What Is Pulmonary Aspergillosis?

Overview

Pulmonary Aspergillosis is a lung condition from inhaling small particles of Aspergillus mould that affects people with pre-existing lung conditions or weak immune systems. It does not usually affect healthy individuals.

Aspergillus is a common type of fungus or mould found all over the world. Approximately 180 species have been identified but not all are known to cause illness in humans. The most common species that causes aspergillosis is Aspergillus fumigatus followed by A. flavus, A. terreus, and A. niger.¹

Types of pulmonary aspergillosis

Aspergillosis can infect either the sinuses, airway, or lungs. 

The Aspergillus & Aspergillosis Organization reports that there are 6 types of Aspergillosis. 

• Allergic Bronchopulmonary Aspergillosis (ABPA)
  • Describes a condition where the person develops an allergic reaction to Aspergillus. This is common in people with asthma and cystic fibrosis. It affects approximately 2.5% of people with adult asthma and 5-10% of people with cystic fibrosis.²
• Aspergillus Bronchitis
  • An infection of the large airway, the bronchi.
• Aspergillus Sinusitis
  • Aspergillus disease within the sinuses, where the fungus “lives” off the mucus in the nose.
• Chronic Pulmonary Aspergillosis (CPA) and Aspergilloma
  • This is a long-term infection of the lungs.
• Invasive Aspergillosis
  • Usually diagnosed in people with severely low immune defences. This case has the highest mortality rate, ranging from 25-90%.³
• Severe Asthma with Fungal Sensitisation (SAFS)
  • A classification for people with severe asthma that are more sensitive to Aspergillus or other fungi but do not have ABPA.

If we look deeper into pulmonary aspergillosis, there can be many classifications that affect the lungs. The Aspergillus & Aspergillosis Organisation reports different types of Chronic Pulmonary Aspergillosis (CPA):

• Chronic Cavitary Pulmonary Aspergillosis (CCPA)
  • The most common form - one or more cavities can be with or without a fungal ball
• Simple aspergilloma
  • An Aspergillus fungal ball growing in one cavity
• Aspergillus nodules
  • Mimics other lung conditions (such as lung cancer) can only be diagnosed with histology
• Chronic Fibrosing Pulmonary Aspergillosis (CFPA)
  • Late-stage CCPA
• Subacute invasive aspergillosis (SAIA)
  • Similar to CCPA. People with develop this already have compromised immune systems due to pre-existing conditions or medications.

Cavities in the lung are from earlier lung infections or diseases that are caused by damage to the lung. The small molecules (spores) that are inhaled can go into the cavity and grow into a fungus ball. These balls can excrete products that can be toxic or cause allergic reactions to make you feel ill. Some people can have cavities from Aspergillus but no fungal ball.

Causes of pulmonary aspergillosis

Pulmonary aspergillosis is caused by inhaling small particles of the Aspergillus mould. This type of mould is common, found all over the world and can be found both in and outside your home. 

In your house, it can be found in:⁴

• Dust
• Bedding
• Damp buildings
• Air conditional units and systems
• Rotting fruit

Outside it can be found in:

• Soil, compost, and leaves
• Plants, crops, and trees

It is rare to get pulmonary aspergillosis if you have a healthy immune system. Those at the highest risk are if you:^4,5

• Have a long-term lung condition such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis
• Have a weakened immune system, from treatments such as chemotherapy or organ transplant or a disease that causes weakened immune systems
• Had tuberculosis
• Severe infection that needed ventilation

Signs and symptoms of pulmonary aspergillosis

During the initial infection, no symptoms may be present. Some common symptoms may be:

• Coughing
• Weight loss
• Fatigue
• Coughing blood
• Shortness of breath
• Fever

Management and treatment for pulmonary aspergillosis

Depending on the type and severity of pulmonary aspergillosis, your doctor may prescribe different treatments. Most treatments include a type of antifungal medication such as itraconazole, voriconazole, or posaconazole. In the case of an aspergilloma, if there is one cavity infected, your doctor may recommend surgery to remove the mould along with taking antifungal medication.

If you are diagnosed with a chronic condition, your doctor may recommend regular chest X-rays to monitor your progress. 

Diagnosis of pulmonary aspergillosis

Your doctor will ask questions and run preliminary tests to rule out more common causes for your symptoms, such as asthma or a cold. If they suspect that you have pulmonary aspergillosis, they will recommend you to a specialist who can run a number of tests to diagnose the type of pulmonary aspergillosis.

Some tests they might run include:

• X-rays and scans to look for lung cavities and mould
• Blood tests to look for antibodies made to fight Aspergillus mould
• Take samples of your mucus
• A bronchoscopy - a tiny camera that a doctor uses to look to see if your lungs are inflamed.

Prevention of pulmonary aspergillosis

To prevent pulmonary aspergillosis, it is vital to regularly clean and air your house to prevent mould growth, especially if you live in areas where there is high humidity.

You may also consider wearing a facemask that filters dust (such as….) when cleaning or in areas with lots of dust. To help keep a cleaner house, you can also consider using an air purifier.

FAQs

Is pulmonary aspergillosis contagious?

Pulmonary aspergillosis is not contagious. You cannot transmit pulmonary aspergillosis between people or animals.

When should I see a doctor?

If you have a past lung condition and your symptoms worsen or if you have had a consistent cough for more than three weeks, see your general practitioner (GP).

If you are coughing blood, you should seek medical attention immediately or call emergency services at 111 in the UK.

Summary

Pulmonary aspergillosis is an infection of the lungs from the Aspergillus mould. Healthy individuals do not get sick. Those with pre-existing lung issues or weakened immune systems are susceptible to getting this if they inhale the mould. The mould likes to grow in cool, damp places both in and outside of your home. Symptoms that may be present are breathlessness, fever, coughing, and weight loss. Your doctor will first rule out more common causes for your symptoms and then can run tests to check your lungs for mould infection. Depending on the type of pulmonary aspergillosis that you are diagnosed with, your doctor will advise you on the best route of treatment. Nearly all cases respond well to antifungal treatment. Some cases may require surgery if severe. To help protect yourself from Aspergillosis, try to keep your house clean with an air purifier or regularly clean your house to prevent moisture buildup. You can also wear a dust face mask when during yard work or in dusty areas.