Chronic pulmonary aspergillosis
Prof. David W Denning
Director, National Aspergillosis Centre, Manchester, UK

Prof. Denning describes chronic pulmonary aspergillosis (CPA) as a long-term invasive disease, generally episodic in nature. Common symptoms are cough, shortness of breath, weight loss, tiredness, coughing up blood and aching or discomfort of the chest.  Occasionally people with CPA will experience fever, severe pain (from rib fractures), additional chest infections, angina and heart attacks.

They will often have other underlying chest conditions, e.g. tuberculosis. Fungal matter – usually Aspergillus fumigatus – will invade one or more cavities in the lungs and form a fungal ball there.

A single fungal ball or aspergilloma can often be removed surgically; where one or more cavities exist which may contain fungal balls (a condition termed chronic cavitary pulmonary apergillosis or CCPA) the person will generally be treated with antifungal medication (e.g. Itraconazole, Voriconazole or Posaconazole).

The prognosis is good for people with CPA once treatment has been established, although there is evidence that long-term treatment is necessary to prevent relapse. As there is an increasing problem with azole resistance, the use of azoles needs to be well monitored.

With thanks to Fran Stokes