Considering Complementary or Alternative Therapies? Here's What You Need to Know

Outside of intensive care units, aspergillosis is usually a chronic disease that is lifelong. It can be difficult to keep a consistent quality of life while being treated for Chronic Pulmonary Aspergillosis (CPA) or Allergic Bronchopulmonary Aspergillosis (ABPA) as the medications used are powerful with potential for causing side effects and interfering with some of your other medications. Understandably, many longer-term patients look for more answers from unconventional complementary or alternative medicine practitioners, so how can we help them do that safely? This article sets out to help:

Introduction. Many people living with chronic illness, pain, fatigue, or breathing issues turn to complementary therapies to feel better, reduce side effects, and support their overall well-being. This guide will help you make safe, informed choices if you're thinking about including complementary approaches alongside your usual medical care.

What Are Complementary Therapies? Complementary therapies are treatments used alongside your usual medical care. They are different from "alternative therapies," which are used instead of conventional medicine. When used correctly, complementary therapies can help improve quality of life, reduce symptoms, and support emotional well-being.

Examples include:

  • Meditation and mindfulness
  • Nutritional therapy
  • Gentle movement (like yoga, tai chi)
  • Acupuncture
  • Massage therapy
  • Herbal supplements

Is There Any Evidence They Work? Some complementary therapies have been studied and show real benefits:

  • Mind-body practices (like breathing exercises, meditation, and CBT) are proven to help with anxiety, breathlessness, and chronic pain.
  • Nutrition and anti-inflammatory diets (like the Mediterranean diet) support overall health and reduce inflammation.
  • Acupuncture may help some people with pain, nausea, or fatigue.
  • Certain supplements (like vitamin D, magnesium, and omega-3s) are helpful if you have a deficiency.

Not all therapies have strong evidence. Some can be expensive or unnecessary. It's important to talk to your healthcare team and do your research.

How to Use Complementary Therapies Safely

  1. Always tell your doctor or nurse about any therapies, supplements, or herbal products you're using.
  2. Don’t stop prescribed treatments unless your doctor agrees.
  3. Choose qualified practitioners who are registered with a professional body (like CNHC, BAcC, or HCPC).
  4. Start slowly and track your symptoms.
  5. Use trusted sources for health information (NHS, hospital websites, academic studies).

Questions to Ask Before Trying a New Therapy

  • What are you hoping this therapy will help with?
  • Is there scientific evidence to support it?
  • What are the risks or side effects?
  • Is the practitioner qualified and insured?
  • Could it interfere with my medications or condition?

Examples of Safe and Evidence-Based Complementary Therapies

Goal Therapy Evidence Level
Reduce anxiety or breathlessness Mindfulness, breathing physio Strong
Support joint and muscle pain Tai chi, massage, acupuncture Moderate
Improve energy and wellbeing Nutrition support, yoga Moderate to strong
Manage inflammation Anti-inflammatory diet, omega-3s Strong


Considering Alternative Therapies? What You Should Know

Alternative therapies are treatments that are used instead of conventional medical care. Some people turn to them out of frustration, fear of side effects, or belief in more “natural” healing methods.

While some approaches may seem appealing, it's important to understand the risks, limitations, and lack of regulation that often surround alternative therapies.

What Counts as an Alternative Therapy? Common examples include:

  • Using only herbal remedies or detoxes instead of prescribed medications
  • Rejecting chemotherapy or antibiotics for serious illness
  • Relying on homeopathy for infections or chronic disease
  • Unregulated “energy healing” or “cleanses” with no scientific backing

Risks of Using Alternative Therapies Instead Of Medical Care

Risk Why It Matters
Delayed treatment Can allow serious conditions to worsen (e.g., cancer, infection, asthma flare)
Interactions with meds Herbs and supplements can interfere with prescription drugs
False claims Some therapies promise cures with no proof, wasting time and money
Unregulated practitioners No licensing means anyone can offer therapy with no safety checks

What Does the Evidence Say?

  • Homeopathy: Consistently shown to perform no better than placebo in high-quality studies.
  • “Detox” treatments: Most are not evidence-based; your liver and kidneys already detox your body.
  • Raw food or extreme diets: Can lead to malnutrition or worsen chronic illness.
  • Anti-vaccine or anti-medical ideologies: Can be harmful and undermine public health.

Some alternative therapies have spiritual or emotional value, but they should not replace evidence-based treatment for serious health conditions.

Why Do Alternative Practitioners Offer These Treatments? Not all alternative practitioners are motivated by money. Many genuinely believe in the value of their approach, often drawing on personal experiences or longstanding traditions. Their justifications may include:

  • A belief in the body's natural ability to heal itself
  • Disappointment with conventional medicine's limits
  • Cultural or spiritual views of illness and healing
  • A desire to offer more time, empathy, or individualised care

That said, it’s also true that some providers operate in unregulated markets and may promote costly or unproven treatments. Patients should stay informed, ask critical questions, and seek practitioners who work ethically and transparently.

Safer Ways to Explore Holistic Health If you’re drawn to alternative ideas because you want:

  • Fewer medications
  • More control
  • A natural approach
  • Better quality of life

Talk to your doctor or nurse about complementary options that are safe, evidence-based, and compatible with your condition.

Final Thoughts Complementary therapies can be a valuable part of your health journey when used wisely. They are not a replacement for medical treatment, but they can complement it beautifully. Stay informed, ask questions, and work with your healthcare team to find what works best for you.

Want to know more? Talk to your GP, specialist nurse, or physiotherapist about safe ways to explore complementary care. They may also be able to refer you to trusted practitioners.
Read NHS Complementary and Alternative Medicine

by GAtherton

Understanding Drug Interactions with Antifungal Medications

Information for patients and carers receiving treatment for aspergillosis

Why drug interactions matter

Many antifungal medications used to treat aspergillosis can affect — or be affected by — other medicines you may be taking. These drug interactions can change how well a medication works, increase side effects, or cause unexpected reactions.

Knowing what to watch for and sharing your full medication list with your healthcare team can help keep you safe.

Antifungal medicines that interact with other drugs

Common antifungals:

  • Voriconazole
  • Posaconazole
  • Itraconazole
  • Isavuconazole

These drugs are processed through the liver and can interfere with enzymes (like CYP3A4) that control how other medications are broken down.

Examples of drugs that may interact

Heart medications

  • Statins (e.g. simvastatin) — can build up and cause muscle damage
  • Calcium channel blockers (e.g. amlodipine) — may cause low blood pressure
  • Warfarin and other anticoagulants — may require closer INR monitoring

Mental health medications

  • SSRIs (e.g. sertraline, fluoxetine) — can increase side effects
  • Benzodiazepines (e.g. diazepam) — may be stronger or last longer

Steroids

  • Prednisolone — levels may increase with antifungals, increasing risk of side effects

Immunosuppressants

  • Tacrolimus, cyclosporine — antifungals can raise their levels significantly

Other

  • Oral contraceptives — effectiveness may be reduced (use backup contraception)
  • Some diabetes medications — risk of low or high blood sugar
  • Antacids or proton pump inhibitors — can reduce absorption of antifungals

What you can do

  • Make sure your drug list is kept up to date and brought to every clinic visit or hospital appointment
  • You can ask your pharmacist or look up your medicines in the British National Formulary (BNF) or NHS Medicines A-Z to find out more about possible interactions. The Fungal Infection Trust also maintains a list specifically for antifungal medication
  • Always give your care team a full, up-to-date medication list, including over-the-counter medicines, supplements, and herbal remedies
  • Don’t stop or start any medicines without checking first
  • Let your GP and pharmacist know you're taking antifungal treatment
  • Ask your team if your medication needs to be monitored more closely (e.g. blood levels)

Signs of a potential drug interaction

  • Unexplained dizziness, fainting, or fast heart rate
  • New or worsening side effects
  • Signs of toxicity (nausea, confusion, muscle pain, tremors)
  • Bleeding or bruising more easily

If you notice anything unusual, contact your healthcare team or pharmacist.

by GAtherton

When to Speak Up About Side Effects

For patients and carers managing aspergillosis treatment

Why this matters

Treatment for aspergillosis is often long-term and involves medications that can affect people in different ways. It's important to know that you don’t have to suffer in silence. Recognising side effects early and reporting them can help you stay well and improve your quality of life.

Medications commonly used in aspergillosis

Antifungals
Voriconazole, Posaconazole, Itraconazole, Isavuconazole

Steroids
Prednisolone (oral), Inhaled corticosteroids

Biologic therapies
Omalizumab (anti-IgE), Mepolizumab/Benralizumab (anti-IL-5), Dupilumab (anti-IL-4/IL-13)

What to watch for

Note: These side effects range from common to rare. Most people do not experience all of them, but it's important to be aware of what might occur. If you’re unsure whether a symptom is related to your medication, always ask.

Cardiac side effects (uncommon to rare, but important to report)

  • Palpitations (racing or irregular heartbeat)
  • Dizziness or fainting
  • Swelling in the legs or ankles
  • Chest pain or tightness
  • Changes in blood pressure or heart rhythm (QT prolongation) (can occur with antifungals or steroids)
  • Palpitations (racing or irregular heartbeat)
  • Dizziness or fainting
  • Swelling in the legs or ankles
  • Chest pain or tightness
  • Changes in blood pressure or heart rhythm (QT prolongation)

Let your healthcare team know if you have a history of heart conditions, or experience any of these symptoms during treatment.

Antifungal side effects (common to occasional)

  • Skin rash, burning, or sun sensitivity, even indoors (through windows or from reflected light)
  • Visual changes (blurred vision, colour distortion, photophobia)
  • Liver enzyme abnormalities (can show up on blood tests)
  • Nausea, abdominal discomfort, or taste changes
  • Hallucinations, anxiety, or confusion (rare but serious — seek help immediately)

Steroid side effects (common with long-term use)

  • Mood swings, anxiety, or irritability
  • Insomnia or restlessness
  • Increased appetite or weight gain
  • High blood sugar, especially if diabetic
  • Bone thinning (osteoporosis) over time
  • Skin thinning, easy bruising, or delayed healing
  • Eye pressure/glaucoma or cataracts (with long-term use)

Biologic side effects (generally well-tolerated; uncommon side effects listed below)

  • Localised reactions at the injection site (pain, swelling, redness)
  • Headache, fatigue, or low-grade fever
  • Worsening eye symptoms, especially with dupilumab (e.g. dry eyes, redness)
  • Rare: allergic reactions or increased infection risk (let your team know if you’re feeling unwell after a dose)

When to get in touch

You should contact your care team if:

  • A side effect is persistent, worsening, or interfering with your daily life
  • You notice any mental health changes (anxiety, low mood, agitation)
  • You feel dizzy, unwell, or unable to tolerate food or fluids
  • There are signs of infection (e.g. fever, cough, chills, pain)
  • You are unsure whether what you’re feeling is a side effect or something else

You're not being a nuisance

Asking questions or raising concerns is part of staying safe. Medications can usually be adjusted, paused, or switched — but your team needs to know how you’re feeling to make those decisions. You are an expert in your own experience.

Tip: Keep a side effect diary

  • Note any changes in sleep, mood, appetite, skin, or digestion
  • Bring this with you to appointments
  • If helpful, ask a family member or friend to help observe changes

by GAtherton

Voriconazole and Sun Sensitivity

People taking voriconazole need to be very cautious in the sun because this antifungal can cause photosensitivity reactions—meaning the skin becomes more sensitive to sunlight, even through glass or on cloudy days. This can lead to severe sunburn, skin blistering, and long-term damage, including premalignant and malignant skin changes (like squamous cell carcinoma), especially with prolonged use.

Here’s what people on voriconazole should do to protect themselves:

☀️ Sun Safety Tips for Voriconazole Users

  1. Avoid direct and reflected sunlight:

    • Try to stay indoors between 10 a.m. and 4 p.m., when UV rays are strongest.

    • Choose shaded routes or walk on the shady side of the street.

    • Avoid indirect or reflected sunlight (e.g. off windows, water, sand, snow)

  2. Wear protective clothing:

    • Long-sleeved tops, trousers, and wide-brimmed hats are essential.

    • Consider UV-protective clothing (many brands offer this specifically).

    • Use UV-protective sunglasses to shield your eyes.

  3. Use high-factor sunscreen:

    • Broad-spectrum SPF 50+ sunscreen is best.

    • Apply generously to all exposed skin, including hands, ears, and neck.

    • Reapply every 2 hours, and after sweating or washing.

  4. Avoid sunbeds and tanning lamps:

    • Artificial UV exposure can also cause damage.

  5. Check windows:

    • UV-A rays can penetrate glass, so use UV-filtering films on car and home windows if needed.

  6. Regular skin checks:

    • Long-term voriconazole use has been linked to skin cancer, especially in immunocompromised individuals.

    • See a dermatologist regularly, and report any new or changing skin lesions.

⚠️ Signs of Photosensitivity to Watch For:

  • Red, itchy, or painful rash in sun-exposed areas

  • Skin blistering or peeling

  • New moles or spots, or changes to existing ones

If you're on long-term voriconazole and sun exposure is unavoidable, it might be worth discussing alternative antifungal treatments with your doctor, especially if skin damage begins to occur.

Here’s a mix of recommended sunscreens and UV-protective gear that people on voriconazole (especially those with prolonged use or immunosuppression) often find effective. These are high-protection, broad-spectrum, and suitable for sensitive or compromised skin.

🧴 Top Sunscreens for Voriconazole Users

🇬🇧 Available in the UK

  1. La Roche-Posay Anthelios UVMune 400 Invisible Fluid SPF 50+

    • Extremely high UVA/UVB protection.

    • Lightweight, non-greasy, great for sensitive skin.

    • Popular among transplant and cancer patients for sun protection.

  2. Altruist Dermatologist Sunscreen SPF 50/50+

    • Developed by a UK dermatologist.

    • Broad-spectrum, affordable, fragrance-free.

    • Available in bulk (good for daily use on large areas).

  3. Ultrasun Extreme SPF 50+

    • Long-lasting protection, water-resistant.

    • Ideal for extreme sun sensitivity.

    • One application can last several hours if you’re not sweating heavily.

  4. Eucerin Sun Fluid Pigment Control SPF 50+

    • High UVA/UVB and HEVIS (visible light) protection.

    • Helps prevent hyperpigmentation from sun damage.

  5. Heliocare 360° Mineral Tolerance Fluid SPF 50+

    • 100% mineral filters (ideal for highly sensitive or reactive skin).

    • Broad-spectrum including infrared and visible light.

    • Often recommended by dermatologists for patients with photosensitive conditions.

👕 UV-Protective Clothing

Look for clothes labelled UPF 50+ (Ultraviolet Protection Factor), which blocks 98% of UV rays. Here are some trusted brands:

🇬🇧 Available in the UK or for international shipping:

  1. Solbari (Australia/UK)

    • Offers UPF 50+ certified clothing, including hats, long-sleeve tops, trousers, and gloves.

    • Specifically designed for people with photosensitivity and skin cancer risks.

  2. Coolibar (US-based, ships to UK)

    • One of the gold-standard brands for UV-protective clothing.

    • Comfortable, stylish, and medically recommended for sun-sensitive conditions.

  3. Uniqlo Airism Long Sleeve Tops

    • While not marketed as UV-protective, many of their Airism or UV-cut ranges have built-in UV filters.

    • Great for layering or casual use.

  4. Decathlon UV Protection Range

    • Affordable UPF clothing, especially good for outdoor walking and travel.

    • Includes UV-protective hats, neck gaiters, and swimwear.

🕶️ UV-Protective Sunglasses

Make sure they:

  • Are labelled UV400 or 100% UVA & UVB protection

  • Preferably have wraparound lenses to protect the sides

  • Brands: Ray-Ban, Oakley, M&S UV-protection glasses, or Fitovers if you already wear prescription glasses.

by GAtherton

What drugs are being developed to reduce steroid intake

New drugs and strategies are being developed or repurposed to reduce or even eliminate the need for steroids in diseases like ABPA, where inflammation is driven by an allergic immune response to Aspergillus.

Here’s a breakdown of what’s already available and what’s on the horizon:

🧬 Biologics – the biggest game-changer

These are antibody-based therapies that target specific immune pathways, rather than suppressing the whole immune system like steroids do.

✅ Already used off-label or in trials for ABPA:

1. Omalizumab (Xolair)

  • Targets IgE (the allergy antibody that’s sky-high in ABPA)

  • Already licensed for severe allergic asthma

  • Studies show it reduces exacerbations, improves lung function, and helps taper off steroids

  • Limitations: expensive, dosing based on IgE levels and weight (difficult in patients with very high IgE)

2. Mepolizumab (Nucala)

  • Targets IL-5, which drives eosinophil activity

  • Approved for eosinophilic asthma

  • Used in some ABPA patients, especially when eosinophils remain high

  • Can help reduce steroid use and fungal exacerbations

3. Benralizumab (Fasenra)

  • Also targets IL-5 receptor – causes direct depletion of eosinophils

  • Similar benefits to mepolizumab but may act faster

  • Small studies and case reports show promise in ABPA and chronic pulmonary aspergillosis with eosinophilia

4. Dupilumab (Dupixent)

  • Blocks IL-4 and IL-13, key drivers of Th2 inflammation

  • Approved for asthma, atopic dermatitis, and nasal polyps

  • Early evidence suggests it may benefit ABPA patients, especially those with co-existing nasal polyps or eczema

  • Could be ideal for steroid-sparing in allergic fungal disease

💊 Antifungals as steroid-sparing agents

Already in use, but still being optimized:

  • Itraconazole

  • Voriconazole

  • Posaconazole

  • Isavuconazole (being explored more recently, better tolerated in some patients)

These reduce fungal burden, which helps turn down the immune overreaction—letting steroids be tapered or even avoided in some patients.

🔬 In Development or Under Investigation

🧪 Tezepelumab

  • Blocks TSLP (thymic stromal lymphopoietin) – an early signal in allergic inflammation

  • In trials for severe asthma

  • May be helpful in ABPA down the line – trials are ongoing

🧪 Anti-IL-33 and Anti-ST2 therapies

  • IL-33 is another "alarmin" involved in allergic responses

  • Still in early stages, but being watched closely for steroid-sparing potential in allergic lung diseases

🌍 Other Strategies Being Studied

  • Inhaled antifungals (e.g., inhaled voriconazole or amphotericin B) – may reduce systemic side effects

  • Vaccines against Aspergillus – still early stage

  • Mucolytics and anti-inflammatory antibiotics (e.g., azithromycin) as steroid-sparing support in some patients

🤔 What You Can Do Now

  • If you’re struggling with steroid side effects or dependency, it’s totally reasonable to ask your respiratory team:

    • “Am I a candidate for a biologic like omalizumab or mepolizumab?”

    • “Is my antifungal therapy optimized?”

    • “Would a switch to inhaled or combination therapy help reduce my steroid use?”

by GAtherton

Swimming for people with aspergillosis

How could you advise someone with aspergillosis who wants to swim but finds the local pool triggers their asthma?

Great question — and can be really important for quality of life. For someone with aspergillosis (especially ABPA or CPA) and asthma that worsens in chlorinated pools, here’s a tailored guide that balances safety with enjoyment:

🏊‍♀️ Swimming with Aspergillosis + Chlorine Sensitivity: A Practical Guide

💡 1. Choose the Right Pool Environment

Goal: Minimise chloramine exposure (which irritates airways).

✅ Best options:

  • Ozone- or UV-treated pools: These significantly reduce chloramine levels.

  • Saltwater pools: Gentler, although still chlorinated (just less harsh).

  • Natural pools or lidos: Often free from chlorine, especially in outdoor settings.

  • Seawater swimming: The ultimate in chlorine-free options if you're near the coast and it's safe.

🚫 Avoid:

  • Indoor pools with poor ventilation

  • Pools that "smell strongly of chlorine" — this usually means high chloramines

🕗 2. Swim at Low-Traffic Times

  • Early morning swims are ideal — before other swimmers add organic matter (sweat, sunscreen, etc.), which reacts with chlorine to form irritants.

  • Ask the pool when they clean/shock it — swimming after that is usually better.

🧤 3. Protect Your Airways

  • Use a nose clip to avoid inhaling water vapor directly through the nasal passages.

  • Consider wearing a light face mask (e.g., FFP2) on the poolside until just before entering, to avoid breathing chloramines in enclosed spaces.

  • Ventolin (salbutamol) or another rescue inhaler should always be close by — even poolside if staff are aware.

💊 4. Pre-medicate if Needed

With your doctor’s advice, consider:

  • Short-acting bronchodilator 15–30 mins before swimming (e.g., salbutamol)

  • Leukotriene receptor antagonists (like montelukast) for added airway protection

  • Nasal rinses or corticosteroid sprays post-swim if you’re prone to sinus issues

🚿 5. Shower Immediately After

To reduce any skin or airway irritation:

  • Warm shower straight after

  • Nasal rinse or saline spray

  • Clean/dry clothes quickly to avoid damp mold exposure

🏞️ 6. Explore Alternative Swimming Options

  • Outdoor pools or lidos

  • Swimming lakes or sea-based pools (like Bude Sea Pool)

  • Private or spa pools with alternative sanitisation systems

  • Aquatherapy centres: Often use lower chemical levels and may cater to sensitive lungs

💬 7. Talk to Pool Staff

Many pools are willing to help. Try:

“I have a medical lung condition that reacts to chloramines — can you tell me when chlorination is lowest or if you use UV systems?”

You might be surprised how supportive they are.

by GAtherton

Help Us Explore a New Treatment for Chronic Pulmonary Aspergillosis (CPA)

We’re Recruiting for a Clinical Trial of Interferon-Gamma (IFNγ)

We’re looking for people with chronic pulmonary aspergillosis (CPA) to take part in an exciting clinical trial testing a new treatment approach using interferon-gamma (IFNγ) — a substance that could help the immune system fight the Aspergillus infection more effectively.

What is CPA?

CPA is a long-term lung infection caused by the fungus Aspergillus. It usually affects people with chronic lung diseases like COPD or those who’ve had tuberculosis (TB) in the past. Over time, CPA can cause:

  • Enlarging cavities in the lungs

  • Recurrent chest infections

  • Persistent coughing and fatigue

  • Worsening breathlessness and reduced quality of life

It’s a progressive condition and can be hard to diagnose early. Around 3,600 people are living with CPA in the UK. Without effective treatment, CPA can be life-limiting — up to 4 in 10 people may die within five years of diagnosis.

Current Treatment Challenges

Treatment typically involves long-term antifungal medication, but:

  • Only about 60% of patients improve

  • Treatment can be lifelong, with relapses common

  • There is only one class of oral antifungals available

  • Side effects and high costs are frequent problems

This is why we urgently need better treatment options.

Why Interferon-Gamma?

Our research suggests that many CPA patients may have a weakened immune response, particularly a lower production of interferon-gamma (IFNγ) — a natural substance that helps the body fight fungal infections like Aspergillus.

In small studies, giving IFNγ to patients who didn’t respond to antifungals showed fewer lung flares, fewer hospital stays, and better quality of life. It’s already used safely in other NHS treatments — now we want to explore its role in CPA.

What This Trial Involves

We’re running a randomised clinical trial to test IFNγ in CPA. Here’s what to expect:

  • You must be starting antifungal treatment for CPA

  • You’ll be randomly placed in one of two groups:

    • One group receives IFNγ + antifungals for 12 weeks

    • The other group receives antifungals only

  • We’ll monitor:

    • Changes in lung CT scans

    • Quality-of-life scores

    • Any side effects or problems with tolerability

The trial will include 50 participants in total (25 in each group) and is expected to run until August 2026.

Why Your Participation Matters

By joining this study, you’ll help us find out whether IFNγ could:

  • Improve treatment outcomes

  • Shorten the duration of therapy

  • Prevent relapses

  • Potentially benefit others with chronic lung diseases

If successful, this could lead to a larger trial and possibly a new standard treatment for CPA.

Interested in Taking Part?

You may be eligible if you:

  • Have been diagnosed with CPA

  • Are about to start antifungal treatment

  • Are willing to attend follow-up appointments for 12 weeks

👉 Click here for full details and how to take part

by GAtherton

Thinking about joining a clinical trial? What are your concerns?

Running clinical trials are how doctors and researchers improve your treatment and care, and how new forms of diagnosis for aspergillosis are advanced. It is particularly difficult to get volunteers when the number of people affected by a disease is small – and aspergillosis is one of those diseases. If we can’t get enough people in trials then the value of that work is weakened and there can be less chance that a new treatment will be made available, or a new way to diagnose those at risk from aspergillosis might be delayed.

That said, there are many perfectly good reasons why someone may not volunteer, and it is a very personal decision. If trials are not for you for any reason then you must not feel compelled to do so. We recently ran a poll on our Facebook group to try to identify some concerns that people may feel with volunteering. The most frequent were:

  1. I live too far away.
    This is fair enough. Most trials are based in or close to large cities and will ask you to travel to the trial centre regularly. There is no point in joining a trial if that journey is arduous and you would be unlikely to be able to travel at any point.
  2. Worried about side effects.
    Side effects happen when you are taking many medications and may well happen if you are taking a new treatment. However you will have a dedicated member of staff looking after you to remedy any that crop up, and if the worst happens and you cannot tolerate the side effect you can leave the trial with our thanks. You are always in control.
  3. I am worried that I might be asked to stop taking my current medication and be given the placebo.
    Before trials are run in the UK and many other countries they all must be passed by an ethics committee. The rules of ethics are guided by a number of national and international bodies to ensure ethical conduct, patient safety, and scientific validity. Allowing one arm of a trial to leave patients untreated for an infectious disease is generally unethical and unlikely to be approved, particularly if effective treatments are available. In most cases a test drug will be offered with standard treatment and compared with a placebo also with standard treatment. Neither arm will be untreated. NB once a new drug has gone through this phase and been shown to be effective at controlling eg aspergillosis, then it may be offered on its own during the next trial if ethics agree.
  4. I rarely hear about any trial that I might be able to volunteer for.
    Most people will hear about a trial when they are asked to join one by their doctor. Most doctors running a trial will check that you fall within the specific trial criteria before approaching you. This saves time but of course, it can only be successful if you see enough appropriate patients to ask, which is why specialist centres with lots of patients run so many trials. If you do not attend a specialist centre but would like to be assessed to participate in a trial you can ask your doctors or do your own research – click on the link below.

UK Clinical trials for aspergillosis

Thanks for considering taking part in a clinical trial.

by GAtherton

Biologics & ABPA - what are they and what can they do?

Biologic medications (also known as biologics) are a class of drugs derived from living organisms or their cells. These treatments are used for various conditions, especially those involving the immune system, such as autoimmune diseases, cancers, and chronic inflammatory disorders. Here’s a breakdown of biologics:

1. What Are Biologics?

  • Biologics are large, complex molecules made using biotechnology. They can be derived from living organisms such as bacteria, yeast, or animal cells.
  • Unlike traditional medications (chemically synthesized), biologics are produced through genetic engineering or cell culture techniques.

2. Types of Biologic Drugs:

  • Monoclonal Antibodies (mAbs): These are engineered antibodies designed to target specific proteins or cells, such as tumor cells or immune system components. Examples include drugs like adalimumab (Humira) for rheumatoid arthritis and rituximab (Rituxan) for certain cancers.
  • Interferons: Proteins that modify immune system activity. They are used for conditions like multiple sclerosis and hepatitis C.
  • Vaccines: Biologic drugs used to stimulate the immune system to protect against infectious diseases (e.g., the flu vaccine, COVID-19 vaccines).
  • Cell and Gene Therapies: These involve altering genes or using stem cells to treat genetic disorders or cancers. CAR T-cell therapies are an example for cancer treatment.

3. Conditions Treated by Biologics:

  • Autoimmune Disorders: Such as rheumatoid arthritis, Crohn’s disease, and psoriasis.
  • Cancer: Biologics like monoclonal antibodies and immune checkpoint inhibitors target cancer cells.
  • Infections: Some biologics, including vaccines, protect against infections like hepatitis, flu, and COVID-19.
  • Chronic Inflammatory Conditions: Such as asthma and inflammatory bowel disease (IBD).

4. Advantages of Biologics:

  • Targeted Action: Biologics can target specific parts of the immune system or cells involved in disease, leading to more effective treatments with fewer side effects compared to traditional drugs.
  • Personalized Treatments: Some biologics can be customized based on a patient's genetics, improving outcomes for certain conditions.

5. Limitations and Side Effects:

  • Expensive: Biologics tend to be more expensive than traditional medications due to the complex production process.
  • Injection or Infusion: Many biologics are administered through injections or intravenous infusions rather than oral tablets.
  • Immune System Effects: Since biologics modify immune system function, they can increase the risk of infections and other immune-related side effects.

Examples of Biologic Medications:

  • Humira (adalimumab) for autoimmune diseases.
  • Keytruda (pembrolizumab) for cancer treatment.
  • Enbrel (etanercept) for rheumatoid arthritis.

Biologics are reshaping the treatment landscape, particularly in conditions where traditional medications were less effective.

In the case of Allergic Bronchopulmonary Aspergillosis (ABPA), biologic medications are increasingly being explored and used as part of treatment, particularly for patients with more severe or resistant forms of the disease. ABPA is an allergic reaction to the fungus Aspergillus, which can lead to airway inflammation and lung damage. Biologic medications, often aimed at modulating the immune system, help in managing this complex condition, especially when conventional treatments like corticosteroids fail to control symptoms or lead to significant side effects.

How Biologics Help in ABPA Treatment:

  1. Targeting Immune System Pathways:
    • Biologics used in ABPA primarily work by targeting specific immune system pathways that drive the inflammatory response triggered by the Aspergillus fungus.
    • For example, biologics that target interleukin-5 (IL-5), such as mepolizumab (Nucala), can help reduce eosinophil levels, a type of white blood cell involved in allergic reactions and inflammation in ABPA. Dupixent, another biologic, targets IL-4 and IL-13, which are cytokines involved in the inflammatory cascade in ABPA, potentially improving lung function and reducing exacerbations .
    • Omalizumab (Xolair) acts directly on the patients IgE antibodies, preventing them triggering allergic inflammation
  2. Reducing Steroids - For ABPA patients who require long-term corticosteroid use, biologics may offer an alternative, reducing dependence on steroids and lowering the risk of long-term steroid side effects (e.g., osteoporosis, diabetes, and weight gain).
    • Biologics can provide a more targeted approach, addressing the underlying immune mechanism, rather than just suppressing the overall immune response with steroids .
  3. Clinical Evidence:
    • In trials, biologics like mepolizumab have shown improvements in asthma control and reduced exacerbations, suggesting potential benefits for ABPA patients with significant asthma components.
    • Dupilumab has also demonstrated potential benefits in patients with ABPA and associated asthma, showing improvements in lung function and reduction in eosinophil levels, thus addressing both the underlying inflammation and allergic reactions .
  4. Safety and Efficacy:
    • While biologics are typically used in cases where standard treatments (steroids, antifungals) are not sufficient or appropriate. These medications are generally well-tolerated, but they do carry risks, such as increased susceptibility to infections due to immune system modulation** .

Summary:

Biologic therapies represent an option for patients with ABPA, particularly those with severe symptoms or who struggle with long-term steroid use. By targeting specific immune pathways, biologics help reduce inflammation and improve lung function without the broad immunosuppression of steroids. Drugs like mepolizumab and dupilumab are showing encouraging results, though their use in ABPA is still being refined and evaluated in clinical trials.

If you're exploring biologics for ABPA treatment, consulting with a specialist in pulmonary or immunologic disorders is crucial, as the benefits and risks of these drugs need to be carefully balanced for each individual patient.

**One common concern is whether these treatments could increase susceptibility to viral infections, particularly respiratory viruses.

Immune Modulation and Viral Infections: Omalizumab (Anti-IgE): Omalizumab reduces IgE levels, which are primarily involved in allergic reactions, not antiviral immunity. Studies show that it may actually decrease the frequency of respiratory viral infections by reducing inflammation and preventing exacerbations triggered by viruses. In clinical trials, omalizumab was not associated with increased viral infection rates and has been shown to lower asthma exacerbations caused by viral infections.

Mepolizumab and Benralizumab (Anti-IL-5): These biologics target IL-5, which reduces eosinophil counts. Eosinophils play a minor role in viral defense, but their reduction does not seem to impair the body's ability to fight viruses significantly. Data suggest that mepolizumab and benralizumab do not increase the incidence of viral infections and can reduce asthma exacerbations, including those triggered by viruses.

Dupilumab (Anti-IL-4/IL-13): Dupilumab inhibits IL-4 and IL-13 signaling, key cytokines in allergic inflammation. It is not associated with increased viral infection susceptibility in clinical trials. It may enhance antiviral defenses by reducing Th2-skewed inflammation, potentially allowing the body to mount a better response to viruses.

Evidence from Studies: Studies have consistently shown that biologics can reduce asthma exacerbations, many of which are triggered by viral infections, suggesting they do not compromise the immune system's ability to fight viruses. No significant increase in viral infections has been observed in large clinical trials for these medications, and they are generally considered safe in this context.

Conclusion: Biologic medications for asthma do not appear to increase vulnerability to viral infections. In fact, they may reduce the risk of virus-induced asthma exacerbations by controlling airway inflammation. However, patients with severe asthma or comorbid conditions should always consult their healthcare provider regarding potential risks.

by GAtherton

Olorofim - a promising new antifungal candidate for aspergillosis treatment.

Olorofim represents a significant advancement in treating aspergillosis, particularly for patients who cannot tolerate or do not respond to existing antifungal therapies. Here’s why it’s important:

1. Novel Mechanism of Action

  • Olorofim is the first antifungal in a new class called orotomides. It inhibits dihydroorotate dehydrogenase, an enzyme essential for fungal pyrimidine biosynthesis.
  • This mechanism is entirely distinct from existing antifungal classes (azoles, polyenes, and echinocandins), making it effective against strains resistant to current treatments​

2. Broad Spectrum and Potency

  • It has demonstrated activity against azole-resistant Aspergillus species and other difficult-to-treat moulds, addressing a major gap in antifungal therapy​

  • This includes rare and often lethal fungal infections like Scedosporium, Lomentospora, and Fusarium, as well as chronic conditions like Chronic Pulmonary Aspergillosis (CPA) and invasive aspergillosis.

3. Oral Administration

  • Unlike many current treatments that require intravenous administration (e.g., amphotericin B), olorofim is taken orally, improving convenience and accessibility for patients needing long-term therapy.

4. Targeting Unmet Needs

  • Aspergillosis, particularly invasive aspergillosis, has high morbidity and mortality rates, especially in immunocompromised patients (e.g., those with cancer, transplant recipients).
  • Current treatments face challenges like resistance, toxicity, and drug-drug interactions. Olorofim addresses these limitations by offering a safer and more tolerable alternative​

5. Regulatory Recognition

  • The drug has been granted Breakthrough Therapy Designation and Orphan Drug Status by the FDA and EMA, underscoring its potential to meet urgent medical needs​
    pharmaphorum GlobeNewswire

Future Implications

Olorofim's availability for treating Chronic Pulmonary Aspergillosis (CPA) depends on its successful progression through clinical trials and regulatory approval. Here's a summary of its current status and potential timeline:

  1. Current Status:
    • Olorofim is in Phase 3 clinical trials (OASIS trial) for invasive fungal diseases, including invasive aspergillosis, a related but more acute condition than CPA.
    • Although the drug has shown promising results in earlier studies, the FDA recently issued a Complete Response Letter, indicating that additional clinical data is required before it can be approved in the U.S.​​
    • CPA is not explicitly listed as a primary indication in current trials, but success in related aspergillosis treatments could lead to future trials or off-label use for CPA.
  2. Timeline to Approval:
    • If the ongoing Phase 3 trial and additional studies satisfy regulatory agencies, olorofim could receive an approval within 2–3 years for its initial indications (e.g., invasive aspergillosis).
    • For CPA specifically:
      • Additional trials may be needed to confirm efficacy and safety, potentially extending approval timelines by 3–5 years.
      • Off-label use might occur sooner, depending on clinician judgment and availability in regions with less restrictive policies.

Given the high unmet need in CPA and the novelty of olorofim’s mechanism, it is closely watched by both the medical community and regulators. If you're a patient with CPA, keeping in touch with your healthcare provider about ongoing trials and compassionate use programs may help you access new treatments sooner.

by GAtherton