Chronic pulmonary aspergillosis (CPA) is a long-term infection caused by Aspergillus mould in people whose lungs have usually been damaged by another condition. It develops gradually and can affect one or both lungs. CPA is different from allergic conditions such as ABPA and from invasive aspergillosis.
CPA can be difficult to recognise because its symptoms overlap with other lung conditions. Diagnosis and treatment usually need specialist input, careful interpretation of scans and tests, and follow-up over time.
Patient-centred information from the National Aspergillosis Centre. This guide combines specialist clinical knowledge with the questions, experiences and practical concerns raised by people living with CPA and their carers.
Key points
- CPA is a long-term lung infection, usually occurring in lungs already affected by disease or previous injury.
- Symptoms may include cough, fatigue, weight loss, breathlessness, chest discomfort and coughing up blood.
- Diagnosis relies on the whole picture: symptoms, scans, blood tests and sometimes sputum or tissue samples.
- Not everyone needs the same treatment. Antifungal medicines, monitoring and treatment of complications are tailored to the individual.
- Living with CPA often involves managing symptoms, treatment burden and uncertainty as well as the infection itself.
What is CPA?
CPA is an infection that persists or progresses slowly in the lungs. It most often affects people with an underlying lung condition or previous lung damage, although the immune system may otherwise be working normally.
Possible underlying conditions include bronchiectasis, chronic obstructive pulmonary disease (COPD), previous tuberculosis, sarcoidosis, emphysema, previous lung surgery and other causes of scarring or cavities in the lungs.
Read: What is aspergillosis? →
Different forms of CPA
CPA is an umbrella term. The names describe the pattern seen on scans and the way the condition behaves.
- Chronic cavitary pulmonary aspergillosis: cavities in the lungs which may change or enlarge over time.
- Chronic fibrosing pulmonary aspergillosis: more extensive scarring that can develop after long-standing cavitary disease.
- Aspergilloma: a fungal ball inside an existing lung cavity. It may cause few symptoms, but can be associated with coughing up blood.
- Aspergillus nodules: nodules which can sometimes resemble other conditions on a scan and may need further investigation.
Read more about aspergilloma and other forms of aspergillosis →
Symptoms of CPA
Symptoms often develop gradually and vary considerably. They may include:
- persistent cough, with or without sputum;
- fatigue, reduced energy or reduced stamina;
- breathlessness or chest discomfort;
- unintended weight loss or poor appetite;
- recurrent chest symptoms or infections; and
- coughing up blood.
Contact your clinical team if symptoms are new, worsening or different from your usual pattern. Seek urgent medical help for significant or repeated coughing up of blood, rapidly worsening breathlessness or severe illness.
Read more about symptoms of Aspergillus disease →
How is CPA diagnosed?
There is no single test for CPA. Clinicians bring together the history of symptoms, scan findings, evidence of Aspergillus infection or immune response, and other possible explanations for the lung changes.
Investigations may include CT scans or chest X-rays, blood tests for Aspergillus-specific antibodies, sputum testing and, in selected situations, bronchoscopy or tissue samples. The aim is to establish whether the scan changes and symptoms are due to CPA and to identify the form of disease.
Treatment and monitoring
Treatment is individual. It depends on the type and extent of CPA, symptoms, scan changes, other lung conditions, the risk of complications and the person’s general health.
Antifungal medicines are often important, but their duration and benefit vary. Treatment may also include airway clearance, management of other lung conditions, nutritional support, treatment for symptoms and procedures to manage significant bleeding. Surgery is considered only for selected situations, such as some single aspergillomas or nodules.
Regular monitoring helps the team understand whether treatment is helping and whether it is safe. This may include symptom review, blood tests, drug levels, liver tests, scans, lung function and sputum results.
Read more about treatment and management →
Living with CPA
CPA can affect daily life as much as it affects the lungs. Fatigue, breathlessness, repeated appointments, medication side effects and anxiety about scans or flare-ups can all take energy. Many people find that pacing, keeping a note of questions and symptoms, and using support from family, carers and other patients makes a real difference.
Common questions
Is CPA contagious?
No. CPA is not passed from person to person.
Does everyone with CPA need lifelong antifungal treatment?
No. Treatment is individual. Some people need long-term antifungal treatment or monitoring, while others may have different management needs. Your specialist team will review what is appropriate for you.
Can CPA be cured?
Some forms can be treated very effectively, but CPA is often managed as a long-term condition. The goals may include controlling infection, preventing progression, protecting lung function and improving quality of life.
Last reviewed: September 2026
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