Fungal Rhinosinusitis
Last reviewed: 17 August 2026
Key points
- Fungal rhinosinusitis describes several different conditions in which fungi are present in, or affect, the nose and sinuses.
- Most fungal sinus disease is non-invasive: the fungus remains within mucus or the sinus cavity rather than growing into surrounding tissue.
- The main non-invasive forms are allergic fungal rhinosinusitis (AFRS), fungal ball and saprophytic fungal colonisation.
- AFRS is an inflammatory and allergic condition associated with fungi and commonly occurs with nasal polyps, asthma and other allergic disease.
- Diagnosis may involve CT scanning, nasal endoscopy, allergy and blood tests, and examination of material removed from the sinuses.
- Treatment depends on the type of fungal sinus disease and may include sinus surgery, saline irrigation, topical corticosteroids or removal of fungal material.
- Invasive fungal rhinosinusitis is different and much more serious. It usually occurs in people with major immune suppression or other important risk factors and requires urgent specialist treatment.
Table of contents
- Overview
- Symptoms
- Diagnosis
- Types of fungal rhinosinusitis
- Allergic Fungal Rhinosinusitis (AFRS)
- Fungal Ball
- Saprophytic Fungal Colonisation
- Invasive Fungal Rhinosinusitis
- Outlook and recurrence
- Common questions
- When to seek medical advice
- Author and review information
- References and further reading
Overview
The sinuses are air-filled spaces in the skull around the nose, cheeks and forehead. They connect with the nasal passages and are lined with a thin layer of mucus-producing tissue.
Fungi are widespread in the environment, and everyone breathes in fungal spores. Usually this causes no problem. In some people, however, fungi can grow within mucus or debris in the sinuses, or contribute to an inflammatory or allergic response.
The term fungal rhinosinusitis describes a group of conditions rather than one single disease.
An important distinction is whether the fungus is non-invasive or invasive.
- Non-invasive fungal rhinosinusitis – fungi remain within mucus, crusts or the sinus cavity and do not invade healthy surrounding tissue.
- Invasive fungal rhinosinusitis – fungal hyphae grow into sinus tissue and may spread into surrounding structures. This is much less common but can be very serious.
The main non-invasive forms are:
- Allergic Fungal Rhinosinusitis (AFRS)
- Fungal ball
- Saprophytic fungal colonisation
These conditions behave differently and require different treatment, so identifying the type of fungal sinus disease is important.
Symptoms
Symptoms vary according to the type and severity of sinus disease. Non-invasive fungal rhinosinusitis can resemble ordinary chronic rhinosinusitis.
Symptoms may include:
- blocked or congested nose
- difficulty breathing through the nose
- thick nasal mucus
- post-nasal drip
- reduced or lost sense of smell
- facial pressure or discomfort
- headaches
- recurrent sinus problems
- fatigue or disturbed sleep
Some people with a fungal ball have surprisingly few symptoms, whereas AFRS can cause extensive sinus inflammation and nasal polyps.
Diagnosis
Persistent or complicated sinus disease is usually assessed by an ear, nose and throat (ENT) specialist.
Depending on the suspected condition, investigations may include:
- CT scanning – to identify blocked or expanded sinuses, accumulated mucus and characteristic dense material within the sinuses
- nasal endoscopy – allowing an ENT specialist to examine the nasal cavity and sinus openings
- blood tests – including total IgE, fungal-specific IgE and eosinophil levels where AFRS is suspected
- allergy testing – using blood tests or skin-prick testing to look for sensitisation to fungi and other allergens
- laboratory examination of sinus material or tissue – particularly when material is removed during surgery
There is no single blood test that can diagnose all forms of fungal rhinosinusitis. Results have to be interpreted alongside symptoms, endoscopic findings and imaging.
Types of fungal rhinosinusitis
Allergic Fungal Rhinosinusitis (AFRS)
What is AFRS?
Allergic fungal rhinosinusitis (AFRS) is a form of chronic rhinosinusitis with nasal polyps in which fungi are associated with a strong allergic and type 2 inflammatory response.
The sinuses may contain very thick, eosinophil-rich mucus containing fungal hyphae. Importantly, however, the fungi do not normally invade the surrounding healthy tissue.
Aspergillus species can be involved, but AFRS may also be associated with other environmental fungi.
AFRS commonly occurs in people who:
- have nasal polyps
- have asthma or other allergic disease
- show sensitisation to fungi
- have a functioning immune system rather than severe immune suppression
How is AFRS diagnosed?
There is currently no single test that confirms AFRS. Diagnosis is based on a combination of clinical findings, imaging, evidence of allergic inflammation and, where available, examination of sinus material.
Doctors may use:
- nasal endoscopy to identify polyps and thick allergic mucus
- CT imaging to identify characteristic changes within affected sinuses
- total IgE and fungal-specific IgE
- eosinophil measurements
- allergy testing
- microscopy, histology or other examination of material removed from the sinuses
Diagnostic criteria for AFRS have been used since the 1990s, but our understanding of the condition has changed substantially. Researchers are now reassessing these criteria and looking for more practical ways to recognise AFRS and distinguish it from other forms of chronic rhinosinusitis.
Read more in our update on how the diagnosis of allergic fungal rhinosinusitis is changing.
Treatment of AFRS
For many people with established AFRS, endoscopic sinus surgery followed by ongoing medical treatment remains the mainstay of management.
Surgery can:
- remove thick allergic mucus and fungal material
- remove obstructing nasal polyps
- open blocked sinus cavities
- allow saline irrigation and topical medicines to reach the affected sinuses more effectively
- provide material for laboratory and pathological examination
Long-term treatment after surgery commonly includes saline irrigation and topical corticosteroids to control inflammation and reduce recurrence.
Systemic corticosteroids, allergen immunotherapy, antifungal treatment and other therapies may be considered in selected patients, but their roles vary and treatment should be individualised.
Biologic treatments
There is growing interest in biologic medicines that target particular parts of type 2 inflammation. Medicines such as dupilumab, mepolizumab and omalizumab are already used in conditions including severe asthma and chronic rhinosinusitis with nasal polyps.
Studies in AFRS have so far been much smaller than those for chronic rhinosinusitis with nasal polyps more generally, but recent systematic reviews have found encouraging improvements in symptoms and measures of inflammation in people with difficult-to-treat AFRS.
Biologics may therefore become increasingly useful for selected people with recurrent or difficult-to-control disease, although more research is needed to establish exactly where they fit alongside surgery and other treatments.
AFRS and allergic bronchopulmonary aspergillosis (ABPA)
Some people with AFRS also have allergic bronchopulmonary aspergillosis (ABPA). Both conditions involve an exaggerated immune response to fungi and can occur in people with asthma or other allergic disease.
In AFRS, the inflammatory response mainly affects the nose and sinuses. In ABPA, it mainly affects the lungs and airways.
Having one condition does not mean that a person will develop the other. However, recognising the possible overlap is important, particularly when someone has both persistent sinus disease and respiratory symptoms.
If someone with AFRS also has asthma, bronchiectasis, recurrent chest symptoms or markedly raised IgE, clinicians may consider whether assessment for ABPA is appropriate.
For more information, visit our ABPA Knowledge Hub.
Fungal Ball
Overview
A fungal ball is a dense collection of fungal hyphae and debris that develops within a sinus. The older term mycetoma is sometimes used, although fungal ball is clearer because mycetoma also describes a different type of fungal disease affecting skin and deeper tissues.
The fungus remains within the sinus cavity and does not invade the surrounding tissue.
Fungal balls often affect a single sinus, particularly the maxillary sinus in the cheek or the sphenoid sinus deeper in the skull. Aspergillus species are frequently found.
Some people have few symptoms, while others experience nasal blockage, discharge, facial pressure, headaches or recurrent sinus problems.
Diagnosis
CT scanning may show characteristic dense or calcified material within the affected sinus. Diagnosis is usually confirmed when the fungal material is removed and examined.
Treatment
Treatment is usually surgical removal of the fungal material and opening of the affected sinus so that it can drain normally.
Antifungal medicines are not usually needed for an uncomplicated fungal ball because the fungus has not invaded the surrounding tissue.
Saprophytic Fungal Colonisation
Overview
Saprophytic fungal colonisation occurs when fungi grow on mucus or crusts within the nasal cavity or sinus openings without invading the underlying tissue.
It may occur after sinus surgery or where persistent crusting and retained mucus provide material on which fungi can grow.
This is generally a relatively minor form of fungal sinus disease.
Treatment
Treatment usually involves removing fungal crusts and debris and improving nasal hygiene with saline irrigation or other measures recommended by the ENT team.
Antifungal medicines are usually not required.
Invasive Fungal Rhinosinusitis
Invasive fungal rhinosinusitis is very different from AFRS, fungal ball and saprophytic colonisation. In invasive disease, fungal hyphae grow into the tissues of the nose and sinuses and can spread into surrounding structures.
Acute invasive fungal rhinosinusitis occurs mainly in people whose immune defences are severely impaired, for example because of some blood cancers, chemotherapy, transplantation, profound neutropenia or other significant immune suppression. Poorly controlled diabetes, particularly with ketoacidosis, is also an important risk factor for some invasive fungal infections.
Symptoms can progress rapidly and may include severe facial pain or swelling, fever, nasal or facial tissue changes, visual symptoms, severe headache or neurological symptoms.
Suspected invasive fungal rhinosinusitis is a medical emergency requiring urgent specialist assessment. Treatment may involve urgent surgery, systemic antifungal medication and treatment of the underlying condition that has increased susceptibility to infection.
Outlook and recurrence
The outlook varies considerably between the different types of fungal rhinosinusitis.
Fungal balls and saprophytic fungal colonisation can usually be treated successfully once the fungal material has been removed.
AFRS is different because the underlying inflammatory tendency remains. Recurrence after treatment is common, so long-term ENT follow-up, topical treatment and monitoring may be required even after successful surgery.
For many people, a combination of surgery and ongoing medical treatment substantially improves nasal obstruction, sinus drainage and other symptoms.
Common questions
Is fungal sinusitis contagious?
No. Fungal rhinosinusitis is not normally passed from one person to another. The fungi involved are generally organisms that are already widespread in the environment.
Does finding fungus mean I have a fungal infection?
Not necessarily. Fungi can be present in the nose and sinuses without invading tissue. In AFRS, much of the disease results from the immune and inflammatory response associated with fungi rather than invasive fungal growth.
Do antifungal medicines always treat fungal sinusitis?
No. Treatment depends on the type of fungal rhinosinusitis. Antifungal medication is generally not required for an uncomplicated fungal ball or saprophytic colonisation, while AFRS management primarily focuses on surgery where necessary and control of inflammation. Invasive fungal disease is different and requires systemic antifungal treatment.
Is fungal rhinosinusitis linked to asthma?
AFRS is strongly associated with allergic disease, and many people with AFRS also have asthma. A smaller number may also have ABPA, in which a related allergic response to fungi affects the lungs.
Can AFRS come back after surgery?
Yes. AFRS has a significant tendency to recur. Surgery removes accumulated material and opens the sinuses, but it does not remove the underlying tendency towards inflammation. Long-term topical treatment and follow-up are therefore important.
Are biologics replacing sinus surgery?
Not at present. Biologic medicines are promising for some people with severe or recurrent AFRS, particularly when there is associated type 2 inflammatory disease such as asthma or nasal polyposis. However, surgery remains an important part of treatment for many patients with established AFRS.
When to seek medical advice
Speak to a healthcare professional if you have:
- sinus symptoms persisting for more than 12 weeks
- persistent nasal blockage
- recurrent sinus problems despite treatment
- significant loss of smell
- persistent facial pressure or pain
- asthma that becomes more difficult to control alongside worsening sinus disease
Seek urgent medical assessment for rapidly worsening facial pain or swelling, visual disturbance, severe headache, neurological symptoms or rapidly progressive sinus symptoms, particularly if you are significantly immunocompromised.
Author and review information
Author: Aspergillosis Website Editorial Team
Audience: Patients, carers, GPs and non-specialists
Last reviewed: 17 August 2026
References and further reading
- Roland LT, Damask C, Luong AU, et al. Allergic Fungal Rhinosinusitis Diagnosis, Management, Associated Conditions, Pathophysiology, and Future Directions: Summary of a Multidisciplinary Workshop. International Forum of Allergy & Rhinology. 2025;15(6):626-641. PubMed PMID: 40310935.
- Allergic Fungal Rhinosinusitis: A Contemporary Update. 2025. PubMed PMID: 40491076.
- Im YH, Stybayeva G, Hwang SH. Short-Term Efficacy of Biologics in Recalcitrant Allergic Fungal Rhinosinusitis: A Systematic Review and Meta-analysis. Otolaryngology–Head and Neck Surgery. 2025;173(4):840-847. PubMed PMID: 40552669.
- Aljubran HJ, Bamalan OA, Alfayez AA, et al. The evaluation of therapeutic outcomes of biologics in allergic fungal rhinosinusitis: a systematic review and meta-analysis. Rhinology. 2025;63(1):118-120. PubMed PMID: 39484735.
- Fokkens WJ, Lund VJ, Hopkins C, et al. European Position Paper on Rhinosinusitis and Nasal Polyps 2020. Rhinology. 2020;58(Suppl S29):1-464. PubMed PMID: 32077450.
- deShazo RD, Swain RE. Diagnostic criteria for allergic fungal sinusitis. Journal of Allergy and Clinical Immunology. 1995;96(1):24-35. PubMed PMID: 7622760.
Online Meeting Recordings
Our regular online meetings bring together people affected by aspergillosis, carers, families and members of the NAC CARES team. They are a chance to hear useful information, share experiences and feel less alone.
If you were unable to attend, or would like to revisit a subject, you can watch a growing collection of selected meeting recordings on our YouTube channel. We also bring together recent videos in short articles, making it easier to find information on a particular topic.
Watch recorded patient meetings on YouTube
Use the chapter timings
Many full meeting recordings include chapter timings in their YouTube descriptions. These let you jump directly to a subject that interests you, such as treatments, biologics, symptoms, research or practical support.
Look for the Chapters list below each video on YouTube. Select a time to start watching from that point.
Latest meeting recordings
Explore recent meeting articles and short video collections. New recordings will appear here as they are published.
- Making room for life alongside aspergillosis (8/28/2026)
- The Thursday Sessions: When Managing Treatment Becomes as Exhausting as Managing Illness (8/27/2026)
- The Thursday Sessions: Living with Aspergillosis Day to Day (8/21/2026)
- Finding Extra Support Beyond Aspergillosis: Groups for People with Lung Conditions (8/19/2026)
- The Future of Aspergillosis Care: Earlier Diagnosis, New Treatments and Personalised Support (8/19/2026)
- Electric Fans in Hot Weather: Helpful or Harmful? (8/19/2026)
What you can find
Recordings cover a range of subjects relevant to living with aspergillosis, including treatments, symptoms, associated lung conditions, self-management, research updates, and patient or carer experiences. Each YouTube video includes a description to help you decide whether it is relevant, with links to further information where available.
Join a future meeting
Live meetings are still the best way to ask questions, hear from others and take part in the conversation. You do not need to book to join.
Find out about upcoming online meetings
A note about the recordings
These recordings provide general information and shared experiences. They cannot replace advice from your own clinical team, who know your individual circumstances.
Some meetings are not recorded, and recordings may occasionally be edited or unavailable in order to protect privacy.
Support and community
Living with aspergillosis can feel isolating. The National Aspergillosis Centre (NAC) offers several ways for patients, carers, families and supporters to find reliable information, meet others who understand and stay connected.
Online meetings
Join our weekly informal support meetings or the longer monthly NAC support meeting.
Online community
Connect with others through our Facebook support group and Telegram discussion group.
Support for carers
Information and practical support for family members, friends and carers.
Support that fits your needs
You do not need to take part in everything. Some people prefer a live meeting; others find written information, a Facebook group, Telegram discussion or support for carers more useful. You are welcome to use whichever options feel right for you.
Our meetings and online communities offer information, peer support and a chance to share experiences. They do not replace advice from your own healthcare team.
Find mental health and emotional wellbeing support
What is Aspergillosis?
Aspergillosis is a group of illnesses caused by a common mould called Aspergillus. This mould is found naturally in the environment and releases microscopic spores into the air. We breathe in these spores every day without noticing.
Most people never become ill because their immune system clears the spores from the airways and lungs. However, in some people, especially those with asthma, other lung disease, or a weakened immune system, Aspergillus can cause allergic reactions, persistent airway problems, or infection.
This page is a starting point. It explains the basics and helps you find the most useful information elsewhere on this website.
Key Points
- Aspergillosis is caused by the mould Aspergillus.
- Aspergillus spores are common in the air and most people breathe them in every day.
- Most people do not become ill.
- Aspergillosis is not one single disease. It is a group of different conditions.
- Some forms are mainly allergic conditions; others are infections.
- The type of illness depends on your lungs, your immune system, and how your body reacts to the fungus.
New to Aspergillosis?
If you have recently been diagnosed, or your doctor suspects aspergillosis, these links may help you get started:
- Which type of aspergillosis do I have?
- How doctors diagnose aspergillosis
- Treatment and management
- Patient support meetings
- Search the Knowledge Hub
Where Does Aspergillus Come From?
Aspergillus is a mould that grows naturally in the environment. It may be found in soil, compost, decaying leaves, dust, and damp indoor areas. Because it is so common, its spores are often present in the air around us.
Most of the time this is not a problem. Healthy lungs and a healthy immune system usually remove the spores without difficulty. Problems can arise if the lungs are already damaged, the airways are sensitive, or the immune system is weakened or altered.
Aspergillosis Is a Group of Conditions
The word aspergillosis does not describe one single illness. It is an umbrella term for several related conditions caused by Aspergillus. The main difference between these conditions is the way the body reacts to the fungus.
Allergic Aspergillus Conditions
In some people, especially those with asthma or related airway disease, the immune system overreacts to Aspergillus. The fungus may not be invading tissue, but it can still trigger substantial inflammation and symptoms.
Chronic Aspergillus Infections
In other people, particularly those with pre-existing lung damage, Aspergillus can persist in the lungs and cause long-term infection or inflammation.
Severe or Invasive Infection
People with severely weakened immune systems can develop invasive aspergillosis, in which the fungus grows more aggressively and can become a medical emergency.
Who Is Most at Risk?
Most people breathe in Aspergillus spores without becoming ill. Risk increases when the lungs are already vulnerable or the immune system cannot respond in the usual way.
People who may be at higher risk include:
- people with asthma
- people with bronchiectasis
- people with chronic obstructive pulmonary disease (COPD)
- people who have had tuberculosis or other lung damage
- people with cystic fibrosis
- people taking medicines that suppress the immune system
- people whose immune systems are weakened by illness or medical treatment
What Symptoms Can Aspergillosis Cause?
Symptoms vary depending on the type of aspergillosis, but common symptoms may include:
- persistent cough
- breathlessness
- wheezing
- bringing up sputum or mucus plugs
- chest discomfort
- fatigue
- weight loss
- coughing up blood in some cases
These symptoms can overlap with many other lung conditions, which is one reason aspergillosis may take time to diagnose.
Why Can Aspergillosis Be Difficult to Diagnose?
Aspergillosis can be difficult to recognise because it is a group of conditions rather than one disease, and its symptoms often overlap with asthma, bronchiectasis, chronic lung infection, or other respiratory illnesses.
Doctors may use a combination of evidence, including symptoms, scans, blood tests, sputum results, and the patient’s medical history. One test alone is often not enough.
How Is Aspergillosis Treated?
Treatment depends on the type of aspergillosis. Some people need antifungal medicines. Others may need steroids, biologic drugs, airway clearance, monitoring, or a combination of treatments. Some conditions need long-term management rather than a short course of treatment.
Read more about treatment and management →
Living With Aspergillosis
Living with aspergillosis often involves more than treating the fungus itself. Many people also need help with fatigue, breathlessness, exercise, nutrition, anxiety, practical adjustments, and understanding how to reduce harmful exposures.
Support from other patients, carers, and specialist teams can make a real difference.
Support and Community
Being diagnosed with a rare condition can feel isolating. Many patients and carers find it helpful to speak to others who understand the challenges of living with aspergillosis.
Our support meetings and patient resources aim to provide reliable information, shared experience, and a sense of community.
Find out about our patient support meetings →
Common Questions
Is aspergillosis contagious?
No. Aspergillosis is not usually passed from one person to another.
Does everyone who breathes in Aspergillus get ill?
No. Most people breathe in spores regularly without becoming ill.
Is aspergillosis one disease?
No. It is a group of different conditions caused by Aspergillus.
Can aspergillosis be cured?
That depends on the type. Some forms can be treated effectively, while others need long-term monitoring and management.
Why have I never heard of it before?
Some forms of aspergillosis are uncommon, and many symptoms overlap with more familiar lung conditions. This can make diagnosis and awareness more difficult.
Where to Go Next
- Learn about the different types of aspergillosis
- Understand how doctors diagnose aspergillosis
- Explore treatment and management options
- Read about living with aspergillosis
- Search the Knowledge Hub for patient questions
Last reviewed: March 2026
Living with Aspergillosis
Living with aspergillosis often involves much more than managing a diagnosis or taking medication. It can affect energy, breathing, confidence, daily routines, work, relationships and emotional wellbeing. The experience varies greatly according to the type of aspergillosis, the health of the lungs, treatment and other medical conditions.
Some people have stable symptoms for long periods. Others experience flare-ups, infections, treatment changes, fatigue or uncertainty about what changing symptoms mean. This page brings together practical information and links to further support, with the aim of helping people maintain the best possible quality of life.
Key points
- Living with aspergillosis often means managing symptoms, treatment, monitoring and everyday practical challenges.
- Fatigue, breathlessness and cough can affect daily life as much as the diagnosis itself.
- Good management may include pacing, symptom monitoring, medicine safety, infection prevention and support from others.
- Mental and emotional wellbeing matter just as much as physical symptoms.
- Support from clinicians, carers, family and patient communities can all play an important part.
Contents
- Daily life with aspergillosis
- Managing symptoms, fatigue and activity
- Medicines, treatment and monitoring
- Work, travel and practical support
- Mental health, relationships and support
- Home environment and exposure
- When to seek medical advice
- Common questions
Daily life with aspergillosis
Even when symptoms are not dramatic, aspergillosis can affect daily life in ways that are easy for others to underestimate. Breathlessness may make ordinary tasks harder; fatigue can be out of proportion to what someone has done. Long-term cough, mucus production, disrupted sleep and the emotional strain of a rare disease can all add up.
Some people also have asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD) or other conditions that make symptoms and treatment more complex. The aim of care is not only to control disease, but also to support independence, confidence and quality of life.
Managing symptoms, fatigue and activity
Long-term symptoms can continue even when aspergillosis is being treated or monitored. Common challenges include breathlessness, cough, sputum, fatigue, chest discomfort, reduced exercise tolerance, sleep disruption, repeated infections or flare-ups, and anxiety about the future.
Fatigue and energy
Fatigue is one of the most common and frustrating parts of living with aspergillosis. It can have many causes, including inflammation, poor sleep, breathlessness, infection, coughing, medication effects and the effort of living with a long-term condition.
Many people find it helpful to think in terms of conserving and pacing energy rather than trying to push through without limits.
- Plan the day around the most important tasks.
- Break activities into smaller steps.
- Rest before becoming completely exhausted.
- Avoid the cycle of overdoing things on a better day and then crashing afterwards.
- Track patterns to understand what worsens fatigue.
Breathlessness, cough and activity
Breathlessness can be caused by aspergillosis, underlying lung disease, deconditioning, or a combination of these. Persistent cough, thick mucus and repeated chest symptoms can also be a major burden. Management depends on the person: better control of inflammation, airway-clearance techniques, hydration or treatment of infection may each be important.
Where appropriate, gentle, steady activity can help maintain strength, confidence, fitness and independence. The right level varies from person to person and may change during a flare-up or infection.
- Pace activity and take breaks before symptoms become overwhelming.
- Use breathing techniques if these have been taught by a clinician or physiotherapist.
- Build activity gradually rather than aiming for sudden large increases.
- Ask about pulmonary rehabilitation or other supervised support if that may be helpful.
If cough, sputum or wheeze changes noticeably, consider whether this could reflect a flare-up, another infection, a treatment issue or progression of the underlying condition.
Medicines, treatment and monitoring
Sometimes the challenge is not only the disease itself, but the work involved in managing it. People may need repeat prescriptions, inhalers, antifungal medicines, biologic therapies, antibiotics, blood tests, scans and discussions with several different clinicians.
Understanding why each medicine is prescribed, how it should be taken, and what side effects or interactions to watch for can help people work more effectively with their healthcare team. Never stop or change prescribed medicines without discussing it with a healthcare professional, especially corticosteroids, antifungals or treatments for severe asthma or allergic bronchopulmonary aspergillosis.
Useful topics include:
Monitoring your condition
It is often helpful to notice patterns over time rather than focusing only on one bad day. A symptom diary can make appointments more useful and help identify whether symptoms are stable, gradually changing or fluctuating.
- Cough, breathlessness and sputum changes
- Fatigue, sleep and weight
- Episodes of wheeze, infection or flare-up symptoms
- Medication changes or possible side effects
- Any coughing up of blood
Depending on the condition, clinicians may use blood tests, CT scans, lung-function tests or, for selected patients, oxygen-saturation monitoring.
Work, travel and practical support
Aspergillosis can affect employment, finances, insurance, travel, family life and independence. Practical support may include workplace adjustments, benefits advice, travel planning, medical letters, vaccination planning and help from local support organisations.
Planning ahead can make a meaningful difference, especially for holidays, insurance, medication supplies, oxygen requirements or specialist appointments.
- Travel with aspergillosis
- Vaccines and infection prevention
- Fatigue and aspergillosis
- Pulmonary rehabilitation
Nutrition and general health
Long-term lung illness can affect appetite, weight, strength and recovery. Good nutrition supports strength and resilience, even though it does not replace medical treatment. Discuss unintended weight loss or poor appetite with a clinician.
Mental health, relationships and support
Living with a rare or poorly understood illness can be mentally exhausting. People may feel anxious, isolated, frustrated, low in mood or uncertain about the future. These reactions are understandable; they do not mean someone is coping badly.
Helpful approaches may include talking openly with trusted family, friends or other patients, keeping questions for appointments, breaking problems into manageable steps and seeking support if low mood or anxiety becomes persistent or overwhelming.
Carers, family and relationships
Aspergillosis affects more than the person with the diagnosis. Partners, family members and carers may be balancing practical support, worry and changing roles. Their needs for information, support and validation matter too.
Finding support
Support can come from specialist clinics, GPs, pharmacists, respiratory teams, specialist nurses, family, friends and patient communities. Peer support does not replace medical advice, but it can reduce isolation and help people share practical coping ideas.
Find out about support, community and online meetings →
Home environment and exposure
Because Aspergillus is common in the environment, complete avoidance is neither possible nor usually the aim. It is more realistic to reduce unnecessary heavy exposure.
- Avoid obvious mould growth in the home.
- Address damp and poor ventilation where possible.
- Be cautious around compost, decaying plant material and dusty environments.
- Use sensible precautions when exposure is hard to avoid.
For practical advice on damp, mould and housing concerns, visit our Damp, Mould and Housing hub.
Search the Knowledge Hub for detailed questions on mould, home environment and exposure.
When to seek medical advice
Seek medical advice if symptoms are changing in a concerning way, especially if you experience:
- New or worsening breathlessness
- Significant or repeated coughing up of blood
- Rapid worsening of cough or sputum
- Chest pain, high fever or severe illness
- Unexplained weight loss or marked deterioration
- Possible serious side effects from treatment
- Symptoms that feel significantly different from your usual pattern
It is better to ask than to sit with uncertainty. In an emergency, use local urgent or emergency medical services.
Common questions
Will I always feel this tired?
Not necessarily. Fatigue can improve, fluctuate or persist depending on the condition, treatment response and other factors. It is worth discussing because it matters greatly to quality of life.
Should I avoid exercise?
Not usually altogether. The right level depends on symptoms, oxygen levels, other health conditions and medical advice. Many people benefit from paced, sensible activity rather than complete avoidance or sudden overexertion.
Do I need to avoid all mould exposure?
Complete avoidance is not realistic. The usual aim is to reduce obvious or heavy exposure where practical.
Can support groups really help?
Many people find support groups helpful, both emotionally and practically. They can reduce isolation and improve confidence in managing a long-term condition.
Where to go next
- What is Aspergillosis?
- Diagnosis of Aspergillosis
- Treatment and Management
- Which type of aspergillosis do I have?
- Support and community
- Search the Knowledge Hub
Last reviewed: August 2026
Treatment and Management of Aspergillosis
Treatment for aspergillosis depends on the type of condition, how severe it is, and the health of the person affected. Aspergillosis is not one single disease, so there is no single treatment plan that suits everyone.
Some people need antifungal medicines. Others need treatment to control inflammation, improve asthma, clear mucus, or manage symptoms such as fatigue and breathlessness. Many people need a combination of treatments and regular monitoring over time.
This page gives an overview of the main approaches used to treat and manage aspergillosis.
Key Points
- Treatment depends on the type of aspergillosis.
- Some treatments target the fungus itself, while others target the body’s inflammatory or allergic response.
- Many patients need long-term monitoring even if they are not on continuous treatment.
- Symptom management is an important part of care.
- Drug interactions and side effects can be an important part of treatment planning.
The Main Goals of Treatment
The aims of treatment may include one or more of the following:
- reducing the amount of fungal growth
- controlling inflammation or allergic reactions
- improving breathing and quality of life
- preventing further lung damage
- monitoring the condition over time
- treating flare-ups or complications
The balance between these goals depends on whether the person has allergic disease, chronic infection, invasive infection, or a mixture of problems.
Treatment Depends on the Type of Aspergillosis
Allergic Aspergillus conditions
In conditions such as Allergic Bronchopulmonary Aspergillosis (ABPA) and Severe Asthma with Fungal Sensitisation (SAFS), treatment often aims to reduce inflammation, control asthma symptoms, and sometimes reduce fungal burden in the airways.
Chronic Aspergillus lung disease
In conditions such as Chronic Pulmonary Aspergillosis (CPA), Aspergillus bronchitis and aspergillus nodules, treatment may focus more on antifungal therapy, monitoring scans and blood results, and managing symptoms over time.
Invasive aspergillosis
Invasive aspergillosis is a serious infection that usually needs urgent antifungal treatment and specialist medical care.
Antifungal Medicines
Antifungal medicines are used to treat or suppress fungal disease. They may be used in chronic infection, invasive infection, and sometimes as part of treatment in allergic disease.
Common antifungal medicines include:
- itraconazole
- voriconazole
- posaconazole
- isavuconazole
- amphotericin B in some settings
Not every antifungal is suitable for every patient. The choice depends on the condition being treated, the likely benefits, side effects, other medications, liver function, kidney function, and whether there is concern about antifungal resistance.
Steroids and Other Anti-inflammatory Treatment
Some forms of aspergillosis, especially allergic disease, are driven not only by the fungus but by the body’s immune response to it. In these situations, treatment may include medicines that reduce inflammation.
These may include:
- inhaled steroids
- oral steroids in some situations
- other treatments aimed at reducing airway inflammation
The aim is often to reduce symptoms such as wheeze, cough, mucus production and flare-ups.
Biologic Medicines
Some patients with severe asthma or allergic Aspergillus disease may be treated with biologic medicines. These drugs target specific parts of the immune system involved in inflammation.
Biologics may be considered when symptoms remain difficult to control, when steroid side effects are a concern, or when the pattern of disease suggests a strong allergic or eosinophilic component.
The decision to use a biologic depends on the clinical picture, previous treatment response and specialist assessment.
Monitoring During Treatment
Monitoring is an important part of aspergillosis care. Even when treatment is helping, doctors often need to follow progress over time.
Monitoring may include:
- review of symptoms
- blood tests
- drug levels for some antifungal medicines
- liver function or other safety blood tests
- repeat CT scans or chest imaging
- sputum tests in some patients
This helps the clinical team judge whether treatment is working, whether side effects are developing, and whether the plan needs to change.
Side Effects and Drug Interactions
Treatment planning is not only about whether a medicine might help. It is also about whether it is safe and practical for the individual person.
Some antifungal medicines can interact with other common drugs. Some can affect the liver, heart rhythm, or levels of other medicines in the body. This is one reason treatment may need adjustment and careful monitoring.
Patients should tell their clinical team about all prescription medicines, over-the-counter medicines and supplements they take.
Surgery and Other Procedures
Most patients with aspergillosis are treated medically, but in some situations surgery or another procedure may be considered. This depends on the type of disease and the problem being treated.
Examples may include:
- surgery for selected aspergillus nodules
- procedures related to significant bleeding
- specialist management of complications in selected cases
These decisions are usually made by specialist teams.
Managing Symptoms and Daily Life
Treatment is not only about fighting the fungus. Many people also need help with the everyday impact of the condition.
Important parts of management may include:
- managing fatigue
- breathlessness and pacing
- nutrition
- airway clearance in some conditions
- support for anxiety, uncertainty or long-term illness
Read more about living with aspergillosis →
When Treatment May Change
Treatment plans may change over time. For example:
- if symptoms improve or worsen
- if scan findings change
- if side effects occur
- if blood tests show a different pattern
- if another health condition affects what treatment is safe
Aspergillosis management is often a process of review and adjustment rather than a single fixed plan.
Common Questions
Will I need treatment forever?
Not always. Some people need treatment for a limited time, while others need long-term therapy or monitoring. This depends on the type of aspergillosis and how it behaves over time.
Do antifungal medicines cure aspergillosis?
They can be very helpful, but the answer depends on the condition. In some cases they suppress disease, improve symptoms, or slow progression rather than providing a simple one-off cure.
Why are blood tests needed during treatment?
Blood tests may be used to monitor safety, check drug levels, and help assess how the disease is responding.
Why might treatment focus on inflammation rather than only the fungus?
Because in allergic disease the body’s immune response may be causing much of the problem. In those cases, reducing inflammation can be just as important as reducing fungal burden.
Where to Go Next
- What is Aspergillosis?
- Which Type of Aspergillosis Do I Have?
- Diagnosis of Aspergillosis
- Living with Aspergillosis
- Search the Knowledge Hub
Last reviewed: March 2026
Diagnosis of Aspergillosis
Diagnosing aspergillosis can be challenging. This is because aspergillosis is not one single disease, and because its symptoms often overlap with asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD), bacterial infection and other lung conditions.
Doctors usually diagnose aspergillosis by combining several different types of information. These may include symptoms, scans, blood tests, sputum results and a person’s underlying lung or immune condition. One test alone is often not enough.
This page gives an overview of how aspergillosis is diagnosed and explains the main types of evidence doctors use.
Key Points
- Diagnosis usually depends on a combination of evidence rather than one single test.
- The tests used depend on the type of aspergillosis being considered.
- Some tests look for the fungus itself, while others look for the body’s immune response.
- Scans are often very important, especially in chronic lung disease.
- Diagnosis may take time because results need to be interpreted together.
Why Diagnosis Can Be Difficult
Aspergillosis can be difficult to diagnose for several reasons. Many symptoms are non-specific, including cough, fatigue, breathlessness and sputum production. Some people already have pre-existing lung disease, which can make it harder to know what is causing their symptoms.
In addition, different forms of aspergillosis need different types of evidence. For example, allergic conditions such as Allergic Bronchopulmonary Aspergillosis (ABPA) rely heavily on blood tests and clinical history, while chronic infections such as Chronic Pulmonary Aspergillosis (CPA) often depend strongly on CT findings and longer-term changes in the lungs.
The Main Streams of Evidence
Doctors often build the diagnosis from several streams of evidence:
- Symptoms and clinical history – what symptoms are present, how long they have been there, and whether there is asthma, bronchiectasis, previous tuberculosis, immune suppression or other risk factors
- Imaging – chest X-rays and especially CT scans can show cavities, nodules, mucus plugging, bronchiectasis or other patterns that support the diagnosis
- Blood tests – these may look for immune responses to Aspergillus, such as raised Immunoglobulin E (IgE), Aspergillus-specific antibodies, or markers of inflammation
- Sputum or airway samples – these may detect Aspergillus growing in the airways or identify fungal material using culture or molecular tests
- Underlying health factors – the state of the immune system and lungs often helps determine which type of aspergillosis is most likely
Symptoms and Medical History
The starting point is often the person’s symptoms and medical background. Doctors may ask about:
- persistent cough
- breathlessness
- wheezing
- fatigue
- weight loss
- coughing up mucus or blood
- history of asthma, bronchiectasis or previous lung infection
- medicines that weaken the immune system
These details help doctors decide which tests are most useful and which form of aspergillosis may be present.
Imaging: CT Scans and Chest X-rays
Imaging is often central to diagnosis, especially in chronic lung disease. CT scans can show much more detail than a standard chest X-ray.
Depending on the condition, imaging may show:
- mucus plugging in the airways
- bronchiectasis
- cavities in the lungs
- aspergillus nodules
- areas of inflammation or infection
These findings need to be interpreted alongside the rest of the clinical picture.
Blood Tests
Blood tests are often used to look for the body’s immune response to Aspergillus or for evidence that supports infection or allergy.
Tests may include:
- Total Immunoglobulin E (IgE) – often important in allergic disease
- Aspergillus-specific IgE – helps support allergic sensitisation
- Aspergillus Immunoglobulin G (IgG) – often useful in chronic infection
- Eosinophils – may be raised in allergic conditions
- Inflammatory markers – sometimes used as part of the wider assessment
Different blood tests matter more in different conditions. For example, allergic conditions rely more on Immunoglobulin E (IgE) and eosinophils, while chronic infection often relies more on Aspergillus Immunoglobulin G (IgG) and imaging.
Sputum and Airway Samples
Sputum can sometimes provide direct evidence of Aspergillus in the airways. Samples may be examined in different ways, including fungal culture and molecular tests.
However, interpretation can be difficult. Finding Aspergillus in sputum does not always prove that it is causing disease, because some people may breathe in spores or have the fungus present without it being the main cause of symptoms. This is why sputum results are interpreted alongside the rest of the evidence.
Tests for the Fungus vs Tests for the Immune Response
Some tests try to detect parts of the fungus itself. Others look at how the body is reacting to the fungus.
Tests looking for the fungus may include sputum culture, microscopy, molecular tests and some fungal biomarkers.
Tests looking at the immune response may include total Immunoglobulin E (IgE), Aspergillus-specific Immunoglobulin E (IgE), Aspergillus Immunoglobulin G (IgG), and eosinophil counts.
Both types of evidence matter, but the balance depends on whether the doctor is considering allergic disease, chronic infection or invasive infection.
Diagnosis in Different Types of Aspergillosis
Allergic disease
In conditions such as Allergic Bronchopulmonary Aspergillosis (ABPA) and Severe Asthma with Fungal Sensitisation (SAFS), diagnosis often depends on a combination of asthma or airway disease, blood test results and imaging.
Chronic infection
In conditions such as Chronic Pulmonary Aspergillosis (CPA), Aspergillus bronchitis and aspergillus nodules, diagnosis often depends on symptoms over time, imaging findings and supportive microbiology or antibody results.
Invasive infection
Invasive aspergillosis is usually considered in people who are very unwell or severely immunocompromised. In this setting, diagnosis may need to happen quickly using scans, laboratory tests and the overall clinical picture.
Why Diagnosis Sometimes Takes Time
Many people feel frustrated when diagnosis is not immediate. This is understandable. Aspergillosis often requires careful interpretation of several test results together, and doctors may need to monitor symptoms, repeat scans, or wait for laboratory results before reaching a firm conclusion.
In some cases, the diagnosis becomes clearer over time rather than at a single appointment.
Common Questions
Can one blood test diagnose aspergillosis?
Usually not. Blood tests are important, but they are normally interpreted together with symptoms, scans and other results.
Why do I need a CT scan?
CT scans can show details in the lungs that are not visible on a standard chest X-ray and are often very important in chronic aspergillus lung disease.
If Aspergillus is found in my sputum, does that prove I have disease?
Not always. It can be an important clue, but it needs to be interpreted in context.
Why do different doctors mention different tests?
Because the most useful tests vary depending on whether they are considering allergic disease, chronic infection or invasive infection.
Where to Go Next
- What is Aspergillosis?
- Which Type of Aspergillosis Do I Have?
- Symptoms of Aspergillus Disease
- Treatment and Management
- Search the Knowledge Hub
Last reviewed: March 2026
Which Type of Aspergillosis Do I Have?
Aspergillosis is not a single disease. It is a group of conditions caused by the fungus Aspergillus. The type of illness someone develops depends mainly on how their immune system reacts to the fungus and on the health of their lungs.
This page explains the main types of aspergillosis and helps you find the information most relevant to your diagnosis.
Key Points
- Aspergillosis includes several different conditions.
- Some forms are mainly allergic reactions to the fungus.
- Other forms are chronic infections in the lungs.
- Rarely, severe infections occur in people with weakened immune systems.
- Your doctor will determine the type using symptoms, scans, blood tests, and other investigations.
Main Types of Aspergillosis
The main forms of aspergillosis fall into three broad groups.
Allergic Aspergillus Conditions
In some people the immune system reacts strongly to Aspergillus spores. This causes inflammation in the airways rather than an invasive infection.
These conditions are most often seen in people with asthma or related airway diseases.
Common features may include:
- worsening asthma symptoms
- wheezing
- cough with mucus plugs
- high levels of IgE in blood tests
Chronic Aspergillus Lung Disease
In people whose lungs have already been damaged by previous illness, Aspergillus can sometimes persist and cause a long-term infection or inflammation.
This group includes:
Common features may include:
- persistent cough
- fatigue
- weight loss
- breathlessness
- abnormal lung scans
These conditions often require long-term monitoring and antifungal treatment.
Invasive Aspergillosis
Invasive aspergillosis is a more severe infection that occurs mainly in people whose immune systems are severely weakened.
This may include people who:
- have recently had chemotherapy
- have had organ or stem cell transplants
- are receiving strong immune-suppressing medicines
- are critically ill in hospital
This form of aspergillosis requires urgent medical treatment.
Read more about invasive aspergillosis →
Other Aspergillus Conditions
Some people may develop related conditions affecting other parts of the body.
- Aspergillus sinusitis
- Allergic fungal rhinosinusitis
- Aspergillus skin infections (rare)
Not Sure Which Type You Have?
If you are unsure which form of aspergillosis you have, you may find it helpful to:
- look at clinic letters from your specialist
- check the name of the diagnosis written in your records
- ask your doctor or nurse directly which form they are treating
Because several tests are often needed, the exact diagnosis may sometimes take time.
Where to Go Next
- What is Aspergillosis?
- How Aspergillosis is Diagnosed
- Treatment and Management
- Patient Support Meetings
- Search the Knowledge Hub
Last reviewed: March 2026
Aspergillosis topics
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Types of aspergillosis
Learn about the different conditions caused by, or associated with,
Aspergillus.
Diagnosis, symptoms and associated conditions
Understand tests, scans and symptoms, and explore how asthma, bronchiectasis, COPD and other respiratory conditions can overlap with aspergillosis.
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complementary approaches.
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Practical support for daily life, emotional wellbeing, travel, your
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developments in aspergillosis research.
Damp, Mould and Housing.
Damp, mould and poor ventilation can worsen respiratory symptoms and make life with a long-term lung condition harder. This hub brings together practical, evidence-based information for people with aspergillosis, their families and carers.
The aim is not to suggest that every damp home causes aspergillosis. Aspergillus is common in the environment, and most exposure does not cause infection. However, persistent damp and mould should be taken seriously, particularly when symptoms are worsening or someone has asthma, bronchiectasis, COPD, a weakened immune system or another lung condition.
Start here
- Damp, mould and health in 2026: what we know and what people can do
- Why damp-home exposure does not usually mean you have aspergillosis
- Damp, mould and aspergillosis in rented homes
- Verified UK resources for damp, mould and health
What you will find here
- Recognising damp, condensation and mould problems
- Reducing exposure sensibly at home
- Advice for tenants, landlords and housing providers
- Indoor air quality, ventilation and practical prevention
- What the evidence says—and how to avoid misleading tests or “detox” claims
For wider advice on gardening, compost, air quality, masks, travel and other environmental exposures, see Prevention & Environment.
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