Other forms of aspergillosis: 🛡️ Tracheobronchial Aspergillosis (TBA), A Rare Airway Form of Aspergillus Infection

🌿 What is Tracheobronchial Aspergillosis?

Tracheobronchial aspergillosis (TBA) is a rare type of aspergillosis that affects the large airways (the trachea and bronchi), rather than the deeper parts of the lungs. It happens when Aspergillus, a common environmental mould, starts to grow in the airways, either sitting in mucus or, in severe cases, invading the airway wall itself.

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❗How Rare Is It?

TBA is uncommon — even among people who already have aspergillosis.
It is mostly seen in:

• Very unwell hospitalised patients

• People with severe immune suppression

• Patients in intensive care units (ICU)

🧠 If you have ABPA, CPA, asthma, or chronic sinus issues, your risk of developing TBA is usually very low, unless your immune system becomes severely weakened.

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🔍 What Causes It?

The Aspergillus fungus is found everywhere — but in some people with weak defences, it can take hold in the airways. Depending on the type and severity, this can cause:

• Thick fungal mucus or plugs in the airways

• Persistent coughing or wheezing

• Breathlessness

• In serious cases, damage to the airway lining or even bleeding

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🚨 Who Is Most at Risk?

People most at risk of invasive or serious TBA include those who are:

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🧬 What About People with CPA, ABPA, or Asthma?

Many people living with:

• Chronic Pulmonary Aspergillosis (CPA)

• Allergic Bronchopulmonary Aspergillosis (ABPA)

• Asthma with fungal sensitisation (SAFS)

…may worry that Aspergillus in their lungs or sinuses could spread to their airways.

🟢 Good news: TBA is not common in these groups unless:

• You become severely immunocompromised (e.g. after a transplant or due to high-dose steroids)

• You are admitted to ICU or receive strong immunosuppressive therapy

If you are on replacement doses of steroids (e.g. for adrenal insufficiency) or biologics for asthma, your risk is generally low, especially if you are also on antifungal treatment when needed.

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🧪 How Is TBA Diagnosed?

Doctors may consider TBA if someone at risk develops:

• New or worsening cough

• Mucus that won’t clear

• Breathing difficulties

• Signs of bleeding in the airways

Diagnosis may involve:

• Bronchoscopy (looking into the lungs with a camera)

• Bronchoalveolar lavage (BAL) to test for Aspergillus DNA or galactomannan

• CT scans of the chest

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💊 How Is TBA Treated?

Treatment depends on whether the infection is simply growing in mucus or is invading tissue:

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✅ Summary for Aspergillosis Patients

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🧠 Final Advice

If you have any form of aspergillosis, it’s important to work closely with your clinical team. Most people will never develop TBA. But if you are on strong immune-suppressing treatment or become very unwell in hospital, make sure your team is aware of your history. With careful monitoring and the right treatment, outcomes can be good.

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