Allergic bronchopulmonary aspergillosis (ABPA): symptoms and treatment

Aspergillosis is a group of conditions caused by aspergillus mould. The NHS explains that it is usually caused by breathing in tiny bits of mould that are found in soil, compost, rotting leaves, dust, bedding and damp buildings, and that most types affect the lungs.

Allergic bronchopulmonary aspergillosis is the allergic type. Asthma + Lung UK says it is an allergic reaction to aspergillus mould that mostly affects people with asthma and can lead to symptoms getting worse or an asthma attack, and it can also affect people with cystic fibrosis. It is one of several types of pulmonary aspergillosis, alongside chronic pulmonary aspergillosis, invasive pulmonary aspergillosis and aspergillus bronchitis.

Unlike invasive aspergillosis, which is a life-threatening infection in people with a very weak immune system, ABPA is driven by the immune system's over-reaction in the airways.

The NHS says aspergillosis is rare in healthy people and you are usually only at risk if you have a lung condition such as asthma, cystic fibrosis or COPD, a weakened immune system, past tuberculosis, or needed ventilation after severe flu or COVID-19. Asthma + Lung UK describes aspergillosis as affecting less than 1 in 2,000 people.

ABPA specifically is linked to asthma and cystic fibrosis. The NHS advises seeing a GP if a lung condition is getting worse or is harder to control with your usual treatment.

The NHS lists symptoms of aspergillosis as shortness of breath, a cough that may bring up blood or lumps of mucus, wheezing, a high temperature, losing weight without trying and feeling tired. Asthma + Lung UK adds chest pain or discomfort and says that if you already have a lung condition you may notice your symptoms get worse.

Asthma + Lung UK says that in ABPA symptoms can lead to asthma getting worse or an asthma attack, and that it can sometimes take time to get a diagnosis because symptoms can be similar to other lung conditions and chest infections.

The NHS says to see a GP if you have a cough for more than 3 weeks, a lung condition that is getting worse or harder to control with your usual treatment, or a weakened immune system and symptoms of aspergillosis. It says to ask for an urgent GP appointment or get help from NHS 111 if you cough up blood.

If you have asthma, follow your asthma action plan during a flare-up and call 999 if you are struggling to breathe or cannot speak in full sentences.

The NHS says it can be difficult to diagnose aspergillosis and may take time. A GP will check your symptoms are not caused by something else like a chest infection and may refer you to a specialist for tests such as X-rays and scans, blood tests or tests on a sample of mucus, allergy tests and a bronchoscopy.

Asthma + Lung UK says allergy tests can show if you are allergic or sensitive to aspergillus mould, but that this does not always mean you have aspergillosis, so you may need to see a specialist for more tests including scans, mucus samples and sometimes bronchoscopy.

The NHS lists treatment for ABPA as steroid tablets and antifungal tablets. Asthma + Lung UK explains that steroids treat inflammation in the airways, that your doctor may prescribe steroid tablets with or without antifungal medicines, and that some people who take steroids for a long time may need a steroid card in case of emergencies.

Antifungal medicines, which Asthma + Lung UK says are the main treatment for all types of aspergillosis, need to be taken for weeks, months or sometimes longer, and the full course should be completed to help prevent resistance. They can react with other medicines, including steroids, so doctors need to know everything you take.

Asthma + Lung UK adds that some people with ABPA or severe asthma with fungal sensitisation may be offered a biologic medicine (monoclonal antibody), given by injection in hospital, which can improve symptoms and avoid the need for long-term steroids.

Asthma + Lung UK says it is impossible to avoid aspergillus spores completely but that you can lower your exposure: avoid compost heaps and rotting leaves, wear a mask when gardening, keep your home dry and well ventilated, avoid drying washing indoors where possible, and keep your home heated between 18 and 21 degrees in cold weather.

It also advises stopping smoking, staying active, having your flu vaccine every year and COVID-19 boosters if eligible, and looking after your mental health. The NHS adds using a dehumidifier or HEPA air purifier if you have a lung condition.

On the NHS, a GP can refer you to a specialist for tests if aspergillosis is suspected, and biologic treatment is described by Asthma + Lung UK as a specialist treatment given by injection in hospital.

Private respiratory consultations can speed up scans and blood tests, but biologics and complex antifungal monitoring are specialist decisions. Share all medicines you take with each clinician, as interactions are common.