Why It Can Be Hard to Clear Carbon Dioxide (CO₂) From the Lungs in Aspergillosis

When we breathe, oxygen comes in and carbon dioxide (CO₂) goes out. For people living with aspergillosis (ABPA or CPA), and sometimes with other conditions like severe asthma, COPD, or bronchiectasis, this process can be much more difficult.

🔴 Why this happens

• Narrow or inflamed airways
  In ABPA or asthma, swelling and tightening of the breathing tubes can trap air inside.

• Collapsed or floppy airways
  In COPD and bronchiectasis, airways may close too soon when you breathe out, leaving CO₂ stuck in the lungs.

• Mucus and plugs
  Thick or sticky mucus — common in ABPA, bronchiectasis, and COPD — blocks airways and reduces airflow.

• Scarred or damaged lungs
  CPA can create cavities and scarring that make air movement less efficient.

• Tired breathing muscles and fatigue
  Long-term illness, steroid use, or simple exhaustion can weaken the diaphragm and chest muscles, making it harder to breathe out fully.

🟢 What can help

• Pursed-lip breathing
  Inhale gently through your nose, then breathe out slowly through pursed lips (like blowing out a candle). This keeps airways open longer so CO₂ can escape.

• Diaphragm (belly) breathing
  Using your stomach muscles for slower, deeper breaths improves oxygen and CO₂ exchange.

• Clear the mucus
  Daily airway clearance (physio techniques, huff coughing, or devices like Acapella, Flutter, Aerobika) can stop mucus building up and blocking airways.

• Pulmonary rehabilitation
  Specialist exercise and breathing training improve stamina, breathing control, and lung efficiency.

• Find the best position
  Sitting upright or leaning forward slightly often makes it easier to breathe out during flare-ups.

• Medical treatments
  Your team may use antifungals, steroids, inhalers, or nebulisers to reduce inflammation and mucus.
  If CO₂ levels remain too high, oxygen therapy or breathing support machines (like BiPAP or CPAP) may be needed.

👩‍⚕️ Who can help most

The best place for personalised advice is usually a respiratory physiotherapist.
They can:

• Teach you the right breathing techniques

• Show you how to clear your airways effectively

• Support you with safe exercise and pacing strategies

🟦 What to do if you panic for breath

Feeling panic when breathless is common — but panic can make breathing even harder. Try these steps:

1. Stop and sit upright — lean slightly forward with your arms supported on a table or your knees.

2. Focus on breathing out — use pursed-lip breathing (in through the nose, out slowly through pursed lips).

3. Slow things down — count “in for 2, out for 4” to calm breathing.

4. Loosen tight clothing — open collars or waistbands to ease pressure on the chest.

5. Use your reliever inhaler or nebuliser if prescribed.

6. Stay calm with grounding techniques — focus on your surroundings (e.g. name things you see or hear) to reduce panic.

⚠️ When to seek urgent help

• If your breathing does not improve after following these steps.

• If you are too breathless to speak in full sentences.

• If you feel faint, confused, or unusually drowsy.

• If you have sudden chest pain or start coughing up a lot of blood.

➡️ Call 999 or go to A&E immediately in these situations.

✅ Key message

For patients with aspergillosis, especially when combined with asthma, COPD, or bronchiectasis, clearing CO₂ can be harder because of blocked or damaged airways, mucus, and fatigue.

• Learning breathing techniques

• Clearing mucus regularly

• Seeking advice from a respiratory physiotherapist

• Knowing what to do if you panic for breath

…can all make a big difference in helping you breathe more easily and safely.