Based on new international guidance (2024)
What is Aspergillus and Why Is It Important?
Aspergillus is a common type of fungus found in the environment. Most people breathe it in every day without any problem. However, if you have a lung condition or a weakened immune system, Aspergillus can cause serious problems. It can:
- Trigger allergic reactions in the lungs
- Infect damaged lung tissue
- Worsen symptoms like coughing, wheezing, or breathlessness
Until recently, doctors treated each type of aspergillus-related lung disease as a separate condition. But new guidance recognises that many patients may have more than one form or sit on a spectrum.
What Conditions Are Included?
The term “aspergillus-related chronic pulmonary disease” covers a range of conditions:
| Condition | What it means |
|---|---|
| ABPA (Allergic Bronchopulmonary Aspergillosis) | An allergic reaction to Aspergillus, usually in asthma or cystic fibrosis patients |
| CPA (Chronic Pulmonary Aspergillosis) | A slow-developing fungal infection, often in people with pre-existing lung damage |
| Aspergillus bronchitis | A fungal infection in the airways, often in people with bronchiectasis |
| Overlap syndromes | Some people show features of more than one of the above |
What Are the Symptoms?
Symptoms can vary, but common signs include:
- Persistent cough (sometimes with mucus or blood)
- Wheezing or breathlessness
- Fatigue and low energy
- Weight loss or loss of appetite
- Repeated chest infections
If you experience these symptoms and have an underlying lung condition, it’s important to ask whether Aspergillus might be involved.
How Is It Diagnosed?
Doctors now use a combination of tests to get a clearer picture:
- Chest CT scan – to look for signs of lung damage or fungal balls
- Sputum samples – to check for the presence of Aspergillus
- Blood tests – to detect allergic antibodies (IgE), immune responses (IgG), or fungal antigens
- Bronchoscopy (sometimes) – to collect samples directly from the lungs
These tests help doctors decide whether it’s an allergic reaction, an infection, or both.
How Is It Treated?
Treatment depends on your symptoms and test results. The aim is to:
- Reduce inflammation
- Clear fungal infection
- Prevent further lung damage
Common treatment options include:
| Treatment | Purpose |
| Steroids (e.g. prednisolone) | Reduce allergic inflammation (especially in ABPA) |
| Antifungal drugs (e.g. itraconazole, voriconazole) | Treat fungal infection and reduce fungal burden |
| Biologic therapies (e.g. omalizumab, dupilumab) | Used in difficult-to-treat allergic cases |
| Nebulised antibiotics | If other infections (like Pseudomonas) are also present |
| Surgery (rarely) | To remove fungal balls or damaged tissue in severe CPA |
What Has Changed in the 2024 Guidance?
- Doctors are now encouraged to look for overlapping features, not just one diagnosis.
- More emphasis is placed on early detection and preventing lung decline.
- Guidelines promote the use of multidisciplinary teams (MDTs) for complex cases.
- Newer treatments, including biologics, are being recommended more often.
- Patients with symptoms but unclear diagnoses should be re-evaluated regularly.
What Can You Do as a Patient?
- Know your diagnosis – Ask your team whether your current label still fits your symptoms
- Track your symptoms – Keep a log of cough, breathlessness, fatigue, and infections
- Ask about specialist referral – For example, to a National Aspergillosis Centre
- Stay informed – Visit aspergillosis.org for up-to-date guidance
- Take medications as prescribed and report any side effects promptly
Support and Information
- Patient support groups can help you connect with others
- Pulmonary rehabilitation and breathing therapy can improve quality of life
- Annual reviews and regular scans can help spot problems early
For more information, leaflets, and help getting the right care, visit: aspergillosis.org
You don’t have to manage this alone.
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