify humidifier/dehumidifier use, and ventilation improvements

3. It highlights the importance of early remediation

Even simple cleaning and remediation steps can dramatically reduce mould burden and symptoms—important for families, vulnerable groups, and those with chronic lung disease.

4. It gives clinicians a clearer evidence base

Respiratory teams can use this to:

  • Recognise when housing contributes to disease flare-ups

  • Understand which conditions are most strongly linked to indoor fungi

  • Make better-informed referrals for environmental health assessments

5. It builds a scientific foundation for future guidelines

The authors point out that national building codes, indoor air quality policies, and public health guidance lag behind the evidence—and this review is intended to inform future regulation.

Who Does This Help Most?

Patients with:

  • Asthma

  • Allergic bronchopulmonary aspergillosis (ABPA)

  • Aspergillus bronchitis

  • COPD (especially those with fungal-associated exacerbations)

  • Hypersensitivity pneumonitis

  • Children with recurrent respiratory infections

  • Anyone living in damp, mouldy, water-damaged, or poorly ventilated homes

Clinicians:

Respiratory physicians, GPs, ENT specialists, allergists, immunologists.

Policy & Housing Professionals:

Public health teams, environmental health officers, social landlords, housing associations.

Researchers:

Those developing diagnostics, fungal exposure studies, indoor air quality monitoring, or patient-centred environmental interventions.

by GAtherton

Using Radiopaedia and Online Imaging Resources Safely: What Expert Patients and Non-Specialist Clinicians Need to Know

Online radiology education platforms such as Radiopaedia (see aspergillosis images here) have transformed access to medical knowledge. They provide high-quality explanations of imaging findings, annotated examples, and differential diagnoses that are invaluable for learning, teaching, and patient empowerment.

For expert patients living with long-term conditions, and for non-specialist clinicians working outside radiology, these resources can greatly improve understanding of scan reports and discussions with healthcare teams. However, it is important to understand what these tools can – and cannot – do.

Radiopaedia is an educational resource, not a diagnostic service

Radiopaedia is designed to teach pattern recognition and radiological reasoning, not to provide individual diagnoses. The cases shown are curated examples, often with classic features, and are presented without the full clinical complexity that accompanies real patients.

Real-world imaging interpretation requires integration of:

  • Clinical history and symptoms

  • Laboratory results (for example inflammatory markers, microbiology, immunology)

  • Prior imaging and disease progression

  • Treatment history and response

  • Knowledge of common mimics and incidental findings

This clinical synthesis cannot be replicated by reviewing example images alone.

Why expert radiologist review still matters

For many diagnoses, there is no substitute for a radiologist formally reviewing and interpreting the imaging.

This is particularly true when:

  • Findings are subtle or evolving

  • Multiple conditions coexist (for example bronchiectasis, infection, scarring, and inflammation together)

  • Imaging appearances overlap between diseases

  • Treatment decisions depend on small but important changes over time

Radiologists are trained to recognise not only “textbook” appearances, but also atypical, incomplete, or misleading patterns, and to weigh uncertainty appropriately in their reports.

Imaging patterns are rarely diagnostic in isolation

Many imaging features are non-specific. For example:

  • Cavities can be caused by infection, inflammation, malignancy, or prior disease

  • Nodules may represent infection, scarring, inflammation, or benign change

  • Mucus plugging can occur in asthma, infection, allergic disease, or chronic airway disease

Educational resources often present differential diagnoses clearly, but deciding which diagnosis applies to a specific patient requires clinical judgment and experience.

A particular note for chronic lung and fungal disease

In complex conditions such as chronic lung disease, allergic lung disease, or fungal infections, imaging interpretation is especially nuanced. Appearances may change slowly, fluctuate with treatment, or overlap with other long-standing abnormalities.

Small changes that are significant to a specialist team may appear minor or ambiguous when viewed without context. Conversely, dramatic-looking findings may represent stable or inactive disease.

This is why specialist radiology input, often alongside multidisciplinary discussion, remains essential.

How expert patients and clinicians should use Radiopaedia

Used appropriately, Radiopaedia can:

  • Improve understanding of scan terminology

  • Help frame informed questions for clinicians

  • Support education and shared decision-making

  • Aid non-specialists in recognising when further advice is needed

It should not be used to:

  • Self-diagnose based on image similarity

  • Override formal radiology reports

  • Draw conclusions without clinical correlation

The key message

Radiopaedia and similar platforms are powerful educational tools. They enhance knowledge, confidence, and communication. But for many diagnoses, they complement rather than replace expert radiologist assessment.

The safest and most effective approach is to use educational resources alongside formal imaging reports, specialist input, and clinical discussion — not instead of them.

by GAtherton

Beyond guidelines: what do I need to know when dealing with fungal diagnostics?

Cornelia Lass-Flörl. Clinical Microbiology and Infection (2025)

PIIS1198743X2500357X

Why this paper matters

Diagnosing invasive fungal infections (including aspergillosis) remains difficult in real-world practice. Guidelines exist, but patients and clinicians often experience confusing or apparently conflicting test results. This narrative review explains why that happens and how results should be interpreted in context, particularly for Aspergillus infections.

Key messages relevant to aspergillosis

1. Your immune system strongly affects test results

The paper clearly explains that diagnostic tests behave very differently depending on immune status:

  • In neutropenic or heavily immunosuppressed patients, antigen tests such as galactomannan tend to perform better, while antibody tests often fail.

  • In immunocompetent or non-neutropenic patients, including many with chronic pulmonary aspergillosis (CPA), Aspergillus IgG antibody tests are often positive and clinically useful.
    This helps explain why some patients are told their blood tests are “negative” despite ongoing disease.

2. Where the sample comes from matters

For lung aspergillosis:

  • Bronchoalveolar lavage (BAL) samples are far more informative than blood.

  • Blood cultures are usually unhelpful for Aspergillus, as the fungus rarely circulates in the bloodstream.

  • A positive sputum culture may represent colonisation rather than infection, especially in people without severe immune suppression.

This reinforces an important patient message: a single test result is rarely enough.

3. Antifungal treatment can hide infection

Starting antifungal therapy early can:

  • Make cultures negative

  • Reduce antigen levels (e.g. galactomannan)

  • Complicate microscopy interpretation

This explains why some patients experience false reassurance from negative tests after treatment has already begun. Serial testing and clinical judgement are often more informative than a single result.

4. False positives and cross-reactivity are common

The review highlights important pitfalls:

  • β-D-glucan can be positive due to bacterial infections or medical materials, not just fungi

  • Galactomannan can cross-react with other fungi (e.g. Fusarium)

  • Mixed infections can occur in immunosuppressed patients

This supports a cautious interpretation of “positive” results and explains why clinicians may hesitate to diagnose aspergillosis based on one test alone.

5. Colonisation vs infection is a central challenge

A particularly relevant section for aspergillosis patients explains:

  • Aspergillus can live in airways without causing invasive disease

  • Diagnosis relies on combining symptoms, imaging, risk factors, and multiple tests
    This reflects the lived experience of many patients with bronchiectasis, asthma, or chronic lung disease.

Strengths of the paper

  • Written by a leading international mycology expert

  • Pragmatic and clinically grounded

  • Explains why guidelines don’t always fit individual patients

  • Particularly strong on Aspergillus diagnostics, including CPA and invasive disease

Limitations

  • Focuses mainly on invasive fungal infections; allergic and chronic syndromes are discussed less

  • Aimed primarily at clinicians and laboratories, not patients

Take-home message for patients

There is no single “definitive” test for aspergillosis. Results depend on immune status, sample type, timing, and prior treatment. Negative tests do not always mean absence of disease, and positive tests do not always mean active infection.

This paper strongly supports the multidisciplinary, experience-based approach used in specialist centres such as the National Aspergillosis Centre.

by GAtherton

The Chief Medical Officer’s Annual Report 2025: Infections

What this document is

The Chief Medical Officer’s Annual Report 2025: Infections is a major national review produced by the Chief Medical Officer for England, Professor Chris Whitty. It is a comprehensive, 371-page assessment of:

  • Current infectious disease threats in England

  • How infections are changing (ageing population, travel, globalisation, antimicrobial resistance)

  • What the NHS, public health services, and government need to do to protect the public

  • Key topics including vaccines, fungal infections, infection in older adults, housing, climate change and more

It includes contributions from national experts—including a full chapter dedicated to fungal infections (section 4.2) and others that touch on issues highly relevant to aspergillosis patients (vaccination, antimicrobial resistance, respiratory infections, housing, and vulnerable populations)

cmo-annual-report-2025-infectio…

Why it is published

The report is published each year to:

1. Advise Government

It sets out the CMO’s expert recommendations on how England should prepare for current and future infection threats, including pandemics, AMR, and emerging fungal pathogens.

2. Influence NHS planning and investment

The report highlights weaknesses in the system and proposes reforms.
This year’s report strongly emphasises:

  • Better infection services

  • Stronger surveillance

  • Improving vaccine uptake

  • Protecting older adults (now the group with most infection-related deaths)

  • Expanding superspecialist expertise—including fungal disease expertise

3. Inform clinicians, researchers, and public health professionals

It provides a current consensus on infectious disease trends, evidence, and priorities.
Chapters are written by leading UK experts in each field (e.g., fungal infections, antimicrobial resistance, vaccines, imported infections)

4. Educate the public and third-sector organisations

The report is open-access and intended to help the public understand why infection preparedness matters and why actions like vaccination, stewardship, and early diagnosis are essential.

Who reads it

The report is widely used across:

Government

  • Department of Health and Social Care

  • UKHSA

  • Cabinet Office (emergency planning)

  • Local authorities

NHS and clinical services

  • Infectious disease physicians

  • Respiratory teams

  • Microbiology and virology specialists

  • Primary care networks

  • ICS / ICB teams planning local services

Researchers and academic institutions

It sets the direction for future research and funding priorities, including for fungal disease and AMR.

Charities, patient organisations and advocates

Groups representing people with chronic, infectious, or respiratory illness read the report to understand system-level changes and advocate for patient needs.

Industry and diagnostics developers

They monitor future needs for antifungals, vaccines, and diagnostic tools.

Why this report is important for aspergillosis patients

Several aspects of the 2025 report directly relate to people with ABPA, CPA, SAFS or Aspergillus bronchitis.

1. Fungal infections are recognised as a major emerging threat

The report includes a dedicated chapter on fungal infections (section 4.2), describing:

  • Rising antifungal resistance

  • Expanding fungal threats globally

  • The importance of specialist mycology expertise

  • The risks from agricultural fungicides

  • The need for improved surveillance and diagnostics

This formal recognition strengthens the case for specialised centres like the National Aspergillosis Centre.

2. It highlights the need for superspecialists in rare and imported infections—including fungal disease

The CMO states that England requires:

“superspecialists to provide advice on and management of infections including… rarer [infections] such as fungal infections.”

cmo-annual-report-2025-infectio…

This directly supports the role and expansion of the NHS mycology services, which Aspergillus patients rely on for accurate diagnosis and treatment.

**3. It reinforces the importance of antimicrobial and antifungal stewardship

For people with aspergillosis, this matters because:

  • Resistance to azoles is rising—and the report explicitly mentions agricultural fungicides as part of the problem.

  • Stewardship ensures patients receive appropriate antifungals, monitored carefully and adjusted safely.

  • It argues for more drug development, which is essential because current antifungal options are limited.

4. It emphasises diagnosing infection in older adults

Older adults are increasingly vulnerable to infections and complications, especially respiratory ones.
The report stresses that:

  • Infection in older adults often has more serious consequences

  • Early diagnosis is essential

  • Access to specialist care must improve

Since many aspergillosis patients are older with complex lung disease, this section validates the need for better recognition and earlier referral.

5. Housing and damp are recognised as infection risks

The chapter Housing and Infection (section 7.2) discusses how substandard housing—including damp and mould—drives respiratory illness.
Although not Aspergillus-specific, it gives important public health backing for patients needing remediation and better housing conditions.

6. The report strengthens the case for national fungal surveillance

Key recommendations include:

  • Improving surveillance of antimicrobial and antifungal resistance

  • Better mapping of emerging pathogens

  • More research into fungal diseases

These system-level improvements directly benefit aspergillosis patients by helping earlier detection and better treatment options.

7. It raises awareness of fungal disease at national level

Simply being included in a flagship CMO report is important.
It means:

  • Policymakers can no longer overlook fungal infections

  • Funding for mycology services becomes easier to justify

  • Clinicians across the NHS will become more aware of CPA, ABPA and related diseases

  • It helps reduce the years-long diagnostic delays many patients face

In short — why Aspergillus patients should care

The 2025 CMO Annual Report is one of the most influential documents shaping future infectious disease strategy in England. For aspergillosis patients, it is important because:

✓ Fungal infections are explicitly highlighted as a growing threat

✓ Specialist mycology services are recognised as essential

✓ Antifungal resistance is identified as a major risk requiring action

✓ Better diagnosis and monitoring of at-risk groups is encouraged

✓ Housing, climate, age and vulnerability—all major issues for patients—are addressed

✓ It strengthens the case for investment in NAC and wider mycology networks

 

This report can be used by patient groups, NAC advocates, and healthcare professionals to press for:

  • More referrals

  • Better awareness among GPs and respiratory teams

  • Expanded mycology diagnostic capacity

  • Greater research funding

  • Better antifungal stewardship

  • National fungal surveillance

by GAtherton

Aspergillosis Research Highlights — Week in Review (Last 7 Days: Week 50)

Seven key publications: pathogenicity, diagnostics, resistance, treatment, maxillofacial disease, and ABPA in COPD.

1. Comparative Overview of A. fumigatus, A. flavus, and A. niger

Rafique et al., J Infect Public Health, 2025
DOI: 10.1016/j.jiph.2025.103070

What this adds

  • A major comparative review (2000–2025) of the three most clinically relevant Aspergillus species.

  • Highlights broad clinical spectrum: allergy → chronic disease → invasive aspergillosis.

  • Identifies species-specific concerns:

    • A. fumigatus: globally dominant, rapidly evolving triazole resistance.

    • A. flavus: important in warmer climates; high aflatoxin relevance.

    • A. niger: relatively lower virulence but significant in sinus disease.

  • Public health message: surveillance gaps persist, especially for non-fumigatus species.

Why it matters

A strong reference paper supporting the WHO prioritisation of Aspergillus, and reinforcing the need for:

  • Better diagnostics

  • Species-level identification

  • Environmental resistance monitoring

2. GFP Fusion Protein Proteolysis in A. fumigatus

Paul & Moye-Rowley, G3 (Bethesda), 2025
DOI: 10.1093/g3journal/jkaf295

What this adds

  • Fundamental molecular biology study revealing regulated degradation pathways of green fluorescent protein (GFP) fusion proteins inside A. fumigatus.

  • Demonstrates how the fungus controls protein turnover under stress conditions.

Why it matters

  • Advances tools for fungal cell biology.

  • Supports drug development by clarifying pathways involved in stress response and antifungal tolerance.

  • Reinforces WHO’s classification of A. fumigatus as one of the four most critical fungi to study.

3. ABPA in COPD: Case Series + Review

Ren et al., BMC Pulmonary Medicine, 2025
DOI: 10.1186/s12890-025-04027-8

What this adds

  • 11 COPD cases with confirmed Allergic Bronchopulmonary Aspergillosis — highlighting:

    • Under-recognition in COPD

    • Overlap with chronic bronchitis/bronchiectasis symptoms

    • Frequent misdiagnosis as recurrent infections or COPD exacerbations

  • Provides diagnostic guidance and a literature synthesis.

Why it matters

  • Significant implications for case finding across the UK.

  • Supports NAC messaging: ABPA is not only an asthma disease.

  • Reinforces need for:

    • IgE/IgG screening

    • Early CT imaging

    • Awareness among COPD teams and primary care

4. EL219: Next-Generation Polyene Antifungal

Youssef et al., AAC, 2025
DOI: 10.1128/aac.01400-25

What this adds

  • Animal model evidence that EL219, a modern polyene, is effective against:

    • Triazole-susceptible A. fumigatus

    • Azole-resistant isolates

    • Difficult species (A. lentulus, A. calidoustus)

Why it matters

  • Highly relevant to rising global antifungal resistance.

  • Early indication that EL219 may fill a clinical gap similar to (or complementary to) olorofim and fosmanogepix.

  • Suggests strong activity even in immunosuppressed models.

5. Misidentification & Triazole Resistance in Aspergillus tubingensis

Wang et al., JAMA Network Open, 2025
DOI: 10.1001/jamanetworkopen.2025.43630

What this adds

  • Large Southern California population study showing:

    • Frequent misidentification of A. tubingensis as A. niger.

    • Notable azole resistance rates in correctly identified isolates.

  • Stresses need for genomic sequencing or MALDI-TOF with updated libraries.

Why it matters

  • Strong evidence that misidentification leads to:

    • Inappropriate antifungal therapy

    • Poor outcomes

  • Supports calls for expanded diagnostic reference services such as MRCM.

6. 50-Year Review of Oral Fungal Infections in Thailand

Kosanwat et al., Clinical Oral Investigations, 2025
DOI: 10.1007/s00784-025-06685-8

What this adds

  • Longitudinal study: 29% of deep infections involved aspergillosis.

  • Mean age 62 → older adults most affected.

  • Many cases were mucormycosis, histoplasmosis, or aspergillosis presenting late.

Why it matters

  • Shows that oral/maxillofacial fungal disease remains under-recognised globally.

  • Relevant to dental teams → better imaging + biopsy protocols needed.

  • May help NAC/CARES identify referral pathways from dental medicine.

7. Management of Maxillary Sinus Aspergillosis with Implants

Khoury et al., Int J Oral Implantol, 2025

What this adds

  • Real-world 3–10 year follow-up of 11 patients.

  • Standardised approach:

    • Surgical clearance

    • Antifungal therapy

    • Successful implant-prosthetic rehabilitation

Why it matters

  • Demonstrates excellent long-term outcomes when sinus aspergillosis is properly treated.

  • Practical implications for:

    • ENT surgeons

    • Oral surgeons

    • Implant dentistry

  • Supports inclusion of aspergillosis in sinus disease differential diagnosis.

Cross-Cutting Themes Emerging This Week

1. Under-recognition and misidentification

  • ABPA in COPD

  • Misidentified A. tubingensis

  • Asymptomatic sinus disease

  • Oral/maxillofacial deep fungal infections

→ Key NAC message: We are missing cases in primary care, COPD clinics, ENT, and dentistry.

2. Antifungal resistance remains a central threat

  • Contemporary reviews of species-specific resistance patterns

  • EL219’s promise against resistant species

  • Misidentification leading to incorrect susceptibility assumptions

3. Need for better diagnostics and reference centres

  • Species-level identification is essential

  • Supports arguments for expansion of MRCM-style national services

4. The clinical spectrum is broad

From allergy (ABPA in COPD) → chronic sinus disease → deep oral infections → invasive pulmonary aspergillosis.
This reinforces the message: aspergillosis is multi-specialty, not confined to respiratory medicine.

Weekly NAC/MRCM Take-Home Messages

  • COPD teams should screen for ABPA more frequently—especially in patients with recurrent “infective exacerbations.”

  • Species-level identification is increasingly important; misidentification contributes to treatment failure.

  • New antifungals like EL219 show promise against resistant strains including A. lentulus.

  • Dental and ENT teams need better awareness: sinus and oral fungal infections remain overlooked but treatable.

  • Global reviews show growing public health significance of Aspergillus species—aligning with WHO priorities.

by GAtherton

⭐ Severe Asthma with Fungal Sensitisation (SAFS): The Hidden Burden Behind Difficult Asthma

Estimated prevalence: 15–30% of severe asthma patients show fungal sensitisation.

Severe Asthma with Fungal Sensitisation (SAFS) describes a group of patients with severe asthma who show sensitisation (allergy) to Aspergillus or other environmental moulds but do not meet criteria for ABPA. These patients often experience persistent inflammation, breathlessness, mucus production, and exacerbations that are not adequately controlled by standard asthma therapies.

Although SAFS is common in severe asthma clinics, it remains poorly recognised, frequently mislabelled, and rarely discussed in routine practice. Yet identifying SAFS is crucial because it opens the door to specific interventions — including antifungals or targeted biologics — that can improve symptoms and reduce hospital admissions.

⭐ How Common Is SAFS?

SAFS is more common than ABPA and CPA combined in asthma services.

Population Estimated prevalence
Moderate asthma ~5%
Severe asthma 15–30%
Patients with frequent exacerbations up to 40%
ABPA-negative patients with mucus plugging high likelihood

Across the UK, this represents tens of thousands of people.

⭐ Why SAFS Is Missed

1. The diagnosis is not widely understood

Unlike ABPA or CPA, SAFS lacks:

  • universally agreed diagnostic criteria

  • clear imaging features

  • a single confirmatory test

This leads to variability in thinking and detection.

2. Symptoms mimic uncontrolled asthma

SAFS patients typically experience:

  • severe breathlessness

  • wheeze

  • mucus production

  • airway plugging

  • poor response to inhalers

  • frequent steroid courses

These appear indistinguishable from “difficult” or “type 2–high” asthma.

3. IgE and eosinophils may be normal

Unlike ABPA:

  • total IgE may be modest

  • Aspergillus IgE may be borderline

  • eosinophils may fluctuate, especially with steroids or biologics

Clinicians are often looking for very high IgE levels — but SAFS patients usually don’t show them.

4. Sputum and CT scans appear non-specific

Typical imaging:

  • mucus plugging

  • small-airway thickening

  • variable, patchy inflammation

  • bronchiectasis may or may not be present

Radiologists often report these changes as:

  • “consistent with asthma”

  • “post-infective”

  • “non-specific inflammatory pattern”

5. The fungal link is overlooked

Many clinicians are unfamiliar with:

  • the role of mould exposure

  • sensitisation thresholds

  • the overlap between environmental allergy and airway disease

  • when antifungals are appropriate

This leads to delays in recognising fungal-driven asthma.

⭐ Who Is at Highest Risk?

1. Severe asthma patients unresponsive to maximal inhaled treatment

Particularly those with:

  • frequent exacerbations

  • nocturnal symptoms

  • long-term steroid use

  • persistently low lung function

  • mucus plugging events

2. Patients sensitised to Aspergillus or multiple moulds

Positive skin tests or specific IgE indicate airway allergy that can drive symptoms.

3. Patients with damp or mould exposure at home or work

An important environmental factor often overlooked.

4. ABPA-negative asthma patients with mucus plugging

A large proportion of these patients fit the SAFS profile.

5. Those with co-existing bronchiectasis

Bronchiectasis amplifies the inflammatory response to fungal exposure.

⭐ Specialties That Need Greater Awareness

  • Severe asthma services & biologics clinics
    (primary diagnostic opportunity)

  • General respiratory clinics

  • Primary care & urgent care
    (patients seen frequently with “persistent asthma symptoms”)

  • Radiology
    (important for identifying mucus plugging)

  • Allergy/Immunology
    (mould sensitisation is central to diagnosis)

  • Environmental health teams
    (exposure to mould and dampness often perpetuates symptoms)

The National Aspergillosis Centre can provide specialist input when diagnosis is unclear or response to treatment is suboptimal.

⭐ Red Flags Suggesting SAFS

1. Severe asthma poorly controlled despite maximal inhalers

Including biologics (omalizumab, mepolizumab, benralizumab, dupilumab, tezepelumab).

2. Sensitisation to Aspergillus fumigatus or multiple moulds

3. Repeated mucus plugging episodes

(or “sticky mucus” symptoms)

4. More than 2–3 steroid-treated exacerbations per year

5. Asthma + bronchiectasis

Even mild bronchiectasis increases fungal risk.

6. Symptoms triggered by damp/mould exposure

7. Persistent airway inflammation despite correct inhaler technique

⭐ Misdiagnoses That Delay Recognition

  • “Difficult asthma”

  • “Brittle asthma”

  • “Post-viral inflammation”

  • “Poor adherence to inhalers”

  • “Asthma–COPD overlap”

  • “Psychogenic dyspnoea”

  • “Recurrent chest infections”

SAFS is a diagnosis hiding in these labels.

⭐ The Cost of Missed SAFS Diagnosis

For patients:

  • persistent symptoms

  • steroid dependence

  • increased risk of ABPA

  • progressive airway damage

  • hospital admissions

  • poor quality of life

  • possible career and lifestyle impact

For healthcare systems:

  • repeated A&E visits

  • asthma admissions

  • high biologic usage without adequate response

  • unnecessary antibiotics

  • escalating steroid toxicity

  • missed environmental interventions

⭐ Conclusion

SAFS is one of the most common — yet least recognised — fungal-related lung conditions. Although it lacks the dramatic imaging changes of ABPA or CPA, its impact on patients is profound.

Recognising mould sensitisation in severe asthma, understanding the role of fungal allergens, and considering targeted therapies can transform disease control. For complex cases or when the diagnosis is uncertain, referral to the National Aspergillosis Centre is recommended.

Early identification and appropriate treatment reduce steroid use, exacerbations, and long-term airway damage.

by GAtherton

⭐ Aspergillus Bronchitis: The Overlooked Condition Hiding in Plain Sight

Estimated prevalence 1–2% in bronchiectasis and chronic airway disease clinics.

Aspergillus Bronchitis (AB) is a chronic, symptomatic infection of the airways caused by Aspergillus species in people with underlying lung disease. It sits between simple colonisation and chronic pulmonary aspergillosis (CPA), and is frequently overlooked or mislabelled as “recurrent infection,” “post-viral symptoms,” or uncontrolled bronchiectasis.

Unlike CPA, Aspergillus Bronchitis does not require cavities or major structural destruction — which makes it both easier to miss and surprisingly common among people with chronic airway disease.

When recognised and treated (usually with antifungal therapy for several months), symptoms often improve significantly. But because awareness remains low, most patients cycle through unnecessary antibiotics, repeated exacerbations, and worsening airway disease before the real cause is identified.

⭐ What Exactly Is Aspergillus Bronchitis?

Aspergillus Bronchitis is defined by:

  • chronic productive cough

  • sputum growing Aspergillus species repeatedly

  • airway inflammation

  • symptoms lasting over 3 months

  • underlying airway disease (bronchiectasis, CF, COPD, prior TB, ABPA)

  • response to antifungal therapy

Unlike ABPA:

  • there is no allergic response,

  • IgE is usually normal,

  • eosinophils are normal or mildly elevated.

Unlike CPA:

  • there are no cavities on imaging,

  • IgG may be normal or only slightly elevated,

  • disease is confined to the airways, not lung tissue.

This places AB in a “grey zone” — often invisible unless specifically looked for.

⭐ Why Aspergillus Bronchitis Is Missed

1. Symptoms mimic common chronic airway disease

Typical AB symptoms include:

  • daily productive cough

  • worsening sputum thickness

  • breathlessness

  • fatigue

  • repeated “chest infections”

  • slow-to-clear mucus

  • crackles or wheeze

These resemble:

  • bronchiectasis exacerbations

  • COPD flare-ups

  • chronic infection with Pseudomonas or NTM

  • post-viral cough

  • uncontrolled asthma

Without fungal awareness, clinicians default to bacterial explanations.

2. Sputum grows multiple organisms — Aspergillus is dismissed

In bronchiectasis, sputum frequently grows:

  • Haemophilus

  • Pseudomonas

  • Staphylococcus

  • Streptococcus

  • NTM

When Aspergillus appears, it’s often labelled:

  • “colonisation”

  • “contaminant”

  • “not clinically relevant”

But repeated isolation with persistent symptoms is highly suggestive of AB.

3. IgE/IgG results may be normal

Many clinicians expect high IgE or IgG to “confirm Aspergillus disease.”
But in Aspergillus Bronchitis:

  • IgE is usually normal

  • IgG can be normal or borderline

This leads to false reassurance.

4. Radiology rarely shows overt features

CT scans in AB may show:

  • mucus plugging

  • mild bronchial wall thickening

  • small nodules

  • progression of bronchiectasis

But they do not show the cavities of CPA or classic features of ABPA.

Therefore radiologists often report scans as “no significant change” or “stable bronchiectasis.”

5. Antibiotics appear to help — temporarily

Patients often improve slightly with:

  • amoxicillin

  • doxycycline

  • macrolides

  • ciprofloxacin

This gives clinicians the impression of bacterial disease, but symptoms soon return.

6. Lack of awareness

Many specialists (even in respiratory clinics) are unaware that Aspergillus Bronchitis:

  • exists as a distinct clinical entity

  • can be disabling

  • responds to antifungals

  • predicts progression to CPA if untreated

This leads to significant diagnostic delay.

⭐ Who Is at Highest Risk?

1. Bronchiectasis

The largest risk group.
Aspergillus Bronchitis may account for 1–2% of all bronchiectasis patients, and up to 5–10% in severe or frequent exacerbator groups.

2. Cystic Fibrosis (CF)

These patients frequently grow Aspergillus but not all have ABPA — some have Aspergillus Bronchitis.

3. COPD and chronic productive cough

Especially those with:

  • frequent mucus plugging

  • repeated “infective exacerbations”

  • progressive sputum production

4. Post-TB airway damage

Chronic airway deformity, scarring, and bronchiectasis from old TB predispose to fungal infection.

5. Post-COVID structural disease

A new and growing risk group, especially after prolonged ICU ventilation.

6. ABPA patients

Some patients develop Aspergillus Bronchitis during steroid-dominated treatment or after stopping antifungals.

⭐ Which Specialities Need Greater Awareness?

  • Respiratory medicine
    (especially bronchiectasis clinicians and severe asthma teams)

  • Infectious Diseases
    (frequent respiratory presentations with chronic airway infection)

  • Radiology
    (to recognise subtle but progressive airway changes)

  • Primary care
    (“recurrent chest infection” or “persistent cough” patients)

  • Physiotherapy & airway clearance teams
    (excessive sputum with fungal elements)

  • Cystic Fibrosis services

The National Aspergillosis Centre is the ideal referral destination when diagnosis is uncertain or symptoms persist despite typical management.

⭐ Red Flags Suggesting Aspergillus Bronchitis

1. Chronic (>3 months) productive cough + repeated Aspergillus in sputum

Even 2 positive sputums in the right clinical context should raise suspicion.

2. Bronchiectasis patient not improving on repeated antibiotics

3. Thick, tenacious mucus with black, grey, or brown plugs

4. Worsening CT bronchiectasis or mucus plugging

5. Absence of features typical for ABPA (normal IgE, no fleeting infiltrates)

6. Asthma or COPD patient with new persistent sputum

7. Partial response to antibiotics but rapid relapse

8. Unexplained fatigue and breathlessness in someone with airway disease

⭐ The Cost of Missed Aspergillus Bronchitis

If AB is not recognised early, consequences include:

  • repeated exacerbations

  • accelerating bronchiectasis

  • long-term airway damage

  • chronic inflammation

  • steroid overuse

  • unnecessary antibiotics

  • repeated hospitalisations

  • progression to CPA in some patients

For health systems, missed diagnosis leads to:

  • higher admission rates

  • inappropriate long-term antibiotic use

  • avoidable CT scans and investigations

  • greater long-term burden of CPA

But antifungal therapy — when appropriately used — can offer marked symptom improvement and reduce exacerbation frequency.

⭐ Conclusion

Aspergillus Bronchitis is a distinct, treatable form of chronic airway disease seen in people with bronchiectasis, asthma, COPD, CF, and post-TB lung damage. Yet lack of awareness means many patients are repeatedly misdiagnosed with bacterial infections or unexplained chronic cough.

Recognising red flags, reviewing sputum results carefully, and considering antifungal therapy can dramatically improve outcomes. Early referral to specialist centres such as the National Aspergillosis Centre is recommended for complex cases or uncertain diagnosis.

Early identification prevents airway deterioration — and reduces the likelihood of progression to CPA.

by GAtherton

⭐ Allergic Bronchopulmonary Aspergillosis (ABPA): Why Diagnosis Is Missed and Who Needs to Be More Aware

With estimated prevalence of 1–2% in asthma clinics and up to 10% in severe asthma services.

Allergic Bronchopulmonary Aspergillosis (ABPA) is a chronic immune reaction to Aspergillus that affects people with asthma or cystic fibrosis. It causes airway inflammation, mucus plugging, recurrent exacerbations, and bronchiectasis if untreated.

Despite being treatable, ABPA remains heavily underdiagnosed, even in countries with advanced respiratory services. Many people are told for years that they have “difficult asthma” or “recurrent chest infections,” only for ABPA to be diagnosed much later, often with significant lung damage already present.

The UK National Aspergillosis Centre (NAC) provides specialist expertise, yet only a small proportion of expected ABPA cases reach specialist review.

This article explains why ABPA is missed, which patients are at risk, which specialities need to be more alert, and the red flags that should prompt testing or referral.

⭐ How Common Is ABPA?

ABPA is more common than most clinicians realise:

Population Estimated prevalence
General asthma 1–2%
Severe asthma clinics 3–10%
Cystic fibrosis 5–15%
Bronchiectasis (non-CF) 1–4%

Across the UK, this equates to an estimated 15,000–25,000 people living with ABPA — but only a small minority ever receive the correct diagnosis.

⭐ Why ABPA Is Often Missed

1. ABPA looks like “difficult asthma”

Typical symptoms — wheeze, cough, mucus, breathlessness — mimic:

  • severe asthma

  • eosinophilic asthma

  • uncontrolled asthma despite treatment

Patients may be repeatedly stepped up through inhalers, oral steroids, and biologics before ABPA is even considered.

2. Exacerbations are mistaken for infections

Many ABPA flare-ups are treated as:

  • pneumonia

  • viral infection

  • “chest infection”

  • post-viral asthma worsening

Without fungal-specific thinking, the diagnosis is rarely made.

3. IgE and eosinophils fluctuate

IgE is a cornerstone of ABPA diagnosis, but:

  • systemic steroids suppress IgE

  • biologics (benralizumab, mepolizumab, dupilumab) reduce eosinophils

  • flare-ups produce temporary spikes

  • baseline ranges vary between labs

Clinicians often overlook ABPA in patients on biologics because eosinophils are normal — despite the underlying fungal allergy still being active.

4. Radiology findings get mislabelled

ABPA causes:

  • mucus plugging

  • “tram lines” and bronchial thickening

  • fleeting infiltrates

  • upper lobe bronchiectasis

These are often:

  • labelled “infection”

  • attributed to asthma airway remodelling

  • not compared across time

  • missed on CT unless specifically looked for

5. Inconsistent awareness across specialities

Some clinicians are unfamiliar with:

  • ISHAM diagnostic criteria

  • interpreting IgE/IgG results

  • the relationship between asthma and fungal allergy

  • the overlap between ABPA and bronchiectasis

This leads to diagnostic delay or misdiagnosis.

6. ABPA evolves into chronic disease if untreated

Repeated inflammation → mucus plugging → bronchiectasis → fibrosis.
By the time a diagnosis is made, airway damage can be permanent.

⭐ Who Is at Highest Risk?

1. Asthma patients with repeated exacerbations

Especially those who:

  • fail maximal inhaler therapy

  • require multiple steroid courses

  • have sudden, dramatic mucus plugging events

  • experience episodic “flares” with no clear cause

2. Severe asthma clinic patients

Prevalence is up to 10%, especially those with:

  • high IgE

  • eosinophilia

  • sensitisation to multiple allergens

  • steroid dependence

3. Bronchiectasis patients

Bronchiectasis often coexists with ABPA and can worsen flares.

4. Patients with mucus plugging (“finger-in-glove” signs)

These striking CT appearances strongly suggest ABPA but are often misattributed to infection.

5. People with CF (Cystic Fibrosis)

5–15% develop ABPA at some stage.

⭐ Which Specialities Need Greater Awareness?

  • Severe asthma services & biologics clinics
    (highest yield group for ABPA detection)

  • Respiratory medicine
    (diagnosis often falls here but is highly variable)

  • General practice
    (sees frequent “exacerbations”)

  • Emergency departments & acute medical units
    (manage acute mucus plugging, chest tightness)

  • Paediatric respiratory medicine
    (early recognition prevents chronic damage)

  • Cystic Fibrosis services

  • Radiology
    (fleeting infiltrates and mucus plugging often give the earliest clues)

The National Aspergillosis Centre should be the referral point for complex or uncertain cases.

⭐ Red Flags Suggesting ABPA

1. Asthma with repeated, unexplained exacerbations

Especially if poorly responsive to normal treatment.

2. High total IgE (>500–1000 IU/mL)

Or rising IgE over time.

3. Eosinophilia (unless suppressed by treatment)

4. Positive Aspergillus sensitisation

(Skin prick test or specific IgE)

5. Bronchiectasis, particularly central or upper lobe

6. Fleeting pulmonary infiltrates

7. Mucus plugging on CT (“finger-in-glove” appearance)

8. ABPA flare triggered by stopping antifungals

9. Asthma + Aspergillus in sputum

⭐ The Cost of Missed ABPA Diagnosis

Failure to diagnose ABPA leads to:

  • progressive airway damage

  • permanent bronchiectasis

  • steroid dependence

  • hospital admissions

  • repeated infections

  • respiratory failure in advanced stages

  • reduced quality of life

  • avoidable healthcare expenditure

Delayed diagnosis increases the risk of progression to CPA, a far more serious chronic fungal infection requiring long-term antifungal therapy.

Early recognition, correct treatment, and referral to specialist centres like the National Aspergillosis Centre dramatically improve long-term outcomes.

⭐ Conclusion

ABPA is not rare — especially within severe asthma clinics, bronchiectasis services, and CF units. Yet it remains significantly underdiagnosed because its symptoms mirror those of common respiratory conditions, and because key investigations like IgE, IgG, and CT interpretation are inconsistently used.

A structured approach — recognising red flags, performing appropriate testing, and referring complex cases to the National Aspergillosis Centre — can reduce the burden of avoidable airway damage and improve the lives of thousands of patients.

by GAtherton

⭐ Chronic Pulmonary Aspergillosis: Why Diagnosis Is Missed and Who Needs to Be More Aware

With estimated prevalence of 3–4 cases per 100,000 population, and far higher rates in high-risk groups.

Chronic Pulmonary Aspergillosis (CPA) is a slowly progressive fungal lung disease affecting an estimated 3–4 per 100,000 people in the UK, with higher estimates in global settings with greater TB prevalence. Despite this, many clinicians will go through entire careers without confidently recognising it — not because it is extremely rare, but because it almost always hides inside other long-term lung diseases.

The UK is unusual in having a nationally commissioned specialist service — the National Aspergillosis Centre (NAC), based at Wythenshawe Hospital, Manchester — offering funded diagnostics, multidisciplinary review, and long-term antifungal management. But only a fraction of expected CPA cases are ever referred. Most are simply never diagnosed.

This article explains why diagnoses are missed, who is at highest risk, which specialities need to be more alert, and the red flags that should trigger testing or referral.

⭐ How Common Is CPA? The Numbers Behind the Problem

The UK prevalence is estimated at 3–4 per 100,000 people — approximately 2,000–2,500 people with CPA at any given time.

But the risk is far higher in specific groups:

Risk Group Estimated CPA prevalence
Post-TB lung disease 6–10% in those with residual cavities
Severe COPD (GOLD III–IV) 1–3%
Bronchiectasis 1–3%
NTM disease 3–10%
Sarcoidosis with fibrosis 1–2%
Immunosuppression (steroids/biologics) Unknown, but rising

Using these figures, the true UK caseload could exceed 4,000–6,000 individuals, yet NAC receives ~500–1,000 referrals, highlighting a large diagnostic gap.

⭐ Why CPA Is So Often Missed

1. Symptoms mimic common chronic lung diseases

CPA presents with:

  • Persistent cough

  • Breathlessness

  • Fatigue

  • Weight loss

  • Recurrent “chest infections”

  • Haemoptysis

These overlap almost perfectly with:

  • COPD

  • bronchiectasis

  • post-TB changes

  • long COVID

  • NTM infection

  • repeatedly “slow to clear” pneumonia

Because symptoms are non-specific, clinicians rarely think fungal.

2. Interpretation of imaging is inconsistent

CPA shows:

  • one or more cavities

  • pleural thickening

  • nodules

  • progressive changes over months

  • fungal balls

Common reporting pitfalls:

  • labelled “post-infective scarring”

  • misinterpreted as malignancy

  • seen but not compared longitudinally

  • incidental CT findings not acted upon

Radiology is one of the biggest missed opportunities for early detection.

3. IgG testing is not routinely requested

Aspergillus IgG is the key diagnostic biomarker — but it is:

  • often confused with IgE

  • not available in some hospitals

  • omitted from workups for recurrent infection

  • unfamiliar to non-respiratory clinicians

Without IgG, CPA is rarely diagnosed.

4. Short-term improvement with antibiotics is misleading

Patients with CPA may temporarily feel better after:

  • broad-spectrum antibiotics

  • steroids

  • physiotherapy

This transient improvement creates false reassurance.

5. CPA spans multiple specialisms — and no one owns it

Diagnosis requires combined expertise across:

  • respiratory medicine

  • infectious diseases

  • radiology

  • microbiology

  • immunology

When no one speciality takes responsibility, patients get lost.

⭐ Which Patients Are at High Risk?

CPA almost always develops on a background of existing lung damage.

1. Post-TB lung disease (PTLD)

Globally the largest CPA population.
Residual cavities are the strongest predictor.

Specialities needing awareness:

  • TB teams

  • ID physicians

  • Radiologists

  • Community TB nurses

  • Public health TB programmes

2. COPD (especially severe / emphysema)

Millions of people are potentially at risk.
Recurrent infections + bullae/cavities = fertile ground for CPA.

Specialities:

  • COPD clinics

  • Pulmonary rehab

  • Acute medicine (frequent admissions)

3. Bronchiectasis

Damaged airways enable persistent Aspergillus colonisation and inflammation.

Specialities:

  • Bronchiectasis MDTs

  • Severe asthma & NTM clinics

  • Respiratory physiotherapy

4. Sarcoidosis and ILD

Fibrosis and traction bronchiectasis develop cavities over time.

5. Post-COVID or post-influenza structural disease

Emerging risk group, especially in patients with:

  • ventilatory lung injury

  • persistent CT abnormalities

  • chronic steroid exposure

6. Chronic steroid or immunomodulator use

While invasive aspergillosis is linked to profound immunosuppression, CPA often affects those with milder, chronic immune dysfunction:

  • systemic steroids

  • high-dose inhaled steroids

  • biologics affecting eosinophils

  • poorly controlled diabetes

  • chronic kidney disease

  • malnutrition

⭐ Which Specialities Need to Be More Alert?

  • Respiratory Medicine – primary detection, but awareness varies greatly

  • Infectious Diseases – especially post-TB and persistent infection clinics

  • Radiology – key to spotting early changes

  • Primary Care – sees patients repeatedly with “ongoing chest infections”

  • Emergency & acute medicine – haemoptysis presentations

  • Bronchiectasis and NTM services – strong overlap

  • Severe asthma and biologics teams – ABPA → CPA evolution

  • TB clinics – highest prevalence globally, often least recognised

The National Aspergillosis Centre should be the referral point for any complex or uncertain case.

⭐ Red Flags: When to Suspect CPA

1. Cavities on CT (thin-, thick-walled, evolving, or multiple)

Especially with pleural thickening.

2. Haemoptysis

CPA is one of the most common causes of haemoptysis in people with cavities.

3. Symptoms lasting >3 months

Chronic cough, fatigue, weight loss, breathlessness.

4. “Recurrent infections” that never fully resolve

5. Post-TB patient with any new or worsening symptoms

6. Bronchiectasis patient with new cavity or Aspergillus culture

7. High or rising Aspergillus IgG

8. ABPA patient who deteriorates off antifungals

⭐ The Cost of Missed Diagnoses

When CPA is not recognised early, the consequences are severe:

  • irreversible lung damage

  • repeated hospitalisations

  • emergency haemoptysis events

  • prolonged antifungal therapy with more toxicity

  • reduced quality of life

  • avoidable deaths

For systems like the NHS, late diagnosis increases costs:

  • unplanned admissions

  • repeated CT imaging

  • prolonged antibiotics

  • intensive care during haemoptysis

  • complex surgery (lobectomy/pneumonectomy)

Early referral to specialist centres like the National Aspergillosis Centre prevents many of these harms.

⭐ Conclusion

CPA is not rare within the populations most likely to develop it.
Missed diagnoses are common, predictable, and preventable.

By increasing awareness across Respiratory, Infectious Diseases, Radiology, Primary Care, TB services, and severe asthma pathways — and by using simple tools such as Aspergillus IgG and careful CT interpretation — clinicians can dramatically reduce the diagnostic delay that damages lungs, quality of life, and survival.

The UK is fortunate to have the National Aspergillosis Centre as a nationally commissioned referral service. Recognising CPA early and referring appropriately has the power to save lives, reduce system costs, and improve long-term outcomes.

by GAtherton

🌐 Promoting the NHS National Aspergillosis Centre (NAC)

Nationally Commissioned Service • Specialist Advice • Remote MDT • Patient Support

Chronic and allergic aspergillosis remain significantly under-recognised across the UK — despite their substantial burden on respiratory, infectious disease, and immunology services.

As the NHS England–commissioned National Aspergillosis Centre (NAC), based at Wythenshawe Hospital (Manchester University NHS Foundation Trust), we provide national expertise, remote support, and shared-care pathways for clinicians managing these complex conditions.

📊 Why This Matters

Chronic pulmonary aspergillosis (CPA) affects an estimated 3–4 per 100,000 people in the UK, with far higher rates in those with:

  • Previous tuberculosis

  • COPD

  • Non-tuberculous mycobacterial (NTM) lung disease

  • Sarcoidosis

  • Bronchiectasis

Allergic bronchopulmonary aspergillosis (ABPA) may affect:

  • 2.5% of adult asthmatics

  • Up to 15% of people with cystic fibrosis

Yet both conditions are frequently undiagnosed or misdiagnosed, leading to delayed treatment and avoidable morbidity.

🏥 How NAC Supports Clinicians Across the UK

As the nationally commissioned centre for chronic aspergillosis, we offer:

🩺 Specialist clinical care

Face-to-face and remote clinics with structured long-term follow-up in partnership with local teams.

👥 National Aspergillosis MDT via Teams Remote Communication

A dedicated MDT where clinicians can refer and discuss complex diagnostic or therapeutic cases.

📧 Consultant-led advice & guidance

Available via phone & email, including:

  • Diagnostic support

  • Interpretation of IgE/IgG and fungal microbiology

  • Antifungal prescribing advice

  • Case planning for ABPA, CPA, SAFS and Aspergillus bronchitis

🔬 Access to advanced diagnostics

Including Aspergillus-specific IgE/IgG, culture, imaging, and molecular testing (e.g. antifungal resistance).

💬 Patient support & education (NAC CARES)

Moderated online groups, weekly patient meetings, webinars, and comprehensive educational resources — helping patients understand their condition and remain safely supported close to home.

🤝 We Welcome Collaboration

We’d be pleased to connect with respiratory, ID, immunology, and internal medicine teams to discuss:

  • Shared-care pathways

  • Diagnostic support

  • Service guidance

  • Virtual or in-person educational sessions

  • Case-specific MDT referrals

📄 Further information

Referral pathways, service scope and patient resources:
👉 https://mft.nhs.uk/wythenshawe/services/infectious-diseases/national-aspergillosis-centre/

Dr Chris Kosmidis
Clinical Lead, NHS National Aspergillosis Centre
Manchester University NHS Foundation Trust

by GAtherton