Inhaled Steroids and ABPA: Do They Help or Should They Be Avoided?

Many people living with allergic bronchopulmonary aspergillosis (ABPA) also use inhaled steroid inhalers such as Symbicort, Fostair, Seretide or Clenil. It’s common to feel confused about whether these inhalers help, whether they should be continued, or whether they could cause harm.

This guide explains what inhaled steroids do, what they don’t do, and how they fit into the treatment of ABPA, asthma, and bronchiectasis.

1. Understanding the basics

What are inhaled steroids?

Inhaled corticosteroids (ICS) are medications breathed directly into the lungs to reduce airway inflammation, especially in asthma. Combination inhalers (e.g., Symbicort, Fostair) contain a steroid + a long-acting bronchodilator.

What they don’t do

Inhaled steroids do not treat ABPA itself.
ABPA is caused by an immune over-reaction to Aspergillus in the lungs. This reaction sits too deep in the airways for inhaled steroids to reach, and the inflammation is too strong for inhaled doses to control.

This is why ABPA flares are treated with:

  • Oral steroids, or

  • Biologics, such as mepolizumab, benralizumab, dupilumab or omalizumab.

2. Why inhaled steroids are still useful for many ABPA patients

Although inhaled steroids don’t treat ABPA directly, most people with ABPA also have asthma.
In asthma:

  • the airways are twitchy

  • inflamed

  • narrow easily

  • and respond well to inhaled steroids

If your symptoms include wheeze, chest tightness, breathlessness that varies from day to day, or a good response to your reliever inhaler, there is a strong chance that asthma is part of your condition.

In those cases, inhaled steroids can be very helpful in keeping the asthma component under control.

3. When inhaled steroids may offer little benefit

Some patients with ABPA have:

  • minimal asthma

  • mainly bronchiectasis

  • or are fully controlled on a biologic

In these situations, inhaled steroids might not provide much additional benefit and occasionally can increase the risk of airway infections, especially in people with significant bronchiectasis.

This is why doctors sometimes sound vague: the answer genuinely depends on your individual mix of ABPA, asthma, and bronchiectasis.

4. How biologics change the picture

Biologics used for ABPA and asthma (e.g., benralizumab, mepolizumab, dupilumab) reduce airway inflammation far more effectively than inhaled steroids. Once a patient is stable on a biologic, many specialists will slowly reduce the inhaled steroid dose if asthma symptoms remain well-controlled.

This does not happen quickly — it is done gradually and only if your breathing tests and symptoms stay stable.

5. Why there is no simple “yes” or “no” answer

Doctors often hesitate to give a straight answer because inhaled steroids can be:

  • Essential for asthma

  • Optional for mild asthma

  • Less useful if ABPA is the main issue

  • Potentially overused in some bronchiectasis patients

  • Safely reduced in people doing well on biologics

Your treatment has to sit in the right place on that spectrum.

6. Questions that can help you get a clear answer from your own team

Many patients say they receive vague responses. These direct questions can help:

✔ “Am I using this inhaler for my asthma, or for my ABPA?”

(If it’s for ABPA, that usually signals a misunderstanding.)

✔ “Do you think my asthma is active, and is the dose of inhaled steroid still appropriate?”

This invites your clinician to be specific.

✔ “If I stay stable on my biologic, could we review the inhaled steroid dose in the future?”

This aligns with typical specialist practice.

7. The bottom line

  • Inhaled steroids do not treat ABPA itself.

  • They are helpful if you also have asthma — which many ABPA patients do.

  • They may be less useful if asthma is mild or absent, especially in pure bronchiectasis.

  • When patients stabilise on biologics, inhaled steroid doses are often reviewed and sometimes reduced.

  • The best approach is individual: the right treatment mix varies from patient to patient.

If you’re unsure what role your inhaler is playing, it’s absolutely reasonable to ask your specialist to explain exactly why you’re on it and whether the dose is still right for you.

by GAtherton

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

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

🔥 Why this flu season is different

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

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

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

🛡️ Does the flu vaccine still work?

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

  • ~70–75% effectiveness in children

  • ~30–40% effectiveness in adults

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

⚠️ Why this matters for people with lung conditions

If you have:

  • ABPA (Allergic Bronchopulmonary Aspergillosis)

  • Bronchiectasis

  • Asthma

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

  • pneumonia

  • severe chest infections

  • hospitalisation

  • long recovery times

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

🔺 What you should do now

1. Get vaccinated immediately

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

2. Be extremely cautious in high-risk environments

  • Schools

  • Public transport

  • Healthcare settings

  • Large indoor gatherings

  • Poorly ventilated rooms

3. Use winter protection behaviours

  • Ventilate indoor spaces

  • Consider wearing a mask in crowded indoor areas

  • Wash hands frequently

  • Avoid contact with people who are unwell

4. If you become ill — act fast

For anyone with ABPA, bronchiectasis or asthma:

  • A sudden fever

  • A sharp rise in cough

  • Change in sputum

  • Chest tightness

  • Breathing changes

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

Summary

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

by GAtherton

🌬️ Breathing Easier: Keeping Your Air Clean at Home, Work and When Travelling

People with lung conditions such as aspergillosis, asthma, or bronchiectasis often find their symptoms worsen in certain environments — especially where the air feels dusty, damp, or polluted.
The good news is that there are simple, practical steps you can take to control your surroundings, reduce flare-ups, and make your home a safer, healthier place to breathe.

🏠 At Home

Keep It Dry and Well-Ventilated

  • Tackle damp and leaks early. Mould thrives in moist places — even hidden behind furniture or under wallpaper.

  • Trust your nose. If something smells damp, it probably is. A musty smell means moisture is trapped somewhere — investigate and dry it before mould can grow.

  • Ventilate daily. Open windows when outdoor air is clean, or use extractor fans in kitchens and bathrooms.

  • Prevent moisture spreading. When showering, cooking, or drying laundry, close doors to other rooms so steam and humidity don’t spread through the house.

    • Run the extractor fan during and for at least 15–20 minutes afterwards, or until humidity drops.

    • Short humidity spikes are normal. It’s common for relative humidity (RH) to rise above 60% during cooking, showering, or drying clothes — what matters is that it returns below 60% quickly once fans or windows are open.

    • If condensation lingers or humidity stays high for more than 30–40 minutes, increase ventilation or use a dehumidifier.

  • Use humidity-sensing extractor fans. These switch on automatically when humidity rises and off when it falls.

    • Choose one with a humidistat and timer, vented directly outdoors (not into a loft or wall cavity).

    • Clean the fan cover and check filters every few months.

  • Dry laundry safely. Use a vented or condenser tumble dryer and empty or clean filters and tanks regularly.

    • Avoid drying clothes on radiators unless you’re using a dehumidifier or have good airflow.

  • Monitor humidity. Use a small digital hygrometer to track RH in different rooms.

    • Aim for 40–60% most of the time — this discourages mould and keeps air comfortable.

    • Above 60% for long periods encourages condensation and spores; below 35% can dry and irritate airways.

  • Use the right size dehumidifier.

    • Check the model’s rated room area (m²) or litres per day extraction rate.

    • A compact unit may cope with a small bedroom or bathroom but not a whole flat or open-plan area.

    • Keep doors closed while it’s running for best results, and empty and clean the water tank regularly to prevent bacterial build-up.

Control Dust and Irritants

  • Vacuum regularly with a HEPA-filtered vacuum cleaner.

  • Use microfibre cloths for dusting rather than dry dusters that stir particles into the air.

  • Avoid strongly fragranced cleaning products, candles, incense, and air fresheners — they release fine particles and chemicals that irritate sensitive lungs.

  • Choose low-VOC (low-odour) paints and furnishings when redecorating.

Keep Air Clean

  • If you live near traffic or building work, keep windows closed during busy times and ventilate later.

  • A room air purifier with a true HEPA filter can remove dust, pollen, and fungal spores effectively.

  • Choose the right size for your room.

    • Check the purifier’s Clean Air Delivery Rate (CADR) or maximum room coverage and ensure it matches or slightly exceeds your room size.

    • A small desktop purifier won’t clean a large living room or bedroom effectively.

    • For open-plan or high-ceiling spaces, you may need more than one unit.

  • Maintain it properly:

    • Replace or clean filters exactly as the manufacturer recommends (usually every 6–12 months).

    • Never wash or vacuum a disposable HEPA filter unless the manual allows it.

    • A clogged or undersized filter won’t clean air effectively and may re-release particles.

🌤️ Knowing When the Outside Air Is Clean — and How to Filter It Indoors

1. Check Air Quality Before Ventilating

It isn’t always obvious when outdoor air is safe to bring inside.
Modern air-quality data helps you choose the best times to open windows or run fans.

How to check:

  • Use free apps such as Air Quality Index (AQI) UK, Breezometer, Plume Labs, or AirVisual.

  • Visit DEFRA’s UK Air Information or check BBC Weather → Air Quality.

  • Look for PM2.5 (fine particles) and NO₂ (traffic pollution) levels — these are key irritants for sensitive lungs.

  • “Good” or “Low” readings mean it’s a good time to ventilate or air rooms.

  • Avoid opening windows near busy roads during rush hour or when pollution alerts are issued.

💡 Tip: Air quality is often better early in the morning or late in the evening when traffic and heat are lower.

2. Filter the Air as It Comes In

If you live near roads, building work, or farmland, you can reduce what enters while keeping ventilation safe:

🪟 Window Vent Filters

  • Many modern trickle vents can take fine mesh or electrostatic filters to trap pollen, dust, and spores.

  • Replace or wash filters regularly — clogged filters restrict airflow.

🌀 Filtered Ventilation Systems

  • MVHR systems (Mechanical Ventilation with Heat Recovery) pull in outdoor air, filter it, and expel stale indoor air — great for energy-efficient or damp-prone homes.

    • They help control humidity and filter pollutants.

    • Filters must be cleaned or replaced every few months.

  • Positive Input Ventilation (PIV) systems bring in filtered air gently from a roof or external vent, improving airflow and reducing condensation.

🧺 DIY Improvements

  • Clip-on intake filters can fit over some wall vents or fan inlets.

  • Use a portable HEPA purifier placed near an open window to “clean” incoming air as it circulates.

  • Keep window ledges, vent grilles, and trickle vents dust-free — they collect spores over time.

3. Balance Fresh Air and Safety

It’s important not to seal up a home completely — stale, humid air encourages mould.
The goal is controlled ventilation:

  • Ventilate when outdoor air is cleanest and driest.

  • Keep extractor fans running during steamy activities.

  • When outdoor air quality is poor, use purifiers and dehumidifiers indoors until it improves.

4. Low-Cost Monitoring at Home

You can buy small indoor/outdoor air-quality monitors that track PM2.5, temperature, and humidity.
These help you:

  • Spot pollution drifting indoors (from traffic, wood smoke, etc.).

  • Choose the best times to ventilate.

  • See how quickly humidity or particles fall after cooking or cleaning.

🌱 Summary

What to Do Why It Helps
Check local air-quality apps before opening windows Avoids letting polluted air inside
Ventilate during low-pollution hours Brings in cleaner, fresher air
Fit filters to vents or use MVHR/PIV systems Reduces dust and spores from incoming air
Clean vents, trickle filters, and window frames regularly Prevents build-up of trapped dust
Use a portable HEPA purifier near open windows Cleans incoming air in real time

🧽 Dealing with Mould and Dust Safely

Even in well-kept homes, mould and dust can build up in damp weather or hidden corners. If you see black or green patches, or notice a musty smell, act promptly — but take care to protect your lungs.

⚠️ Before You Start

  • Protect yourself: wear a well-fitted FFP2 or N95 mask, gloves, and, if possible, eye protection.

  • Avoid dry brushing or vacuuming visible mould — this can spread spores into the air.

  • Keep the area well ventilated but close doors to other rooms so spores don’t travel.

  • If the mould covers more than 1 square metre, keeps returning, or is linked to a leak, ask your landlord or council for professional help.

🧴 Cleaning Small Areas of Mould

  1. Wipe gently — don’t scrape.
    Use disposable cloths or ones you can boil-wash later. Avoid wire brushes.

  2. Use mild cleaning solutions:

    • Mix a few drops of washing-up liquid in warm water, or

    • Use a dilute bleach solution (1 part thin bleach to 9 parts water) on tiles or uPVC — ventilate well and never mix bleach with other cleaners, or

    • Try a specialist anti-fungal cleaner for painted or porous surfaces.

  3. Dry the area thoroughly.
    Use ventilation or a dehumidifier; mould will return if the surface stays damp.

  4. Dispose of cloths and gloves in a sealed bag. Wash hands well afterwards.

🧹 Managing Dust and Allergens

  • Vacuum at least twice weekly with a HEPA-filtered cleaner.

  • Dust with a damp microfibre cloth, not a feather duster.

  • Wash bedding and soft furnishings regularly at 60 °C if the fabric allows.

  • Avoid clutter that collects dust (papers, books, soft toys).

  • Keep humidity within 40–60% and fix damp quickly.

🌱 Preventing Mould and Dust Returning

Action Why It Helps
Find and fix leaks or condensation sources Mould needs moisture to grow
Ventilate kitchens, bathrooms, and drying areas Removes steam before it spreads
Use humidity-sensing fans or dehumidifiers Keeps humidity in a safe range
Maintain a steady indoor temperature Reduces cold surfaces and condensation
Close doors during steamy activities Stops damp air moving into other rooms
Replace or clean HEPA filters regularly Maintains air-cleaning performance
Check behind furniture and on windowsills Finds hidden damp early
Repaint cleaned areas with mould-resistant paint Discourages regrowth

🚫 What Not to Do

  • Don’t paint over mould — it will grow back.

  • Don’t use strong chemicals or foggers in small spaces — they can irritate lungs.

  • Don’t use steam cleaners on large mould patches — they can spread spores.

  • Don’t ignore damp smells — they always mean hidden moisture somewhere.

💼 At Work

  • Ask about ventilation and report any damp, leaks, or condensation.

  • Keep your workspace tidy and free of dust-collecting clutter.

  • If cleaning sprays or perfumes cause coughing, discuss adjustments with your manager or occupational health team.

✈️ When Travelling

  • Check air-quality forecasts before travelling and avoid outdoor activity on high-pollution or pollen days.

  • Choose clean, dry accommodation — avoid musty or damp-smelling rooms.

  • Pack a small hygrometer or travel dehumidifier for longer stays.

  • Use a well-fitted FFP2 or N95 mask in crowded or polluted environments.

  • Stay hydrated and pace activities in humid or hot weather.

🩺 Listen to Your Body

Keep a short diary of when and where your symptoms flare up, along with temperature, humidity, or smells you notice. Patterns often reveal your personal triggers.

🌱 Key Points

Good Practice Why It Matters
Keep home dry, clean, and ventilated Reduces mould and spore exposure
If it smells damp, it probably is Early warning of hidden moisture
Humidity above 60% after showering or cooking is normal — keep it short Prevents condensation and mould
Close doors while cooking, showering, or drying laundry Stops moisture spreading
Use humidity-sensing extractor fans Clears steam automatically
Monitor humidity (40–60%) Keeps air comfortable and discourages spores
Match HEPA filters and dehumidifiers to room size Ensures real air-cleaning and drying effect
Maintain and replace filters regularly Keeps air safe and fresh
Check outside air quality before opening windows Avoids bringing pollution indoors
Filter incoming air with vents or MVHR/PIV systems Keeps dust and spores out
Clean small mould patches safely with mild detergent Removes spores without irritation
Fix leaks, repaint with mould-resistant paint Prevents regrowth
Avoid strong scents and aerosols Reduces airway irritation
Plan travel around clean-air days Lowers risk of flares and infections

💬 Final Thought

You can’t control every environment — but small, steady habits make a big difference.
If something smells damp, it probably is. Deal with it early, clean gently, dry thoroughly, and keep air moving.
Short humidity spikes after showering or cooking are normal — just make sure they don’t linger.
Choose purifiers and dehumidifiers that are the right size for your rooms, and maintain them well.
Check outdoor air quality before airing your home, and use filters to keep what’s good while blocking what’s not.
A dry, clean, well-ventilated home gives your lungs the best chance to stay healthy every day — wherever you are.

by GAtherton

🧪 Why New Antifungal Trials Start with Invasive Aspergillosis

When you hear about promising new antifungal medicines such as Olorofim or Fosmanogepix, you may wonder why the first studies always seem to involve people with invasive aspergillosis — not those with chronic pulmonary aspergillosis (CPA) or allergic bronchopulmonary aspergillosis (ABPA).

It might seem unfair, especially when chronic forms of aspergillosis are so common and long-lasting.
But there are good reasons why research has to begin with invasive disease.

Here’s how it works — and why it’s still good news for everyone living with aspergillosis.

⚠️ 1. Invasive Aspergillosis Is the Most Dangerous Form

Invasive aspergillosis happens when Aspergillus spreads deep into the lungs or bloodstream, usually in people with a very weak immune system — for example, after chemotherapy, transplant, or high-dose steroid use.

Without prompt treatment, it can be fatal within days or weeks.
Because it is so serious, regulators such as the MHRA (UK), EMA (Europe) and FDA (USA) allow new drugs for invasive infections to be tested and reviewed much faster than they would for less urgent diseases.

This approach means that if a new antifungal proves helpful and safe, it can reach patients in greatest need more quickly — often saving lives while also building the data needed for later studies in other conditions.

📈 2. It’s Easier to Measure Whether the Drug Works

For invasive disease, the goal is very clear:

The infection either clears up, or it doesn’t.

That makes the results of a study straightforward to interpret.

With chronic or allergic aspergillosis, improvement takes much longer to measure:

  • Scans may take months to show change,

  • Symptoms can fluctuate naturally, and

  • Other lung problems (like COPD or bronchiectasis) can confuse the results.

So trials in chronic disease need larger patient numbers and longer follow-up, which are expensive and take years. Starting with invasive aspergillosis lets researchers get the essential safety and efficacy answers first.

🧾 3. The Regulatory Framework Focuses on Invasive Disease

Drug-approval rules for antifungals were originally designed for the most life-threatening infections.
Official guidance documents — from the EMA, FDA and others — describe exactly how to test new drugs for invasive fungal infections, but there are no formal international standards yet for chronic or allergic aspergillosis.

That means developers start where the rules are clear — and then adapt once regulators, researchers, and clinicians agree on what a “successful outcome” looks like for chronic disease.

⚖️ 4. Safety and Ethics Come First

When a new antifungal is in early testing, doctors don’t yet know all its side-effects or how it behaves during long-term use.
For ethical reasons, it’s safer to begin in patients with very few other treatment options, where the potential benefit outweighs the risk.

As safety data builds up — including how the medicine interacts with other drugs — it becomes safer to test in people with more stable chronic conditions such as CPA.

🩺 5. Once Proven Safe, Use Can Expand

Once a drug like Olorofim or Fosmanogepix:

  • works well in invasive aspergillosis,

  • has solid safety data, and

  • earns its first licence,

the manufacturer and research partners (such as the National Aspergillosis Centre) can propose new studies in CPA or other forms of aspergillosis.

By then, regulators already know the drug’s risk profile, dosing, and monitoring needs — so further approvals for chronic disease can move faster.

🧩 In Summary

Reason Why invasive aspergillosis comes first
Urgency It’s the most life-threatening form, so ethics allow faster testing
Clear results Success or failure can be measured more easily
Existing standards Regulatory guidance already written for invasive disease
Safety first Starts with people who have no other treatment
Builds the base Data from invasive disease supports later CPA/ABPA trials

🌱 Looking Ahead

Starting with invasive aspergillosis is a gateway, not a dead-end.
Every study adds vital knowledge about how these new antifungals work, how safe they are, and which patients might benefit most.

Once enough evidence exists, clinical trials can — and almost certainly will — expand to include chronic pulmonary aspergillosis (CPA) and possibly even allergic forms of the disease.

So while the research focus may begin with the most critical cases, the progress made there ultimately helps everyone living with aspergillosis.

by GAtherton

🩺 Why New Antifungal Medicines Aren’t for Everyone (Yet)

When new medicines are announced, it’s natural to wonder:

“If they’re better than what we already have, why can’t everyone start using them straight away?”

Two new antifungal drugs — Olorofim and Fosmanogepix — are generating real excitement because they work in completely new ways and could help people whose fungal infections no longer respond to existing treatments.

But before any new drug becomes widely available, it must go through a careful process to make sure it’s safe, effective, affordable, and used in the right patients. Here’s why most people with aspergillosis will still be treated with existing antifungal medicines for now.

🧪 1. They’re Still Being Tested

Olorofim and Fosmanogepix are still classed as investigational medicines.
That means they have shown promise in early studies — especially for severe or drug-resistant infections — but they are not yet approved for general medical use.

Regulators such as the MHRA (UK), EMA (Europe), and FDA (USA) require large, carefully controlled studies to confirm:

  • that the drugs are safe for different types of patients,

  • that they work as well as or better than existing treatments, and

  • that the benefits clearly outweigh any risks.

Until that evidence is complete, they can only be prescribed within clinical trials or under special compassionate-use programmes at specialist hospitals.

💨 2. Different Types of Aspergillosis Need Different Treatments

Aspergillosis isn’t one single disease. It includes:

  • Invasive aspergillosis, a dangerous infection in people with weak immune systems.

  • Chronic pulmonary aspergillosis (CPA), a long-term infection in people with lung damage.

  • Allergic bronchopulmonary aspergillosis (ABPA), an allergic reaction rather than a true infection.

The new antifungals are currently being tested only for invasive aspergillosis — the most severe form.
They haven’t yet been studied in chronic or allergic forms like CPA or ABPA, so we don’t yet know if they would work or be safe for those conditions.

💊 3. Current Medicines Still Work Well for Most Patients

Existing antifungal drugs such as itraconazole, voriconazole, posaconazole, and isavuconazole remain effective for most people with aspergillosis.

Doctors already know:

  • how to monitor their levels in the blood,

  • how to manage side-effects, and

  • how to combine them safely with other medicines.

New drugs can bring new possibilities — but they can also bring unknown side-effects or interactions. Doctors need strong, long-term evidence before changing large numbers of patients to new treatments.

💷 4. Cost and Access Take Time

Developing antifungal drugs takes years and costs millions of pounds.
When a new medicine is finally approved, it is often very expensive at first.

In the UK, every new treatment must go through NICE (the National Institute for Health and Care Excellence).
NICE checks:

  • how well it works,

  • how safe it is, and

  • whether the NHS can afford to provide it fairly to all who need it.

Only once NICE recommends a drug can NHS England fund it for routine use — and even then, it may be limited to certain hospitals or patient groups at first.

⚖️ 5. A Step-by-Step Approach Keeps Patients Safe

New medicines are introduced gradually — starting with people who have no other treatment options.
If they prove safe, effective, and affordable in that group, their use can be expanded step by step to include more patients and other forms of disease.

This careful rollout protects patients from unexpected risks and helps prevent early resistance, so the drugs stay effective for longer.

🧭 6. Who Decides When a New Antifungal Can Be Used for CPA?

Bringing a new antifungal from its first approval to wider use in chronic diseases like CPA involves several levels of decision-making:

1️⃣ The Manufacturer

Companies such as Shionogi Europe (Olorofim) or Basilea/Pfizer (Fosmanogepix) design the trials and decide which conditions to test first — usually the most life-threatening ones.
If early results are good, they can plan new studies for CPA or other chronic lung infections.

2️⃣ Clinical Researchers and Specialist Centres

Centres such as the National Aspergillosis Centre (NAC) collect real-world data from patients who receive these drugs through compassionate-use programmes.
If several patients with CPA improve, these results may encourage formal CPA-specific trials.

3️⃣ Regulatory Authorities

Bodies such as the MHRA (UK), EMA (Europe), or FDA (USA) decide which diseases a drug can officially be marketed for.
To add CPA as a licensed use, the company must submit:

  • new clinical trial data,

  • long-term safety information, and

  • a formal request to extend the drug’s licence.

Until that happens, doctors can only prescribe it for CPA off-label — usually within strict hospital governance systems.

4️⃣ NICE and NHS England

Even after regulatory approval, NICE must review cost and benefit before the NHS can fund the drug for CPA.
Without a positive NICE recommendation, it can’t be routinely prescribed in the UK.

5️⃣ Specialist Clinical Networks

Finally, once approved and funded, expert groups like the NAC and national respiratory networks decide how and when the drug should be used — for example:

  • only for patients with azole-resistant CPA,

  • after all standard options have failed, and

  • with careful monitoring.

This information is then built into national and local treatment guidelines.

🔄 Example Pathway: Olorofim’s Future Use for CPA

Stage Who acts What happens
1️⃣ Shionogi Gains approval for invasive aspergillosis
2️⃣ NAC & academic partners Report successful CPA case studies
3️⃣ Shionogi + NAC Launch a formal CPA clinical trial
4️⃣ MHRA / EMA Extend licence to include CPA
5️⃣ NICE Reviews cost-effectiveness for CPA
6️⃣ NHS England Approves CPA use in NHS centres

🩸 In Summary

Reason Why we can’t all switch now
Still in trials Not yet fully approved for use
Different diseases Only tested for invasive aspergillosis so far
Known vs unknown Established drugs work well for most people
Cost and access NHS approval and funding take time
Safe rollout New drugs introduced step-by-step

🌱 Looking Ahead

Both Olorofim and Fosmanogepix represent the most promising antifungal advances in decades.
If they continue to perform well in trials, they could become vital options for people whose infections no longer respond to standard medicines — and, in time, for chronic conditions like chronic pulmonary aspergillosis (CPA).

For now, the safest and most effective approach remains to use proven antifungals under expert supervision, while keeping a close watch on these exciting new developments.

by GAtherton

🌿 New Antifungal Medicines on the Horizon: Olorofim and Fosmanogepix

For many years, doctors have relied on the same small group of antifungal drugs — mainly azoles (like itraconazole and voriconazole), amphotericin, and echinocandins. These have saved lives, but some fungi are becoming resistant, and some people can’t tolerate them because of side-effects or drug interactions.

Two completely new antifungal medicines — Olorofim and Fosmanogepix — are now in the final stages of research. They work in new ways and could help patients whose infections no longer respond to current treatments.

🧬 Olorofim (by F2G Ltd, UK)

How it works:
Olorofim blocks a vital process that fungi need to make DNA. It belongs to a brand-new group called orotomides, and works very differently from other antifungals.

Which infections it targets first:

  • The first planned use will be for people with invasive mould infections (for example, Aspergillus fumigatus and some rare moulds) when existing medicines don’t work or can’t be used.

  • It is especially promising for azole-resistant Aspergillus, which is becoming more common.

How it might help in the future:
Although early studies are focused on severe infections in people with weak immune systems, Olorofim has also shown good results in some patients with chronic pulmonary aspergillosis (CPA) who could not take azoles.
Once it is licensed, hospitals such as the National Aspergillosis Centre may be able to use it for difficult or resistant cases of CPA on a specialist-approval basis.

When it might be available:
F2G has completed late-stage studies and is preparing for regulatory approval.
If all goes well, Olorofim could be available around 2026–2027 in some countries, with the UK likely to follow once it is approved and adopted by the NHS.

⚗️ Fosmanogepix (by Basilea and Pfizer)

How it works:
Fosmanogepix (converted in the body to manogepix) blocks the fungus from making a protective coating around its cell surface. This prevents it from growing and spreading. It belongs to another new group of antifungal drugs.

Which infections it targets first:

  • The first major study is for Candida bloodstream infections (candidemia) and other serious yeast infections.

  • A second study focuses on invasive mould infections, including aspergillosis, in patients with few treatment options.

How it might help in the future:
Once approved for invasive infections, Fosmanogepix could later be tested in longer-term or chronic lung infections, such as CPA, if it proves safe for long-term use.

When it might be available:

  • The first approval (for Candida) may come around 2027.

  • The aspergillosis trial is still running and not expected to finish before 2028–2029, so that indication will follow later.

🩺 What This Means for People with Aspergillosis

Drug New or existing? First use likely for Could later help with When available (approx.)
Olorofim New class (orotomide) Invasive Aspergillus and resistant moulds Difficult or resistant cases of chronic pulmonary aspergillosis (CPA) 2026–2027
Fosmanogepix New class (Gwt1 inhibitor) Candida bloodstream infections Invasive mould infections, possibly CPA later 2027–2029

🧩 In summary

  • These two drugs represent the first completely new antifungal classes in decades.

  • They are being tested mainly for life-threatening fungal infections where current medicines fail.

  • Once approved, they may offer new options for people with resistant or difficult-to-treat forms of aspergillosis, including some patients with CPA.

  • They are not yet available on prescription, but progress looks very promising.

by GAtherton

Understanding Risk from Aspergillosis — and What’s Improving

🧫 How risky is aspergillosis?

The outlook for people with aspergillosis has improved dramatically in the past two decades.
Two things have changed that make a huge difference:

  1. We diagnose it earlier.
    Better scans, blood tests (like galactomannan and PCR), and greater awareness mean the infection or allergic reaction is recognised much sooner.

  2. We treat it better.
    Modern antifungal medicines, steroid-sparing biologics, and specialist clinics have all transformed care and monitoring.

⚖️ Risk of death — managed vs. unmanaged

Type of Aspergillosis If well managed If unmanaged or poorly treated
Allergic (ABPA) Survival > 95 % About 90 % (may progress to chronic lung damage)
Chronic (CPA) 5-year survival ≈ 80–90 % 5-year survival ≈ 50 %
Invasive (IA) 5-year survival ≈ 50–70 % < 20 % (often fatal if untreated)

Across all forms of aspergillosis, the risk of death has fallen by roughly 50 % since the early 2000s.

💊 What’s driven this improvement

  • New antifungal drugs — triazoles (itraconazole, voriconazole, posaconazole, isavuconazole) now form the backbone of long-term therapy.

  • Rapid diagnosis — galactomannan, PCR, and CT scanning detect infection days earlier than before.

  • Improved hospital and ICU care — faster recognition and better ventilation strategies save lives in invasive cases.

  • Specialist clinics and monitoring — regular blood tests, imaging, and drug-level checks prevent deterioration and drug toxicity.

  • Biologic therapies — agents that target allergic inflammation (like anti-IgE or anti-IL-5 biologics) help reduce steroid use and preserve lung function.

🚀 What could make outcomes even better

Researchers and clinicians are optimistic about the next decade.
Future advances are already on the horizon:

Future area How it helps
Next-generation antifungals – Olorofim, Fosmanogepix Active against azole-resistant strains and safer for long-term use
Combination or personalised therapy Matching the right drug and dose to each patient’s response pattern
Routine antifungal-resistance testing Prevents treatment failure by identifying resistant Aspergillus early
Rapid home or bedside testing Detects infection flare-ups before symptoms become severe
Improved imaging and AI-supported analysis Spots fungal cavities or airway changes at an earlier, reversible stage
Global stewardship of agricultural azoles Reduces environmental resistance by limiting unnecessary fungicide use
Patient self-monitoring and digital follow-up Enables early reporting of symptoms and better long-term adherence

⚠️ Potential barriers to further progress

Even with all these advances, several important challenges could slow improvement if left unaddressed:

Barrier Why it matters
Antifungal resistance Aspergillus fumigatus is developing resistance to azoles used both in medicine and agriculture. Resistant strains can make first-line treatment fail unless resistance testing is done.
Delayed or missed diagnosis Symptoms often mimic other lung conditions. Late recognition allows infection or inflammation to cause irreversible damage.
Limited access to specialist care Some regions lack experienced clinicians, diagnostic testing, or antifungal drug availability, increasing global inequality in outcomes.
Drug toxicity and interactions Long-term antifungal therapy can affect the liver or interfere with other medicines if not closely monitored.
Environmental change Warmer, wetter climates and increased composting or construction may raise Aspergillus exposure for vulnerable people.
Healthcare strain and cost Long-term follow-up, monitoring, and expensive new drugs may challenge already stretched healthcare systems.

Each of these barriers needs attention through research, public health policy, and education to ensure the gains of the last 20 years continue.

❤️ The key message

Aspergillosis is still a serious disease, but its outlook is far better than it used to be.
With modern antifungals, biologics, and regular monitoring, most people live many years — and new treatments promise even better results.

Patients can help by:

  • Reporting new symptoms early.

  • Keeping up with regular blood and imaging checks.

  • Asking about resistance testing and treatment options.

  • Staying informed about new drugs and trials.

🌅 A hopeful future

In just twenty years, deaths from aspergillosis have halved.
If we continue improving diagnosis, drug development, and resistance control, survival will rise even higher — turning aspergillosis from a life-threatening infection into a long-term but manageable condition for most people.

by GAtherton

Understanding Risk: How Common Is “Rare”?

When doctors talk about risk, it can sound worrying — especially when you’re already living with a lung condition.
But every day, we all take small, managed risks without realising it.

Understanding how everyday risks compare with medical or vaccine risks helps put the numbers into perspective — and shows why treatment is almost always worth it.

🚶‍♀️ Everyday activities carry small risks

Everyday life is full of tiny risks we accept because the benefits are clear — exercise, travel, independence, and social connection.

Activity Estimated risk of serious harm Equivalent comparison
Driving a car for 250 miles About 1 in 1 million chance of fatal accident Roughly the same as the risk of a severe vaccine reaction
Cycling for 30 minutes About 1 in 3 million Similar to being struck by lightning in your lifetime
Walking near traffic for a day Around 1 in 15 million Negligible, but not zero
Taking a domestic flight (UK) Less than 1 in 10 million chance of fatal accident Far safer than most road journeys
Catching flu during winter Around 1 in 10 chance of getting ill Much higher risk than most medicine side effects

We don’t think of these activities as “dangerous” because the benefit far outweighs the risk — just as it does with most treatments.

💊 Medicines and vaccines we take safely every day

Most common medicines have mild, short-lived side effects. Serious reactions are possible but extremely rare.

Medicine Typical mild effects Serious reactions (approx. frequency) Comment
Paracetamol (acetaminophen) Nausea, rash Serious liver injury ≈ 1 in 100,000 (usually after overdose) Very safe when taken correctly
Ibuprofen Heartburn, upset stomach Ulcer or stomach bleed ≈ 1 in 1,000 if used long term Safer when taken with food
Amoxicillin Diarrhoea, mild rash Severe allergic reaction ≈ 1 in 5,000–10,000 Rare but recognised
Influenza vaccine Sore arm, tiredness Severe allergic reaction ≈ 1 in 1 million Prevents thousands of serious infections yearly
COVID-19 vaccine Mild flu-like symptoms (≈ 1 in 10) Severe allergic reaction ≈ 1 in 100,000 Benefits far outweigh risks
Oral steroids (short course) Increased appetite, insomnia Major side effects only with prolonged use Vital during ABPA or asthma flares

⚕️ What does “serious side effect” really mean?

When you read about serious reactions in medical leaflets or vaccine information, it doesn’t necessarily mean life-changing.
The term “serious” has a specific medical meaning, used by the MHRA, EMA, and WHO.

A reaction is called serious if it:

  • leads to hospitalisation,

  • is life-threatening at the time,

  • causes temporary disability or incapacity,

  • results in death, or

  • causes a birth defect.

👉 It’s about medical urgency, not always long-term harm.

In reality, most serious reactions are short-lived and fully reversible with prompt treatment.
For example:

  • An anaphylactic reaction to a vaccine is medically serious because it needs immediate care — but nearly everyone recovers completely once treated.

  • A high fever or rash that requires a day in hospital may be serious in reporting terms, but causes no permanent damage.

By contrast, life-changing reactions (such as nerve injury or organ failure) are extraordinarily rare — far rarer than being struck by lightning.

“When doctors say ‘serious reaction’, they mean something that needs urgent medical attention — not something that will leave you permanently unwell.”

🩺 More common health risks we all face

While medicine risks are very small, the everyday risks to life and health are much higher — especially if conditions go untreated.

Health event or cause Approximate annual risk (UK adult) Lifetime risk Notes
Heart attack Around 1 in 200–300 per year 1 in 4 men, 1 in 6 women Increases with age, smoking, and high blood pressure
Stroke Around 1 in 250 per year About 1 in 5 adults Preventable with healthy lifestyle and medication
Cancer (any type) Around 1 in 125 per year Around 1 in 2 people in their lifetime Most treatable when found early
Serious road accident About 1 in 15,000 per year Around 1 in 100 lifetime Far higher than a vaccine reaction
Severe flu needing hospital care Around 1 in 500 per winter Higher for people with lung disease Preventable by flu vaccination
Fatal asthma attack About 1 in 100,000 per year Higher in uncontrolled asthma Preventable with good management
COVID-19 death (current UK levels) Around 1 in 2,000–5,000 per year for older/vulnerable adults Major reason vaccination still matters
Lightning strike About 1 in 15 million per year Around 1 in 300,000 lifetime Benchmark for “extremely rare” risk

⚖️ Making sense of the numbers

  • A 1 in 1,000 risk means one person in a large GP practice might experience it.

  • A 1 in 100,000 risk means one person in a football stadium crowd.

  • A 1 in 1 million risk is so rare that most doctors never see it in their career.

So when you hear that a serious vaccine reaction occurs in one in a million people, that’s about the same as:

  • being struck by lightning once in your life, or

  • winning a small lottery prize several times in a row.

❤️ The real takeaway

The greatest risks to life and health are the common diseases we can prevent or treat — not the rare side effects of treatment.

Every vaccine or medicine is carefully assessed so that its benefits far outweigh its risks, especially for people with asthma, ABPA, bronchiectasis, or weakened immunity.
Treatments don’t add danger — they reduce the much bigger risks from infection, inflammation, and lung damage.

🧭 Key message

We all live with risk, but:

  • Most everyday and health-related risks are far greater than the tiny chance of a medicine reaction.

  • Managing your lung condition well — with the right treatment, vaccines, and follow-up — protects your lungs and lengthens your life.

  • The safest path is always informed care, not avoidance through fear.

by GAtherton

Aspergillosis & Asthma: When Risks Peak Through the Year

Many people living with aspergillosis, asthma, or bronchiectasis notice that their symptoms change with the seasons.
This is no coincidence — environmental factors such as temperature, humidity, pollen, spores, and viral infections all vary through the year, and these can strongly influence both lung health and allergic or fungal disease.

Understanding these patterns can help you plan ahead, reduce exposure, and know when to take extra care.

🌸 Spring: Pollen and Early Spore Season

As temperatures rise, tree pollen (especially birch, oak, and plane) and Aspergillus spores begin to increase in outdoor air.
For people with Allergic Bronchopulmonary Aspergillosis (ABPA) or Severe Asthma with Fungal Sensitisation (SAFS), this can trigger cough, wheeze, and chest tightness.

  • Keep an eye on Met Office pollen and spore forecasts.

  • Open windows on dry days, but check for signs of mould indoors, especially around windows and bathrooms.

  • If you notice symptoms flaring every spring, let your respiratory team know — small medication adjustments may help.

📊 Data source: Met Office spore count data.

☀️ Summer: Soil, Compost, and Renovation Hazards

Warm, humid conditions mean fungi thrive — especially outdoors.
Compost heaps, garden soil, and grass cuttings can release very high levels of Aspergillus spores.
People with chronic lung disease, ABPA, or Chronic Pulmonary Aspergillosis (CPA) are at greater risk of exacerbations during this period.

  • If gardening or using compost, wear gloves and an FFP2/FFP3 mask.

  • Avoid turning compost heaps or cleaning bird feeders if you are immunocompromised.

  • Keep home humidity below 60% and ventilate well during warm spells.

🪴 Source: Protective mask and compost safety advice.

🍂 Autumn: Damp Homes and Viral Load

As the weather cools, we close windows and turn on heating — trapping moisture indoors.
This increases damp and mould growth, particularly in poorly ventilated areas.
At the same time, colds, flu, and RSV infections surge, all of which can make fungal or allergic conditions worse.

  • Use a dehumidifier and ensure air can circulate behind furniture.

  • Check for leaks, condensation, or cold corners.

  • Stay up to date with flu and COVID vaccinations if eligible.

💧 Source: Aspergillosis.org damp guidance.

❄️ Winter: Indoor Season and Medication Review

Outdoor spore levels are lowest in winter, but indoor exposure dominates — from bathrooms, humidifiers, and heating systems.
Viral infections remain a major trigger for asthma and ABPA flare-ups, and antifungal or steroid treatments may need review.

  • Keep homes warm but ventilated where possible.

  • Review your treatment plan with your clinical team, especially if you’re using steroids or biologics.

  • Contact your GP or specialist early if you notice an increase in cough, breathlessness, or mucus plugs.

🧭 Key Takeaway

Aspergillosis and asthma flare-ups often follow the seasons:

Season Main Risks Take Action
Spring Pollen, outdoor spores Monitor counts, check home for mould
Summer Compost, soil, renovation dust Use masks/gloves, avoid heavy exposure
Autumn Damp homes, viruses Dehumidify, ventilate, manage infections
Winter Indoor air, viruses Keep warm, review treatment

By spotting your personal pattern, you and your care team can plan ahead — reducing exacerbations and staying well all year.

by GAtherton

🧠 Article 2: Why Awareness Matters – Staying Safe and Confident on Aspergillosis Treatment

Subtitle: How understanding your medicines can protect you and improve your quality of life.

💬 Awareness Means Safety

For people managing aspergillosis or related lung conditions, awareness isn’t just about learning facts — it’s about staying safe.
Knowing how your treatment works, what to expect, and who to ask for help gives you control and confidence.

1️⃣ Awareness Builds Understanding

Understanding each medicine’s purpose helps you:

  • Recognise genuine warning signs early.

  • Avoid anxiety over mild or harmless side effects.

  • Know when something needs professional advice.

Example: a patient who knows voriconazole can cause brief light sensitivity won’t panic, but they will report a new rash or jaundice straight away.

2️⃣ Awareness Improves Communication

Informed patients are better partners in care.
You can explain symptoms clearly, ask the right questions, and notice how medicines affect you.
This helps doctors and nurses tailor treatment quickly and safely.

3️⃣ Awareness Supports Safer Treatment

Many aspergillosis patients take multiple interacting medicines — antifungals, steroids, antibiotics, and sometimes biologics.
Being aware of potential interactions means you can prevent problems before they happen.

You can check interactions using the official
👉 BNF Interactions Checker – NICE Medicines Guidance
(Free, reliable, and used by UK healthcare professionals.)

💡 Tip: If you find a possible interaction online, don’t stop any medicine yourself. Take a screenshot or note and discuss it with your pharmacist or specialist.

🧴 Awareness Includes Working With Your Pharmacist

Pharmacists — both hospital and community — are a vital part of your care team.
They are medicine specialists who can:

  • Review your prescriptions for clashes between antifungals, steroids, and other drugs.

  • Advise how to take medicines for best absorption (for example, itraconazole with food, not with omeprazole).

  • Explain potential side effects and how to manage them safely.

  • Contact your GP or hospital consultant if adjustments are needed.

Whenever you start or stop a medicine — even an over-the-counter painkiller or herbal supplement — let your pharmacist know.
They can quickly check your full medication list using the same professional databases doctors use.

🧭 Remember: Your pharmacist is your first safety checkpoint.
They’re there to protect you, clarify confusion, and help your medicines work safely together.

4️⃣ Awareness Builds Confidence and Control

Long-term illness can feel unpredictable.
Understanding your medicines helps you:

  • Manage flare-ups calmly.

  • Recognise early changes and act quickly.

  • Feel more confident talking with your care team.

Research shows that informed patients have fewer hospital admissions, better symptom control, and improved wellbeing.

⚖️ Balanced Information

Awareness is only helpful if it’s accurate.
Stick to trusted sources such as:

  • aspergillosis.org

  • NHS and NICE websites

  • Your hospital’s patient information leaflets

  • Local or hospital pharmacists who can explain details clearly

Avoid social-media “miracle cures” or alarming headlines that lack evidence.

🌱 The Bottom Line

Awareness doesn’t just make you more knowledgeable — it makes you safer.

Learn what each medicine does, recognise early warning signs, and use trusted resources like the BNF Interactions Checker and your pharmacist to keep your treatment on track.
Awareness turns uncertainty into confidence — and confidence into better health.

🔗 Related Resource

Managing Side Effects of Aspergillosis Treatments » — detailed guide to medicines, monitoring, and how pharmacists and doctors work together to keep you safe.

by GAtherton