Chronic Pulmonary Aspergillosis (CPA)

🫁 Overview

Chronic Pulmonary Aspergillosis (CPA) is a long-term fungal infection of the lungs, most often caused by Aspergillus fumigatus.
It develops slowly over months or years and usually affects people who already have some damage to their lungs from another condition.

Doctors currently recognise five forms of CPA:

  1. Chronic Cavitary Pulmonary Aspergillosis (CCPA) – the most common form, where one or more cavities (holes) develop in the lungs. These may contain a fungal ball.

  2. Simple Aspergilloma – a single fungal ball growing inside a pre-existing cavity.

  3. Aspergillus Nodules – small lumps caused by Aspergillus infection that can sometimes look like lung cancer on scans; diagnosis needs a biopsy.

  4. Chronic Fibrosing Pulmonary Aspergillosis (CFPA) – a later stage of CCPA where scarring (fibrosis) has developed.

  5. Subacute Invasive Aspergillosis (SAIA) – similar to CCPA, but occurs in people who are mildly immunocompromised (for example, due to steroids or other medications).

⚠️ Symptoms

Symptoms often develop slowly, usually lasting more than three months, and can vary from mild to severe.
Common symptoms include:

  • Persistent cough (sometimes with mucus or blood)

  • Fatigue and low energy

  • Weight loss or loss of appetite

  • Shortness of breath (breathlessness)

  • Coughing up blood (haemoptysis) – this can range from small streaks to larger amounts

People with a fungal ball (aspergilloma) may have few symptoms but are at particular risk of coughing up blood — this happens in around half to 90% of patients.

🧬 Causes

CPA usually affects people with otherwise normal immune systems, but whose lungs are already damaged or scarred from another condition.
The fungus Aspergillus fumigatus is common in the environment (for example, in soil, compost, or decaying leaves). When its spores are inhaled, they can settle in damaged lung tissue and gradually grow, forming cavities or fungal balls.

Common underlying lung conditions include:

  • Asthma

  • Chronic obstructive pulmonary disease (COPD)

  • Sarcoidosis

  • Previous tuberculosis (TB)

  • Cystic fibrosis (CF)

  • Chronic granulomatous disease (CGD)

  • Any previous lung damage or surgery

🩻 Diagnosis

Diagnosing CPA can be difficult, and often needs specialist input.
At the National Aspergillosis Centre (NAC) in Manchester, diagnosis usually combines several tests:

  • Chest X-rays or CT scans – to look for cavities, fungal balls, or scarring

  • Blood tests – to check for antibodies against Aspergillus

  • Sputum samples – to look for fungal growth or DNA

  • Biopsy or tissue samples – sometimes needed for confirmation

Because CPA can look similar to other lung diseases, it’s important to be assessed by a specialist team.
➡️ Find out more about CPA diagnosis

💊 Treatment and Management

Treatment depends on the form of CPA, your symptoms, and overall lung health.
Typical treatments include:

  • Antifungal medicines (e.g. itraconazole, voriconazole, or posaconazole) – often taken long-term or lifelong

  • Surgery – sometimes used for a single aspergilloma

  • Tranexamic acid – to help control coughing up blood

  • Bronchial artery embolisation – a procedure to stop bleeding that cannot be controlled by medication

  • Immune-supporting therapy – in selected cases

Ongoing care focuses on controlling symptoms, slowing progression, and preserving lung function. Many people need regular follow-up with a specialist team.

💚 Prognosis and Living with CPA

CPA is a chronic (long-term) condition which usually needs lifelong management.
The main goals are to:

  • Reduce symptoms

  • Maintain quality of life

  • Prevent further lung damage or scarring

  • Treat flare-ups early

Some patients remain stable for years without needing continuous treatment, while others need ongoing antifungal therapy.

For practical tips, see the the wealth of information under the Information and Support for Patients tab above

➡️ Information and Support

📚 Further Reading for Professional Clinicians and Researchers

A full medical overview is available on the website at Information for Professionals.
It contains detailed clinical information for doctors and healthcare professionals.

🎥 Patient Stories

In these short videos made for World Aspergillosis Day 2022, two patients share their experiences of living with CPA:

  • Gwynedd – diagnosed with CPA and Allergic Bronchopulmonary Aspergillosis (ABPA)

  • Mick – living with CPA and managing daily life with the condition

➡️ Watch their stories

** Last Reviewed Oct 2025