Why the Microbiome Matters for Aspergillosis Patients

Looking after the microbiome is increasingly recognised as important for people with aspergillosis, especially those with chronic pulmonary aspergillosis (CPA), ABPA, or recurrent infections. Many of these patients are on long-term antifungals, corticosteroids, or antibiotics — all of which can disrupt the body’s natural microbial balance.

Here’s a patient-focused guide with practical advice:

🦠 Why the Microbiome Matters for Aspergillosis Patients
Your microbiome (especially in the gut, lungs, and skin) plays a vital role in:

• Regulating the immune system
• Protecting against harmful microbes
• Supporting digestion and nutrient absorption
• Possibly influencing lung inflammation and fungal balance

✅ Practical Steps to Support Your Microbiome
1. Be Aware of Medications That Disrupt the Microbiome

• Antifungal medications (e.g. itraconazole, voriconazole) can affect fungal balance beyond the lungs.
• Broad-spectrum antibiotics kill good gut bacteria as well as infections.
• Steroids (oral or inhaled) may also affect gut and respiratory flora.

👉 Ask your team whether regular use is necessary or whether treatment can be pulsed or minimised during stable phases.

2. Eat to Support Gut Health

• Include prebiotic fibres: oats, onions, leeks, bananas, chicory, garlic, asparagus
• Add fermented foods (if tolerated): yoghurt (live cultures), kefir, sauerkraut, kimchi, miso
• Include polyphenol-rich foods: berries, green tea, olive oil, nuts
• ❗ Avoid unpasteurised or homemade ferments if immunocompromised — check with your specialist first.

3. Consider Probiotics — with Caution

• Some evidence suggests benefit after antibiotics, especially in reducing gut side effects.
• Not all probiotics are equal; discuss with your clinical team if you:
  • Are on long-term antifungals
  • Are immunosuppressed
  • Have had recent hospitalisation or central lines

👉 Probiotics may be risky in certain patients (e.g. severe immunosuppression or gut damage).

4. Stay Active and Manage Stress

• Moderate physical activity supports a healthier microbiome.
• Chronic stress and poor sleep can negatively affect gut flora.

5. Avoid Overuse of Antimicrobials

• Don’t use antiseptic mouthwashes, medicated shampoos, or antibacterial soaps routinely.
• Only use topical antifungals or antibiotics where medically advised.

6. Lung Microbiome: Avoid Over-sanitising

• Inhaled antifungals (e.g. amphotericin B) may affect lung flora but are sometimes essential.
• Good airway clearance, physiotherapy, and hydration help maintain a stable lung environment.

💬 What to Ask Your Doctor

• Could gut support (prebiotics or probiotics) help during or after treatment?
• Are any medications I’m on harming my microbiome unnecessarily?
• Could faecal microbiota transplant (FMT) ever be an option in my case?
• What dietary changes would benefit me, given my medications?