Aspergillosis

Aspergillosis is a group of conditions caused by breathing in aspergillus mould. Most people who breathe in aspergillus mould do not get ill, as the body’s immune system destroys them. But aspergillosis can develop in people with an existing lung condition or a weakened immune system.

There are different types of aspergillosis infection - most affect the lungs and cause breathing difficulties:

• allergic bronchopulmonary aspergillosis (ABPA) – an allergic reaction to aspergillus mould, usually in people with asthma or cystic fibrosis
• chronic pulmonary aspergillosis (CPA) – a long-term (chronic) infection in the lungs
• acute invasive pulmonary aspergillus (IPA) - a life-threatening infection in people with a weakened immune system where the fungal infection has spread into the lung tissue
• aspergilloma – a ball of mould in the lungs which usually occurs in areas of the lung damaged by previous infections, such as tuberculosis (TB). It’s often linked with chronic pulmonary aspergillosis (CPA)
• aspergillus bronchitis (AB) – aspergillus mould causes an infection in the large airways (bronchi)
• severe asthma with fungal sensitisation (SAFS) – if you have asthma that flares up a lot, you might be sensitive to fungi.

Aspergillosis is caused by breathing in small particles, called spores, of aspergillus in the air. Aspergillus is a common type of fungus (mould). Find out how to stop mould from growing in your home.

The mould can be found in:

• soil, compost and rotting leaves
• plants, trees and crops
• dust and bedding
• damp buildings
• air conditioning systems.

You cannot catch aspergillosis from another person or animal.

Some older houses may not have covered water tanks, or the covers may not be fixed. If you live in a house with an old water tank, it’s worth checking if it has a cover and that the cover fits securely.

Aspergillosis is rare in people with healthy immune systems. You’re more at risk if:

• you have a long-term lung condition like asthma, cystic fibrosis, bronchiectasis, sarcoidosis or chronic obstructive pulmonary disease (COPD)
• you have a weakened immune system, for example, if you have had chemotherapy or an organ transplant
• you have had lung tuberculosis (TB)
• you have had severe flu or coronavirus and were treated with mechanical ventilation (a breathing machine).

Symptoms of aspergillosis include:

• shortness of breath
• a cough – which may bring up blood or mucus (which can become very thick)
• wheeze (a whistling sound when breathing)
• a high temperature of 38C or above
• weight loss
• fatigue (feeling tired or weak).

If you already have a lung condition and you get an aspergillosis infection, your existing symptoms can also get worse.

Getting a diagnosis for aspergillosis may take some time, as your doctor will rule out other causes first. They’ll check for any common causes of your symptoms, like a chest infection or symptoms of an existing lung condition.

You may need to see a specialist or have tests such as:

• X-rays and scans
• blood tests including for aspergillus antibodies
• tests on a sample of your mucus
• a bronchoscopy to look inside your lungs.

If you have a lung condition and your symptoms are worse despite your usual treatment or you’ve had a cough for more than three weeks, make an appointment with your GP.

The treatment for aspergillosis depends on the type you have:

• Allergic bronchopulmonary aspergillosis (ABPA) - you may need to take steroid and antifungal medicines for some months. Some patients may be eligible for new monoclonal antibody treatment, only available via respiratory specialists in a hospital.
• Chronic pulmonary aspergillosis (CPA) – this is a long-term infection so you may need long-term (possibly life-long) treatment with antifungal medicines.
• Acute Invasive pulmonary aspergillus (AIPA) - you will be treated in hospital with antifungal medicines given directly into a vein.
• Aspergilloma – if appropriate, you may need to have surgery to remove the ball of mould, often after antifungal therapy.

It is important to get treatment as, without treatment, aspergillosis can progress and cause lung damage.

How do antifungal medicines work?

Antifungal medicines for aspergillosis work by killing the fungus and preventing it from growing again.

It’s not possible to completely avoid aspergillus mould. But there are things you can do to reduce the risk of catching aspergillosis:

• cold, damp conditions make mould more likely to grow. Dry your laundry outside, in a tumble dryer, airing cupboard, or well-ventilated room – avoid drying it in your bedroom or living space
• try and avoid places where aspergillus mould is often found
• close your windows if there’s construction work or digging outside
• wear a facemask (FFP2/3) in dusty places and consider using an air purifier
• wear a facemask (FFP2/3) when gardening, disturbing compost or carrying out any other dusty work.

Preventing antifungal resistance

• Always take the full course of antifungal medication as prescribed by your doctors
• Avoid handling imported plant materials, such as flower bulbs, as these can cause resistance to antifungal medication.

Find out more about how to stop mould from growing in your home.

• Aspergillosis Patients and Carers – information and support for people with aspergillosis.
• Aspergillus & Aspergillosis Website – information on aspergillus mould for health care professionals and patients.
• National Aspergillosis Centre – MFT Wythenshawe – the centre for aspergillosis, based in Manchester.