Sinusitis in Patients with ABPA

When to suspect it, when to investigate, and when to refer

Why this matters

Patients with allergic bronchopulmonary aspergillosis (ABPA) are usually managed as having a lung disease. Diagnosis, monitoring, and treatment focus appropriately on the chest, immunology, and asthma control.

However, ABPA occurs within a single continuous airway, extending from the nose and sinuses to the lungs. Disease in the upper airway can coexist with, exacerbate, or complicate lower airway inflammation — yet sinus disease is not routinely assessed in ABPA care pathways.

This article outlines:

What is known about sinus disease in this context
Which symptoms should raise suspicion
When investigation or ENT referral should be considered
What GPs and non-specialists can reasonably do

The united airway: a brief reminder

The upper and lower airways share:

Type 2 (eosinophilic) inflammation
Immunoglobulin E–mediated immune responses
Common triggers, including allergens and fungi

Chronic rhinosinusitis is common in asthma and severe asthma, and treatment of sinus disease can improve lower airway outcomes in some patients.
ABPA sits within this same inflammatory spectrum, even though its management is lung-centred.

Sinus disease in ABPA: what is (and isn’t) known

What we know

Chronic rhinosinusitis is common in patients with asthma and severe asthma
Sinus disease may be symptomatic or relatively silent
ABPA guidelines do not mandate routine ENT review or sinus imaging
ENT involvement, therefore, varies widely between centres

What we do not know

Whether routine ENT assessment improves ABPA outcomes
Which ABPA patients benefit most from sinus intervention
The optimal timing for ENT referral in ABPA

As a result, clinical judgement remains central.

Symptoms that should prompt consideration of sinus disease

Sinusitis in ABPA patients does not always present with classic “blocked nose and facial pain”.
Key symptoms include:

Common but often overlooked

Persistent post-nasal drip
Foul, bitter, metallic, or “infected” taste in the mouth
Throat clearing, chronic cough
Thick or sticky mucus sensation
Symptoms are worse on waking or lying flat

More typical sinonasal features

Nasal blockage or congestion
Facial pressure or fullness
Reduced or altered sense of smell
Nasal crusting or discharge

Contextual clues

Poor durability of response to steroids or antifungals
Recurrent “flares” without clear chest triggers
Coexisting severe asthma or nasal polyps
Symptoms are worse in damp or mould-affected housing

A persistent foul taste in the mouth is a recognised symptom of chronic sinus disease, usually due to post-nasal drainage of inflamed secretions.

Damp homes and sinus disease

Living in damp or mould-affected environments is associated with:

Higher rates of chronic rhinosinusitis
Upper airway irritation and inflammation
Allergic sensitisation to fungal spores

In most cases, this results in inflammatory or allergic sinusitis, not invasive fungal infection.
Fungal involvement may act as an immune trigger, even when not labelled as “fungal sinusitis”.

Fungal sinusitis: rare vs under-recognised

It is important to distinguish between entities:

Type	Frequency	Key point
Invasive fungal sinusitis	Rare	Usually immunocompromised; dramatic presentation
Fungal ball (mycetoma)	Uncommon	Usually obvious on CT
Allergic fungal rhinosinusitis	Likely under-recognised	Requires active suspicion

Allergic fungal rhinosinusitis overlaps biologically with ABPA:

IgE-mediated
Eosinophilic inflammation
Thick allergic mucin

It is not routinely sought, so it may be under-diagnosed in at-risk groups.

What GPs and non-specialists can reasonably do

1. Take upper airway symptoms seriously

Especially in ABPA or severe asthma patients with:

Persistent post-nasal symptoms
Foul taste
Recurrent unexplained deterioration

2. Examine the nose and throat

Look for polyps, discharge, and crusting
Note mouth breathing or altered voice quality
Check dentition (to exclude dental causes)

3. Consider imaging when symptoms persist

CT sinuses (not plain X-ray) is the imaging of choice
Particularly appropriate if symptoms last >8–12 weeks or recur

4. Refer to ENT when:

Symptoms are persistent or progressive
CT shows significant sinus disease
There is a poor response to standard medical therapy
There is diagnostic uncertainty

Referral does not imply surgery — ENT input may be diagnostic or medical.

What this article is not saying

It does not suggest that all ABPA patients need an ENT referral
It does not claim that sinus treatment improves ABPA outcomes
It does not override existing guidelines

It does suggest that earlier consideration of the upper airway is reasonable in selected patients.

Key take-home points for clinicians

The airway functions as a single inflammatory system
Sinus disease may be subtle, under-reported, or atypical
A foul taste in the mouth is a meaningful symptom
Damp or mould exposure increases sinus disease risk
ENT referral is appropriate when symptoms persist or recur
Evidence gaps remain — but clinical vigilance is justified

In summary

ABPA is managed as a lung disease, but patients live with a whole airway.
Recognising when sinus disease may be contributing can help explain persistent symptoms and guide appropriate referral — without over-investigation or over-treatment.

by GAtherton

ABPA and Work: What a Patient Poll Tells Us About Employment, Health, and Real-World Impact

An article for patients, GPs, and non-specialist healthcare professionals

Allergic bronchopulmonary aspergillosis (ABPA) is often discussed in terms of lung function, immunology, and imaging. Far less often do we talk about its impact on everyday life, particularly on a person’s ability to work.

A poll run within the National Aspergillosis Centre patient community asked a simple but powerful question:

Who is still able to work while living with ABPA – and who has had to stop or retire?

The responses provide an important insight into the functional and socioeconomic burden of ABPA.

Key findings from the poll (patient-reported)

Working full time: 17%
Working part time (days or hours): 18% combined
Not working: 30%
Retirement age: 21%
Retired early for health reasons: 12%
Currently on sick leave / full-time carer / pre-diagnosis: small but notable groups

Even allowing for the informal nature of a social media poll, the overall pattern is clear.

What this tells us

1. Sustained full-time work is uncommon in ABPA

Fewer than one in five respondents were able to work full time. Even among those still working, many described reduced hours, flexible arrangements, or fragile employment dependent on day-to-day health.

ABPA is often incompatible with predictable, high-demand working patterns.

2. ABPA frequently leads to work loss or early retirement

A substantial proportion of respondents were either:

No longer working at all, or
Retired earlier than planned specifically because of health

This is particularly striking given that ABPA often affects people during their working years and may coexist with asthma, bronchiectasis, or long-term steroid use.

3. “Retirement age” can hide health-forced exit

Some respondents selected “retirement age,” but accompanying comments revealed that many:

Left work earlier than expected
Changed careers or reduced responsibilities years before retirement
Worked through ill health until they no longer could

This matters when interpreting employment statistics: health-driven work loss may be underestimated.

4. Unpaid work and instability are often overlooked

The poll also highlighted:

People currently on prolonged sick leave
Full-time unpaid carers
Individuals still awaiting diagnosis but already struggling to work

These groups are frequently invisible in employment data, yet represent significant personal and societal impact.

Why ABPA affects the ability to work

For patients and non-specialists, it is important to understand that work difficulties in ABPA are not simply due to “asthma symptoms.”

Common contributors include:

Chronic breathlessness and cough
Severe fatigue and post-exertional exhaustion
Recurrent chest infections
Steroid side-effects (muscle weakness, bone disease, mood changes, diabetes risk)
Unpredictable flare-ups requiring rest, antibiotics, or hospital care
Cognitive and emotional burden of long-term illness

Together, these make consistent attendance, physical work, and high cognitive load difficult to sustain.

Implications for patients

Difficulty working is not a personal failure
Many others with ABPA face similar challenges
Adjustments, reduced hours, or stopping work altogether may be medically appropriate
Asking for support is reasonable and justified

Implications for GPs and non-specialist clinicians

Employment status should be considered a key outcome of disease control
Fit notes, occupational health input, and benefits documentation are part of holistic care
ABPA is a fluctuating condition – patients may cope for periods and then deteriorate
Statements such as “lung function is stable” do not always reflect real-world functioning

Understanding the work impact helps clinicians better support patients in consultations, reports, and advocacy.

Implications for systems and policy

This poll reinforces that ABPA carries a significant socioeconomic burden, including:

Reduced workforce participation
Early retirement
Increased reliance on health and social support systems

Any assessment of disability, employment capability, or long-term planning must take into account:

Variability over time
Treatment burden
Side-effects of necessary medications

In summary

This patient poll sends a consistent message:

ABPA commonly limits the ability to work, often leading to reduced hours, unstable employment, or early exit from the workforce.

For patients, this experience is shared and valid.
For clinicians, it is a reminder that ABPA is not just a radiological or immunological diagnosis, but a life-limiting condition with real-world consequences.

by GAtherton

Hydrocortisone dosing in adrenal insufficiency

Why adrenal insufficiency can happen in people with aspergillosis

Many people with aspergillosis, particularly those with asthma-related conditions such as allergic bronchopulmonary aspergillosis (ABPA) or more severe chronic lung disease, need treatment with steroid medicines at some point. These treatments — often essential to control inflammation, protect the lungs, and improve breathing — may include repeated or long-term courses of steroids such as prednisolone.

When steroid treatment is used over time, it can reduce the body’s own production of cortisol by the adrenal glands. In some people, the adrenal glands do not fully recover, leading to adrenal insufficiency. Cortisol is a vital hormone that helps the body manage energy, illness, infection, and physical stress. When it cannot be made reliably, hydrocortisone replacement is needed to keep the body safe and functioning.

In this situation, hydrocortisone is prescribed to replace the cortisol your body can no longer make, usually after prednisolone has been reduced or stopped, or when prednisolone is no longer needed to control lung inflammation but adrenal support is still required.

Adrenal insufficiency in people with aspergillosis is not a failure and not something you have caused. It is a recognised consequence of necessary treatment for a serious, long-term condition. With the right information, a personalised dosing plan, and medical support, adrenal insufficiency can be managed safely alongside aspergillosis.

A patient guide to everyday (basal) dosing, higher-dose needs, and short-term stress dosing

If you take hydrocortisone because you have adrenal insufficiency, understanding how your dose works — both day to day and during illness or stress — is essential for your safety and wellbeing.

This guide explains:

What your basal (everyday) dose is for
Why some people need higher basal doses
When and how stress dosing is used — and why it is short term
Why some doctors may hesitate — and how to work safely with them
Where to find trusted patient and clinician resources

Very important first point ❗

Any changes to your hydrocortisone dose must be agreed in advance with a doctor or specialist nurse who knows your adrenal insufficiency.

This includes:

Your usual daily dose
Your stress-dosing (“sick day”) plan
Emergency injection instructions

This guide does not replace medical advice.
It is designed to help you understand your treatment and communicate clearly with healthcare professionals.

1) Your basal (everyday) hydrocortisone dose

What the basal dose is for

Your basal dose is the hydrocortisone you take on an ordinary day, when you are not ill or under unusual stress. Its purpose is to:

Replace the cortisol your body cannot make reliably
Support normal daily function (energy, blood pressure, mood)
Help your body feel stable and safe
Reduce the risk of chronic under-replacement

It is replacement, not treatment for inflammation.

A key point many patients are not told

Being consistently under-replaced does not help adrenal recovery.

Ongoing symptoms such as:

Constant exhaustion
Dizziness or nausea on standing
Brain fog or low mood
Poor tolerance of everyday stress
Frequent “crashes” or infections

can delay recovery, not speed it. Stability supports healing.

What doctors usually mean by a “physiological” dose

Most adults naturally produce the equivalent of about 15–25 mg of hydrocortisone per day.

Doctors aim for a dose in this range and adjust for:

Body size
Activity level
Other medical conditions
Individual response

This is replacement, not “high-dose steroids”.

How basal hydrocortisone is usually taken

To mimic the body’s natural rhythm, doses are often split:

A larger dose in the morning
Smaller doses later in the day
Avoiding late evening doses where possible

This supports:

Energy and blood pressure
Sleep
Mood and concentration

Signs your basal dose may be too low

Tell your doctor if you have persistent:

Severe fatigue despite rest
“Wired but empty” feeling
Dizziness, nausea, or salt craving
Poor concentration or memory
Low mood or anxiety
Frequent need for rescue or stress doses

These symptoms matter even if blood tests look reassuring.

Blood tests are only part of the picture

Cortisol and ACTH tests:

Help with diagnosis
Are less helpful for adjusting daily dose
Do not always reflect how well you function

Doctors experienced with adrenal insufficiency rely heavily on how you feel and cope day to day.

The right balance

Rather than “as low as possible,” a safer aim is:

Low enough to avoid overtreatment, but high enough to live a stable, functional life.

Living in constant deficit is not success.

2) When a higher basal dose may be appropriate

Some people with adrenal insufficiency — particularly those with chronic illness — may genuinely need a higher basal hydrocortisone dose (for example 25–30 mg/day).

This does not automatically mean overtreatment.

Well-recognised examples include:

Chronic inflammatory lung disease (including ABPA)

Ongoing airway inflammation and immune activation
Recurrent infective or inflammatory flares
The body may never be in a true “resting” state
Standard doses may leave patients under-replaced
A stable higher dose can reduce repeated stress dosing and improve daily function

Frequent infections or slow recovery

Repeated illness or prolonged recovery
Frequent “temporary” stress dosing just to cope with everyday life

Long-standing steroid-induced adrenal insufficiency

Years of prednisolone or similar treatment
Deep suppression of the adrenal system

Larger body size or higher metabolic demand

Cortisol needs vary with body size and activity

Autonomic symptoms or low blood pressure

Postural dizziness or faintness
Often benefit from a higher morning dose

Clinical clue:
If someone repeatedly needs stress dosing just to manage ordinary days, their basal dose may be too low for their current physiology.

Important reassurance

Higher basal doses can be appropriate, temporary, or longer-term
They do not automatically prevent recovery
Ongoing inflammation and repeated physiological stress suppress recovery more than adequate replacement
Doses should always be prescribed, documented, and reviewed

3) Stress dosing — when your body temporarily needs more

What stress dosing means

A healthy body automatically makes more cortisol during:

Illness or infection
Fever
Vomiting or diarrhoea
Injury or trauma
Severe pain
Surgery or medical procedures
Major physical stress

If you have adrenal insufficiency:
➡️ your body cannot do this, so doctors prescribe stress dosing in advance as part of your safety plan.

Stress dosing is essential — but it is short term

Stress dosing is meant to last only as long as the stress lasts.

It covers a temporary increase in need, not your everyday requirements.

What “short term” usually means

Stress dosing may last:

24–48 hours for minor illness or fever
Several days for infections or recovery from injury
During and immediately after surgery or procedures

Your doctor should advise:

When to increase
How much to increase
When and how to return to your usual dose

Why stress dosing should not continue indefinitely

If higher doses are needed for longer, something usually needs review:

Infection or inflammation has not settled
The basal dose may be too low
Another medical problem is present

If stress dosing is still needed after the original stress has passed, it’s time to talk to your doctor.

Stepping back down safely

Doctors usually advise returning to baseline
Sometimes a 1–2 day step-down is used
You should not remain on stress doses “just in case”

Stress dosing does NOT:

Stop adrenal recovery
Mean you are “failing”
Cause long-term harm when used correctly

Not stress dosing can:

Make you seriously unwell
Delay recovery
Lead to adrenal crisis

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https://www.endocrinology.org/media/3705/nhs-steroid-card-front.jpg?format=webp&quality=20&width=700

4) Why some doctors seem hesitant

Doctors outside endocrinology (GPs, A&E, ward teams):

Are trained to minimise steroid use
Often think of steroids only as anti-inflammatory drugs
May rarely manage adrenal insufficiency

What they may not realise immediately:

Your hydrocortisone is replacing a missing hormone — it is essential, not extra.

5) How to advocate safely (with medical backing)

It is appropriate to say:

“I have adrenal insufficiency. My doctor has advised stress dosing during illness to prevent adrenal crisis.”

If you have them, show:

Your Steroid Emergency Card
A written stress-dosing plan
A clinic letter or summary

6) Trusted resources & further support (with links)

The following organisations provide reliable, clinician-endorsed information on adrenal insufficiency, hydrocortisone replacement, stress dosing, and emergency care.
They are widely recognised by NHS endocrinology teams and safe to share with patients, families, and healthcare professionals.

UK patient and professional resources

Addison’s Disease Self-Help Group (ADSHG)
Website: https://www.addisonsdisease.org.uk

What it offers:

Clear explanations of basal vs stress dosing
Patient-friendly sick-day rules
Emergency hydrocortisone injection guidance
Downloadable patient leaflets used in NHS clinics
Webinars, helpline, and peer support

Why it’s useful:
ADSHG explicitly supports individualised dosing and crisis prevention.

Society for Endocrinology
Steroid Emergency Card & adrenal crisis guidance:
https://www.endocrinology.org/clinical-practice/steroid-emergency-card/

Why it’s useful:

Highly trusted by doctors, A&E, and ward teams
Clear professional wording that reassures non-specialists
Supports rapid decision-making in emergencies

NHS (England)
Steroid Emergency Card information:
https://www.nhs.uk/conditions/steroid-emergency-card/

Why it’s useful:

Official NHS backing
Useful for legitimacy in emergency or inpatient settings

International patient resources (useful supplements)

Endocrine Society
Patient information on adrenal insufficiency:
https://www.endocrine.org/patient-engagement/endocrine-library/adrenal-insufficiency

Why it’s useful:

Clear explanations of cortisol physiology
Conservative, authoritative tone
Helpful for patients seeking international consensus

National Adrenal Diseases Foundation (NADF)
Website: https://www.nadf.us

What it offers:

Practical sick-day rules
Emergency preparedness guidance
Injection training resources

Particularly helpful for patients with long-standing adrenal insufficiency or frequent illness.

Resources especially relevant for ABPA & chronic lung disease

National Aspergillosis Centre
Website: https://mft.nhs.uk/wythenshawe/services/infectious-diseases/national-aspergillosis-centre/

Why it’s relevant:

Specialist centre where ABPA and adrenal insufficiency often overlap
Supports personalised care plans in complex disease

Aspergillosis Trust
Website: https://www.aspergillosistrust.org

Why it’s useful:

Patient-focused education and advocacy
Helps explain the chronic physiological stress of ABPA
Supports conversations about higher basal hydrocortisone needs

Quick-access patient checklist (phone / wallet)

Patients are encouraged to keep:

Steroid Emergency Card
Sick-day rules (ADSHG)
Personal stress-dosing plan (agreed with doctor)
Clinic letter or summary

Many patients keep photos of these documents on their phone for emergencies.

Final reassurance

These resources support — not replace — medical advice.
They exist to help patients stay safe, informed, and confident when managing hydrocortisone and communicating with healthcare professionals.

by GAtherton

Season’s Greeting

As the year draws to a close, we would like to send warm wishes to everyone in the aspergillosis community — patients, families, carers, clinicians, nurses, scientists, and all professionals working to improve care and understanding.

Living with aspergillosis, or supporting those who do, often requires resilience, patience, and compassion. Throughout this year, we have seen remarkable strength from patients, dedication from healthcare teams, and generosity of spirit across our wider community.

At this time of reflection and renewal — whether you mark Christmas, another festival, or simply the turning of the year — we hope you find moments of rest, comfort, and connection. May the days ahead bring steadier health where possible, renewed energy, and continued progress in care, research, and support.
Thank you for being part of this community.

With warmest wishes for peace, kindness, and hope — now and into the New Year.

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

⭐ 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