Tremor (Shaking) in Aspergillosis, Asthma, COPD and TB: Causes, Meaning and When to Seek Help

Last reviewed: 16 April 2026
For: Patients, carers, general practitioners, nurses and non-specialists
Topic: Tremor (shaking) in aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) and tuberculosis (TB)

Shaking or tremor can feel alarming, but in most people with lung conditions it has a clear and manageable cause.

Key points

• A tremor is a shaking movement, usually affecting the hands.
• In people with aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB), tremor is usually not caused by the lung condition itself.
• The most common causes are medications, breathlessness, stress, fatigue, weakness, or an unrelated tremor condition such as essential tremor.
• Reliever inhalers such as salbutamol commonly cause a fine shaking of the hands.
• Antifungal medicines can sometimes contribute to tremor directly or through drug interactions.
• Biologic treatments used for severe asthma are not usually a cause of tremor and may sometimes reduce tremor indirectly by lowering steroid or reliever inhaler use.
• Most tremors in this setting do not mean the underlying disease is worsening.
• A new tremor should still be mentioned to a healthcare professional, especially if it is worsening, happens at rest, or comes with stiffness, slowness or balance problems.

Contents

• What is a tremor?
• Why can it happen in lung conditions?
• What sort of tremor might it be?
• What is essential tremor?
• Is it Parkinson’s disease?
• Do biologics play a part?
• Will it get worse?
• What can help?
• When to seek medical advice
• Common questions
• References

If you are newly diagnosed, you may find it helpful to start with our overview of what aspergillosis is and how it affects the lungs, as well as our broader guide to information for patients and carers.

What is a tremor?

A tremor is an involuntary shaking movement. It most often affects the hands, but it can also affect the head, jaw or voice. People may notice it when holding a cup, using cutlery, writing, typing, or holding their arms out in front of them.

Tremor can be worrying, especially if it is new. Some people fear it means their infection is spreading, their lungs are failing, or they are developing Parkinson’s disease. In most people with respiratory conditions, that is not the case.

Why can it happen in lung conditions?

For most people with aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB), tremor is usually explained by one or more of the following:

1. Medications

This is the most common explanation. Reliever inhalers such as salbutamol are well known to cause a fine tremor, especially in the hands. Steroids can also make people feel shaky, wired, weak or restless. In people with aspergillosis, antifungal medicines such as itraconazole or voriconazole may sometimes contribute to tremor or make it more noticeable, particularly if they interact with other medicines.

If you are taking antifungal medication, you may also find it helpful to read our guide to antifungal treatments and side effects, including how different drugs can interact with each other.

2. Breathlessness, stress and adrenaline

When the body is under strain, trembling can become more noticeable. Breathlessness, anxiety, poor sleep, infection, inflammation and exhaustion can all amplify the body’s normal background tremor.

3. Fatigue and muscle weakness

Muscles that are tired or weakened tend to shake more easily. This can happen in chronic respiratory disease, after infections, during recovery, or after long periods of reduced activity.

People living with long-term conditions such as Chronic Pulmonary Aspergillosis (CPA) may experience fatigue and reduced muscle strength, both of which can make tremor more noticeable.

4. An unrelated tremor condition

Some people have a separate condition such as essential tremor. This may have been mild for years and only become noticeable during a period of illness, stress, treatment changes or increased reliever inhaler use.

5. Less common neurological causes

Less commonly, tremor may be due to a neurological condition such as Parkinson’s disease or to another medical problem such as thyroid disease, low blood sugar, or medication side effects from medicines unrelated to the lungs. This is why a new tremor should not be ignored, even though the cause is often straightforward.

What sort of tremor might it be?

The type of tremor can give useful clues.

Action or postural tremor

This is the most common type in people with lung disease. It appears when using the hands or holding them in a position, such as lifting a drink, eating, writing, or stretching the arms out. This pattern often fits tremor linked to salbutamol, stress, fatigue, steroids, or essential tremor.

Enhanced physiological tremor

Everyone has a tiny natural tremor. Illness, adrenaline, fatigue, caffeine, poor sleep, fever, pain and some medicines can make it much more obvious. This often causes a fine, fast, variable shakiness.

Essential tremor

This is a common neurological condition that usually causes shaking during movement or when holding a posture. It often affects both hands and may slowly become more noticeable over time.

Rest tremor

This happens when the hand is fully relaxed and not being used. A true rest tremor is less typical of inhaler- or stress-related shaking, so it deserves more careful assessment.

What is essential tremor?

Essential tremor is one of the most common movement disorders. It usually affects both hands, although one side can be worse than the other. It tends to happen during action rather than complete rest. Some people also notice tremor of the head or voice.

Essential tremor is not caused by aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB). However, illness, tiredness, anxiety, reliever inhalers and medication changes can all make an underlying essential tremor more obvious.

For many people, essential tremor remains mild for years. It can slowly worsen over time, but it does not usually turn into Parkinson’s disease.

Is it Parkinson’s disease?

Most tremor in respiratory patients is not Parkinson’s disease. Parkinson’s disease usually causes a different pattern, often with tremor at rest, stiffness, slowness, reduced arm swing, or changes in walking. A tremor that only happens after inhaler use or when someone is tired, anxious or unwell is less suggestive of Parkinson’s disease.

That said, not every tremor in a person with lung disease should be blamed on medications. If the tremor is clearly happening at rest, is becoming more obvious over time, or is linked with stiffness or slowed movement, it should be assessed properly.

Do biologics play a part?

Biologic treatments used for severe asthma and some cases of Allergic Bronchopulmonary Aspergillosis (ABPA), such as omalizumab, mepolizumab, benralizumab and dupilumab, are not usually associated with tremor. They are much less likely to cause shaking than reliever inhalers or steroids.

If you are receiving advanced asthma treatments, you can read more in our guide to biologic therapies for asthma and ABPA, which explains how these treatments work and what side effects to expect.

In practice, biologics may sometimes help indirectly. If they improve asthma control, reduce flare-ups, lower oral steroid use, or reduce the need for frequent salbutamol, tremor may improve rather than worsen.

If someone develops shaking while on a biologic, it is usually sensible to look first at the broader picture: reliever inhaler use, steroid dose, antifungal treatment, other medicines, fatigue, anxiety, and whether the tremor started after a different medication change.

Will it get worse?

Often, the answer is reassuring: not necessarily.

If the tremor is linked to salbutamol or another medicine

It may improve once the dose is reduced, the timing is adjusted, the medicine is changed, or the underlying breathing problem is better controlled. Some medication-related tremors fluctuate rather than steadily worsening.

If the tremor is linked to illness, fatigue or stress

It often comes and goes. It may be worse during flare-ups, infections, poor sleep, low mood, pain or periods of worry, and better on good days.

If it is essential tremor

Essential tremor can slowly progress over time, but this usually happens over years rather than days or weeks. Many people remain stable for long periods.

If it is Parkinson’s disease or another neurological cause

That requires separate assessment. It is much less common than action tremor related to medicines or illness in respiratory patients, but it should be considered when the pattern fits.

Overall, a tremor does not usually mean aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB) is worsening in the lungs.

If your symptoms have been difficult to control, it may also help to read why chest infections do not always improve with antibiotics, particularly in conditions such as aspergillosis.

What can help?

• Notice when the tremor happens: after inhalers, when tired, during stress, or all the time.
• Keep a note of recent treatment changes, including inhalers, steroids, antifungals and any new tablets.
• Check whether the tremor happens during action, at rest, or both.
• Try to reduce obvious triggers where possible, such as exhaustion, missed meals, dehydration and excess caffeine.
• Ask for a medication review if the tremor is new or troublesome.
• If you have asthma or Chronic Obstructive Pulmonary Disease (COPD), discuss whether frequent reliever inhaler use means your maintenance treatment needs reviewing.

When to seek medical advice

Reassurance for patients and carers

Tremor can be unsettling, but it is common and often explainable. In people living with aspergillosis, asthma, Chronic Obstructive Pulmonary Disease (COPD) or tuberculosis (TB), the cause is usually medication effects, body stress, fatigue, or an unrelated essential tremor rather than the lung condition itself damaging the nervous system.

That means there is often room to improve things: inhalers can be reviewed, other medicines checked, triggers reduced, and the tremor pattern assessed properly. Most importantly, a tremor does not automatically mean the worst.

Common questions

Does aspergillosis itself cause tremor?

Usually no. Tremor in people with aspergillosis is much more likely to be related to medication, fatigue, illness, anxiety, or a separate tremor condition.

Can salbutamol make you shake?

Yes. This is a very well recognised side effect. It usually causes a fine tremor in the hands.

Can antifungal treatment cause tremor?

It can in some people, either directly or through interactions with other medicines. If tremor appears after starting or changing antifungal treatment, it is worth raising.

Do biologics usually cause tremor?

No. Biologics are not a common cause of tremor and may sometimes reduce tremor indirectly by improving control and reducing the need for steroids or frequent reliever inhalers.

Will this definitely get worse?

No. Many tremors stay mild, fluctuate, or improve when the cause is identified and managed.

References

1. British National Formulary (BNF) – Salbutamol
   Describes common side effects of beta-2 agonists, including tremor and shakiness.
   https://bnf.nice.org.uk/drugs/salbutamol/
2. NHS – Tremor
   Overview of tremor types, causes, and when to seek medical advice.
   https://www.nhs.uk/conditions/tremor/
3. NHS / Neurology Guidance – Essential Tremor
   Clinical overview of essential tremor, including action/postural tremor characteristics and distinction from Parkinson’s disease.
   https://rightdecisions.scot.nhs.uk/neurology-pathways-including-headache/gp-factsheets/essential-tremor/
4. Electronic Medicines Compendium (eMC) – Voriconazole (Vfend) Summary of Product Characteristics
   Details neurological side effects and drug interaction potential of voriconazole.
   https://www.medicines.org.uk/emc/product/7981/smpc
5. Electronic Medicines Compendium (eMC) – Itraconazole Summary of Product Characteristics
   Provides prescribing information, including neurological effects and interactions.
   https://www.medicines.org.uk/emc/search?q=itraconazole
6. NICE Guidance – Asthma (NG80)
   Covers pharmacological management of asthma, including use of bronchodilators and biologics.
   https://www.nice.org.uk/guidance/ng80
7. NICE Technology Appraisals – Biologic therapies for severe asthma
   Includes guidance on omalizumab, mepolizumab, benralizumab and dupilumab.
   https://www.nice.org.uk/guidance/ta278
8. NHS – Parkinson’s Disease
   Overview of symptoms including resting tremor, stiffness and slowed movement.
   https://www.nhs.uk/conditions/parkinsons-disease/

Author note: This article is for general education and is not a substitute for individual medical advice. People with new, worsening or unexplained tremor should discuss it with their usual healthcare professional.

You can explore more topics like this in our latest patient questions and answers, where we regularly explain common symptoms and concerns raised by people living with aspergillosis and other lung conditions.