Chronic Pulmonary Aspergillosis (CPA) for Expert Patients and Non-Specialist Clinicians

Expert Information for Patients, GPs, and Specialist Nurses

🔎 What Is CPA?

Chronic Pulmonary Aspergillosis (CPA) is a long-term fungal lung infection caused by Aspergillus, typically A. fumigatus. It occurs in individuals with underlying lung damage and can progress slowly over months to years. It includes several subtypes ranging from cavitary lesions to fibrosing disease and fungal balls (aspergillomas).

🧬 Subtypes of CPA

👥 Who Is at Risk?

CPA typically affects people with pre-existing lung disease or immune dysfunction, including:

• Tuberculosis (old or active)

• COPD and emphysema

• Bronchiectasis

• Sarcoidosis

• Prior pneumothorax

• Lung cancer or surgery

• Diabetes mellitus

• Low-dose or chronic steroid use

⚠️ Common Symptoms

CPA symptoms often evolve insidiously over >3 months:

• Chronic productive cough

• Haemoptysis (may be mild or massive)

• Fatigue and weight loss

• Breathlessness

• Chest discomfort

• Fever (occasional)

🧪 Diagnosis

Diagnosis of CPA requires the combination of:

1. Symptoms ≥3 months

2. Imaging:

   • CT chest: cavitary lesions, pleural thickening, aspergilloma, fibrotic changes

3. Microbiology:

   • Positive sputum culture, PCR, or histopathology for A. fumigatus

4. Serology:

   • Elevated Aspergillus IgG antibodies (essential for diagnosis)

5. Exclusion of other diseases:

   • Especially active TB, malignancy, and bacterial infections

💊 Treatment

First-Line:

• Oral triazole antifungals (minimum 6 months, often longer)

  • Itraconazole

  • Voriconazole

  • Posaconazole

• Therapeutic drug monitoring is crucial

Additional:

• Inhaled antifungals (e.g. amphotericin B) in selected cases

• Surgery for localised disease or life-threatening haemoptysis (if fit)

• Bronchial artery embolisation for bleeding control

• Physiotherapy and nutritional support

🧾 Monitoring

• CT scan every 3–6 months during treatment

• Aspergillus IgG titres to monitor disease activity

• Liver function and antifungal levels (monthly at minimum)

• Symptom tracking (cough, energy, weight, breathlessness)

📚 More Information

• Referral: Hospital patients can be referred to the National Aspergillosis Centre (NAC) for diagnosis, treatment, and specialist input. NAC does not accept referrals directly from a GP – GP’s should refer to their local Infectious Disease or Respiratory service.

• Patient Support: aspergillosis.org, NAC Facebook Group

• Guidelines: CPA Guidelines