Medicines for Aspergillosis

What it is

Aspergillosis is the name for a group of conditions caused by a common mould called aspergillus, which is found widely in the environment (in soil, decaying vegetation, dust, and damp buildings). Most people breathe in aspergillus spores regularly without any harm, because a healthy immune system clears them. However, in certain people, aspergillus can cause disease, and the type depends largely on the person's lungs and immune system. The main forms include: allergic bronchopulmonary aspergillosis (ABPA), an allergic reaction to the mould that mainly affects people with asthma or cystic fibrosis, causing worsening asthma-like symptoms, cough, and mucus; an "aspergilloma", a ball of fungus that can grow in a pre-existing cavity in the lung (for example from previous tuberculosis or other lung damage); chronic aspergillosis, a long-term lung infection in people with underlying lung disease; and invasive aspergillosis, a serious, aggressive infection that mainly affects people with severely weakened immune systems (such as some people having chemotherapy or after transplants), where the infection can spread. So aspergillosis ranges from an allergic condition to a serious infection, and it mainly affects people with underlying lung conditions or weakened immunity, rather than healthy people. The approach and treatment depend on which form is present.

How it is treated

Aspergillosis is diagnosed and managed based on which form it is, usually with specialist input, using tests such as blood tests (including for the allergic reaction), imaging (chest X-ray and CT), sputum tests, and sometimes examination of the airways. Treatment is tailored to the type. Allergic bronchopulmonary aspergillosis (ABPA) is treated by controlling the allergic inflammation — often with steroids, alongside optimising treatment of the underlying asthma or cystic fibrosis — and sometimes antifungal medicines. Chronic aspergillosis is usually treated with long-term antifungal medicines, and complications are managed; an aspergilloma may be monitored or, if it causes problems (such as coughing up blood), treated, sometimes with surgery. Invasive aspergillosis, being a serious infection in people with weakened immunity, needs prompt, intensive treatment with antifungal medicines, along with supporting the immune system where possible; preventing it in high-risk people is also important. Managing the underlying condition (such as asthma or immune suppression) is central throughout. The reassuring message is that aspergillosis mainly affects people with underlying lung conditions or weakened immunity rather than healthy people, and that it is treatable — with the approach tailored to the specific form, from controlling an allergic reaction to antifungal treatment for infection.