Treatment for aspergillosis varies depending on the type of infection. Treatment may include steroid or antifungal medication. In some cases, surgery is necessary.
Allergic bronchopulmonary aspergillosis (ABPA)
Allergic bronchopulmonary aspergillosis (ABPA) is treated using corticosteroid tablets (oral corticosteroids).
Corticosteroids suppress the immune system. This helps prevent the allergic reaction that ABPA can cause.
Most people need a three- to six-month course of oral corticosteroids. The dose is gradually reduced over time before treatment is stopped.
The side effects of oral corticosteroids include:
You will also need regular appointments to check for high blood pressure, diabetes and osteoporosis when taking corticosteroids.
Often, aspergilloma doesn't need to be treated. If your doctor thinks that treatment is needed, you may be given antifungal medications such as itraconazole. This is usually given as tablets.
How long you will need to take itraconazole depends on how well your symptoms react to it. Side effects are rare, but may include:
Surgical resection (see below) may also be an option in some cases.
Some people may need injections of an antifungal medication called amphotericin B. An injection is usually given directly into the lungs. The doctor giving the injection will use a CT scanner to guide the needle to the site of the fungal ball.
Chronic necrotizing aspergillosis (CNA) and invasive pulmonary aspergillosis (IPA)
Because of the similarities between the causes of chronic necrotizing aspergillosis (CNA) and invasive pulmonary aspergillosis (IPA), these conditions are treated in the same way.
If you are diagnosed with CNA or IPA, you may be admitted to hospital so that your health can be carefully monitored. You will also receive assistance with your breathing, if required.
CNA and IPA are usually treated with injections of a powerful antifungal medication called voriconazole.
Common side effects of voriconazole include:
Rarer side effects of voriconazole include:
If you also have a weakened immune system, you may be given additional treatment to help strengthen it. This includes a type of medication known as colony-stimulating factors (CSFs). CSFs help encourage your bone marrow to produce more white blood cells, which fight infection.
A medication called interferon gamma can also be used to boost the immune system. Interferon gamma is a genetically engineered version of a protein that the immune system uses to fight off infection.
The most common side effects of interferon gamma and CSFs are flu-like symptoms, such as:
Surgery may be required if CNA, IPA and aspergilloma do not respond to antifungal treatment, or if the coughing up of blood is thought to be life threatening. Extensive coughing up of blood can cause the lung tissue to become filled with blood, leading to suffocation.
Surgical resection of the lung, to remove the infected piece of lung tissue, is one treatment option in severe CNA, IPA and aspergilloma.
Depending on the extent of the infection, the type of surgical resection used could be:
- a wedge resection, where a small piece of lung is removed
- a lobectomy, where the top or bottom half of the lung (known as a lobe) is removed
- a pneumonectomy, where the entire lung is removed
Many people who have a surgical resection are worried that they will not be able to breathe properly afterwards, but it is possible to breathe with just one lung.
Bronchial artery embolisation
Bronchial artery embolisation (BAE) is a common treatment for coughing up of blood that is life threatening.
Coughing up blood is caused when one of the bronchial arteries (the major blood vessels in the lungs) is weakened by infection. The weakened artery ruptures, releasing blood. BAE is used to block the flow of blood out of the artery.
During a BAE, a small, flexible tube called a catheter is guided into your lungs. A CT scanner is usually used to guide the catheter to the exact site of the rupture.
A jelly-like solution is passed down the catheter. This blocks the site of the rupture and prevents further bleeding.