Aspergillosis - Treatment 

Treating aspergillosis 

Treatment for aspergillosis varies, depending on the type you have and how severe it is.

Most cases are treated with medication, although occasionally surgery may be necessary.

Allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitisation

Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) are often treated using steroid medication and antifungal medication.

Measures to reduce your risk of further exposure to the aspergillus mould may also help. Read more about preventing aspergillosis.

Steroid medication for ABPA and SAFS

Steroid tablets suppress the immune system, which helps to prevent the allergic reaction associated with ABPA and SAFS.

Treatment is usually required for at least a few months, to help keep symptoms under control.

However, taking steroids for a long time can lead to side effects such as weight gain, high blood pressure and osteoporosis. You'll need regular check-ups during treatment to check for these.

Antifungals for ABPA and SAFS

An antifungal medication called itraconazole is often used to treat ABPA and SAFS. It works by killing the aspergillus mould that causes these conditions.

If you have asthma, bear in mind that itraconazole can increase the effectiveness of some steroid treatments you may be using to control the condition. This means that, when steroids are stopped, it is possible that you may experience symptoms of steroid withdrawal (such as weight loss, muscle weakness and low blood pressure).

Some steroids are affected by itraconazole more than others, so make sure to check with your doctor. Even inhaled steroids used for asthma can be affected by itraconazole. You can read more about interactions between antifungals and other medicines on the Aspergillus & Aspergillosis Website.

Chronic pulmonary aspergillosis and aspergilloma

Chronic pulmonary aspergillosis (CPA) often requires long-term treatment with antifungal medication, but occasionally surgery may be necessary.

An aspergilloma (fungal ball in the lungs) doesn't always need to be treated, but sometimes antifungals may be prescribed or surgery may be carried out.

Antifungals for CPA

Itraconazole, voriconazole and posaconazole are the antifungals used to treat chronic pulmonary aspergillosis and aspergilloma.

Itraconazole is usually tried first, but if it’s ineffective or has troublesome side effects, voriconazole or posaconazole may be used instead. These medicines are usually taken as a liquid or tablets, although antifungal injections may be used if these don’t work.

How long you'll need to take these for will depend on how well your symptoms react to them. Some people will require lifelong treatment.

Itraconazole comes in tablet and liquid form. The tablets need to be taken with food, while the liquid needs to be taken on a empty stomach.

Common side effects of itraconazole include:

• headaches
• feeling sick
• liver problems
• ankle swelling
• abdominal (tummy) pain
• diarrhoea or constipation
• an itchy rash

Less common side effects can include peripheral neuropathy (tingling or numbness, usually in the feet or hands), hair loss, blurred or double vision, and tinnitus.

Like all antifungal medications, itraconazole can interact with other medications, so it’s important to let your doctor know if you're taking any other medicines. You can check the interactions between antifungals and other medicines on the Aspergillus & Aspergillosis Website.

Posaconazole also comes in liquid and tablet form. The liquid has to be taken with a fatty meal, while the tablet can be taken with or without food.

Possible side effects of posaconazole include feeling sick, liver problems and peripheral neuropathy. You can read about the side effects of voriconazole below.

Surgery for CPA

If you have CPA, surgery may be carried out to:

• remove an aspergilloma
• block some blood vessels in the lungs if you experience severe bleeding
• remove part of a lung or an entire infected lung if antifungals aren't helping

Many people who have surgery to remove a lung worry that they'll be unable to breathe properly afterwards, but it's possible to breathe normally with just one lung.

Invasive pulmonary aspergillosis

Treatment for invasive pulmonary aspergillosis (IPA) involves taking antifungal medication to tackle the infection and having treatment to boost your immune system.

In some cases, surgery may also be necessary.

Antifungals for IPA

Voriconazole is a powerful antifungal medication that's usually used to treat IPA. It can be given directly through a drip into a vein (intravenously) or as tablets.

If you're diagnosed with IPA, it's likely that you'll be admitted to hospital so that you can be carefully monitored while you're on voriconazole. You may be given assistance with your breathing if you need it.

Common side effects of voriconazole include:

• blurred vision or seeing colours (this is temporary and not dangerous)
• vivid dreams
• a rash on your skin that gets worse after exposure to the sun
• a high temperature (fever)
• diarrhoea
• breathing difficulties
• tingling or numbness in your feet or hands

Less common side effects include depression, anxiety, insomnia, fainting and a very fast or very slow heartbeat.

Boosting the immune system in people with IPA

Most people with IPA also have a weakened immune system, so will be given treatment to help strengthen it.

This may involve reducing the dose of any medication you're currently taking that weakens your immune system – such as anti-rejection (immunosuppressant) medication following an organ transplant.

Additional medication can also be given to temporarily boost your immune system, such as colony-stimulating factors (CSFs). CSFs encourage your bone marrow to produce more white blood cells, which help fight infection.

The most common side effects of CSFs include joint and muscle pain, headaches and nausea.

Surgery for IPA

In severe cases, where antifungal medications aren't helping and the infection has spread within the lungs or to other parts of the body, such as the skin, surgery may be needed to remove the infected areas.