Which specialists do we need to help manage aspergillosis?

When dealing with aspergillosis you’ll want a multidisciplinary team or at least access to the right specialists. Here’s a breakdown of who can help, why they’re important, and how they might support a no-steroid or steroid-sparing approach:

🫁 1. Respiratory Consultant (Pulmonologist)

Why:

• They’re the lead experts for lung diseases like ABPA and CPA.

• They can interpret HRCTs, monitor lung function, and guide antifungal and biologic therapy.

• Experienced ones will know about steroid-sparing regimens and how to handle medication allergies or side effects.

Look for:

• A specialist with experience in fungal lung diseases, asthma with fungal sensitization, or bronchiectasis.

• Often linked with centers that collaborate with microbiologists and infectious disease teams.

💊 2. Infectious Disease (ID) Consultant

Why:

• They understand fungal infections and antifungal medications deeply.

• They’re especially helpful if there’s drug resistance, intolerance, or interactions with other conditions (like adrenal insufficiency or kidney problems).

• Also useful in CPA or suspected invasive disease.

🧬 3. Clinical Immunologist / Allergist

Why:

• Especially helpful in ABPA, where the immune system’s allergic reaction is the main issue.

• They can assess IgE levels, sensitization patterns, and recommend biologics like omalizumab (anti-IgE) or mepolizumab (anti-IL-5).

• Essential when corticosteroids are contraindicated.

🧠 4. Endocrinologist

Why:

• If you’re steroid-allergic or have adrenal insufficiency (as you do), they’re crucial for managing hormone balance, preventing crises, and advising on alternatives.

• They can help monitor your HPA axis (especially if you were previously on steroids).

🧪 5. Medical Microbiologist / Mycologist

Why:

• Behind the scenes but essential: they interpret fungal cultures, PCRs, and sensitivities.

• Can guide antifungal selection and resistance issues.

• Some major centers have a mycology reference lab—these are gold-standard for Aspergillus workups.

🏥 6. Specialist Aspergillosis Centres

Examples in the UK:

• National Aspergillosis Centre (NAC) in Manchester

• Royal Brompton Hospital (London)

• Glenfield Hospital (Leicester)

These centres bring together pulmonology, infectious disease, microbiology, immunology, and research. They’re the most likely to support non-steroid options and offer cutting-edge care.

👩‍⚕️ Other Useful Roles

• GP / Primary Care Doctor – coordinates care and helps with prescriptions, monitoring side effects, and referrals.

• Respiratory Physiotherapist – helps improve lung clearance and function, especially if avoiding systemic meds.

• Pharmacist – keeps an eye on interactions and helps manage antifungal regimens.