Pulmonary aspergillosis: Causes, symptoms, and more

You probably don’t spend much time thinking about moldunless it’s on yesterday’s leftovers. But some molds are
more than just a reason to toss your lunch. A group of molds called Aspergillus can cause
serious problems in the lungs, especially in people with asthma, chronic lung disease, or weakened immune
systems. The result is a group of conditions known as pulmonary aspergillosis.

This fungal lung infection ranges from “barely on your radar” to “medical emergency,” depending on your health
and which type you have. Understanding the causes, symptoms, and treatment options can help you know when to
relax, when to call your doctor, and when to head to the emergency room.

This article breaks down the main types of pulmonary aspergillosis, how they develop, what they feel like, how
doctors diagnose them, and what treatment usually involves. It’s meant for educationnot to replace professional
medical adviceso always check in with your own healthcare team about your specific situation.

What is pulmonary aspergillosis?

Pulmonary aspergillosis refers to a group of conditions in which a mold called
Aspergillus infects or irritates the lungs. Aspergillus is everywherein soil, dust, compost piles, air
vents, and decaying plant matter. Most healthy people inhale these microscopic spores every day and never get
sick. Your immune system just shrugs and sweeps them out.

Problems arise when the immune system is weakened, the lungs are damaged, or the immune response is a little
overdramatic (looking at you, allergies). In those settings, Aspergillus can either:

• Trigger an allergic reaction in the airways
• Grow in preexisting lung cavities and form a fungal ball
• Cause a long-term, slowly progressive lung infection
• Invade lung tissue and blood vessels, leading to severe, invasive disease

Major types of pulmonary aspergillosis

Doctors usually talk about several main forms of Aspergillus lung disease:

• Allergic bronchopulmonary aspergillosis (ABPA) – An allergic reaction to Aspergillus in the
  airways, most often in people with asthma or cystic fibrosis. This causes inflammation, mucus plugging, and
  worsening asthma symptoms.
• Chronic pulmonary aspergillosis (CPA) – A long-term lung infection that usually happens in
  people with underlying lung damage (such as prior tuberculosis, COPD, or sarcoidosis). It can cause cavities in
  the lung, weight loss, and chronic cough.
• Aspergilloma – A “fungus ball” of Aspergillus growing inside a lung cavity left behind by a
  previous disease. Sometimes it just hangs out quietly; sometimes it causes coughing up blood.
• Invasive pulmonary aspergillosis (IPA) – The most serious form. Here, Aspergillus invades lung
  tissue and blood vessels, usually in people with severely weakened immune systems (such as after chemotherapy,
  stem cell or organ transplant, or high-dose steroids). This can be life-threatening and requires urgent
  treatment.

All of these are technically Aspergillus infections in the lungs, but their behavior, risk factors, and treatments
are quite differentso getting the specific diagnosis right is crucial.

Causes and risk factors

Where Aspergillus comes from

Aspergillus species are environmental molds. They thrive on damp, decaying organic materialthink compost piles,
stored grain, damp basements, construction dust, and HVAC systems. You can’t really “avoid Aspergillus completely”
unless you plan to stop breathing, which is not recommended.

For most people, inhaled spores are filtered by the nose and upper airways or destroyed by immune cells in the
lungs. But when those defenses are weakened or overwhelmed, Aspergillus can take advantage.

Who is at higher risk?

Risk factors depend on the type of pulmonary aspergillosis, but common ones include:

• Weakened immune system:
  • Recent chemotherapy
  • Stem cell or solid organ transplant
  • Prolonged neutropenia (very low white blood cell counts)
  • High-dose or long-term corticosteroid use
  • Advanced HIV infection or other severe immune deficiencies
• Chronic lung disease:
  • Chronic obstructive pulmonary disease (COPD)
  • Past tuberculosis or other infections that left lung cavities
  • Emphysema, fibrotic lung disease, or sarcoidosis
• Asthma or cystic fibrosis – These are classic risk factors for allergic bronchopulmonary
  aspergillosis.
• Frequent exposure to mold-rich environments, like farming, composting, or working around
  decaying plant matter, especially if you also have one of the conditions above.

In short: healthy lungs + healthy immune system usually means Aspergillus is just background noise.
Damaged lungs or weakened immunity shifts the balance in the mold’s favor.

Symptoms of pulmonary aspergillosis

One of the tricky things about pulmonary aspergillosis is that the symptoms can look a lot like other lung
conditionssuch as regular asthma, bronchitis, or pneumonia. But each type has a typical pattern.

Symptoms of allergic bronchopulmonary aspergillosis (ABPA)

ABPA is essentially asthma on hard mode. Common symptoms include:

• Worsening wheezing and shortness of breath
• Frequent asthma flare-ups that don’t respond as well to usual inhalers
• Cough with thick, sometimes brownish mucus plugs
• Fatigue and feeling “run down”
• Occasionally, low-grade fever or coughing up small amounts of blood

Over time, repeated inflammation and mucus plugging can damage the airways and lead to bronchiectasis (permanent
widening of the airways), which makes flare-ups and infections more likely.

Symptoms of chronic pulmonary aspergillosis (CPA)

CPA moves slowly but steadily. It often affects people who already have chronic lung problems. Typical symptoms
include:

• Chronic cough (weeks to months)
• Coughing up sputum, sometimes with blood
• Unintentional weight loss
• Fatigue and low energy
• Shortness of breath, especially on exertion
• Low-grade fevers or night sweats

On chest imaging, doctors may see cavities in the lungs, sometimes with a mass inside (a fungus ball) and
surrounding scarring.

Symptoms of aspergilloma (fungus ball)

A single aspergilloma sitting in an old lung cavity can be surprisingly quiet. Many people have no symptoms and
only discover it when a chest X-ray or CT scan is done for another reason. When symptoms do occur, they often
include:

• Coughing up blood (hemoptysis), which can range from streaks to larger amounts
• Chronic cough
• Mild shortness of breath or chest discomfort

The biggest concern with aspergillomas is significant bleeding. Sudden, heavy hemoptysis is a
medical emergency and needs immediate attention.

Symptoms of invasive pulmonary aspergillosis (IPA)

Invasive disease is an emergency situation, mostly seen in people with severely weakened immune systems. Symptoms
may include:

• Fever that doesn’t improve with antibiotics
• Rapidly worsening shortness of breath
• Dry or productive cough, often with blood
• Pleuritic chest pain (sharp pain that worsens with deep breaths)
• Chills, fatigue, and overall feeling very ill

Without prompt treatment, IPA can progress quickly, spreading beyond the lungs and becoming life-threatening.

How pulmonary aspergillosis is diagnosed

Diagnosing pulmonary aspergillosis is rarely as simple as “You inhaled mold, case closed.” Doctors usually piece
together several clues: your symptoms, risk factors, imaging, and lab tests. No single test is perfect, and
interpretations depend on your overall clinical picture.

Medical history and physical exam

Your healthcare provider will typically start by asking about:

• Existing conditions like asthma, COPD, cystic fibrosis, or prior lung infections
• Immune-suppressing medications (chemotherapy, steroids, transplant medicines)
• Occupational or environmental exposures (farming, gardening, construction, compost)
• Specific symptoms: cough, wheeze, shortness of breath, weight loss, fever, or hemoptysis

Imaging tests

Common imaging tools include:

• Chest X-ray – A quick look that can reveal cavities, masses, or areas of lung damage, but can
  miss early changes.
• Chest CT scan – More detailed and often crucial. It can show:
  • Cavities with or without a fungus ball
  • Nodules or “halo sign” in invasive disease
  • Bronchiectasis and mucus plugging in ABPA

Laboratory and microbiology tests

Depending on the suspected type, doctors may order:

• Sputum or bronchoalveolar lavage (BAL) cultures to look for Aspergillus species. A positive
  culture supports the diagnosis but doesn’t always prove invasive disease.
• Blood tests, such as:
  • Aspergillus-specific IgE and total IgE levels (especially in suspected ABPA)
  • Aspergillus-specific IgG (often elevated in CPA)
  • Galactomannan or beta-D-glucan tests (markers that suggest invasive fungal infection in the right context)
• Skin testing for Aspergillus in some cases of suspected ABPA, depending on local practice.

In complex or unclear cases, a lung biopsy may be needed to confirm that Aspergillus is actually
invading lung tissue rather than just colonizing damaged airways.

Treatment options for pulmonary aspergillosis

Treatment depends on which form of pulmonary aspergillosis you have, how sick you are, and what other conditions
you’re dealing with. Therapies may include antifungal medications, steroids, surgical procedures, or a combination
of these.

Allergic bronchopulmonary aspergillosis (ABPA)

The main problem in ABPA is an overactive immune response to Aspergillus, not aggressive invasion
by the fungus. Treatment usually focuses on calming the immune system and reducing inflammation:

• Oral corticosteroids (such as prednisone) are often the first-line therapy to control
  inflammation and prevent further lung damage.
• Antifungal medications (like itraconazole or voriconazole) may be added to reduce the fungal
  burden and help control symptoms.
• Standard asthma or cystic fibrosis therapies (inhalers, airway clearance techniques) remain
  important.

The goal is to prevent recurrent flare-ups, limit structural damage to the lungs, and keep asthma or CF as
well-controlled as possible.

Chronic pulmonary aspergillosis (CPA)

CPA is a long game. Treatment often involves months to years of therapy:

• Oral antifungal medications, typically itraconazole or voriconazole, are the mainstay. These
  drugs help slow or stop progression, improve symptoms, and reduce hemoptysis.
• Monitoring for side effects and drug levels is important, since azole antifungals can interact
  with other medications and affect the liver.
• Management of hemoptysis may involve medications, bronchial artery embolization (a procedure to
  block bleeding vessels), or surgery in severe cases.
• Supportive care includes smoking cessation, vaccination (for influenza and pneumonia), pulmonary
  rehabilitation, and nutrition support.

Aspergilloma

For a quiet, asymptomatic aspergilloma, doctors may simply watch and wait with periodic imaging,
especially if surgery would be high risk.

When there is significant or recurrent bleeding, options include:

• Surgical removal of the affected portion of lung, if the person is a good surgical candidate.
• Bronchial artery embolization to control bleeding, sometimes as a bridge to surgery.
• Adjunct antifungal therapy, depending on the overall clinical picture.

Invasive pulmonary aspergillosis (IPA)

IPA is a medical emergency. Treatment typically includes:

• Rapid initiation of systemic antifungal therapy – usually with medications such as voriconazole
  or isavuconazole as first-line treatment, sometimes combined with or followed by other antifungals.
• Re-evaluating immune suppression – if possible, reducing or adjusting immunosuppressive drugs
  (while staying safe for transplants or autoimmune diseases).
• Intensive supportive care in the hospital, which may include oxygen, ventilatory support, and
  close monitoring.

Even with treatment, invasive aspergillosis can be life-threatening, so early recognition and aggressive care are
key.

Complications and outlook

The prognosis for pulmonary aspergillosis varies widely. Some people live for years with stable disease; others
face life-threatening complications.

• ABPA – With early treatment and good asthma or CF control, many people do well, though some may
  develop permanent bronchiectasis or recurrent flares.
• CPA – Tends to be chronic and slowly progressive. Long-term antifungal treatment can stabilize
  or improve symptoms, but close follow-up is required.
• Aspergilloma – The biggest risk is sudden, significant hemoptysis. Regular monitoring and
  planning with a lung specialist are important.
• IPA – Has a more guarded prognosis, especially in severely immunocompromised patients. Outcomes
  have improved with modern antifungals, but it remains a serious condition.

Across all types, the earlier pulmonary aspergillosis is recognized and treated, the better the chance of avoiding
irreversible lung damage and serious complications.

Living with pulmonary aspergillosis

If you’ve been diagnosed with a form of Aspergillus lung disease, you’re not expected to move into a sterile
bubble and swear off houseplants forever. But a few practical steps can make life easier and safer.

Practical lifestyle tips

• Reduce heavy mold exposure – If possible, avoid turning compost piles, cleaning very dusty or
  moldy spaces, or spending long periods in barns, grain storage, or construction dust without protection.
• Use protective gear – When you can’t avoid these environments, wearing a well-fitted
  high-filtration mask (such as an N95) and gloves can help reduce exposure.
• Don’t smoke – Smoking and vaping further damage the lungs and make fungal infections harder to
  manage.
• Stay up to date on vaccines – Influenza and pneumococcal vaccinations can reduce your risk of
  additional infections on top of Aspergillus-related disease.
• Take medications as prescribed – Antifungals often need to be taken for months. Stopping early
  on your own may allow the infection to rebound or become resistant.
• Keep regular follow-up appointments – Your care team may need to monitor lung function, imaging,
  and blood tests over time.

And of course, if you develop new or worsening symptomsespecially significant shortness of breath, chest pain, or
coughing up bloodseek urgent medical care.

Real-world experiences and practical insights

Statistics and definitions are useful, but pulmonary aspergillosis really comes to life (no pun intended) when you
look at what it’s like for real people. These examples are compositesblended from typical clinical stories rather
than any one individualbut they highlight what many patients experience.

Emma: When “just asthma” wasn’t the whole story

Emma is a 32-year-old teacher with a long history of asthma. For years, her inhalers worked well. Then, over about
a year, something changed. She started waking up at night coughing, wheezing more often, and needing her rescue
inhaler almost daily. She blamed stress, chalked it up to “bad allergy season,” and powered through.

Eventually, her symptoms got so persistent that she saw her pulmonologist. A CT scan showed bronchiectasis and
mucus plugging. Blood tests revealed very high IgE levels and antibodies against Aspergillus. The diagnosis:
allergic bronchopulmonary aspergillosis.

Emma started treatment with oral steroids and an antifungal medication. Within weeks, she was breathing easier, and
her nighttime symptoms improved. She learned that managing ABPA meant paying closer attention to her environment
(avoiding dust and moldy areas when possible), sticking to her medication schedule, and getting regular monitoring.
Her asthma didn’t disappear, but it became manageable againonce the Aspergillus problem was recognized.

Robert: The “mystery weight loss” that wasn’t just aging

Robert, 64, had a history of treated tuberculosis from his twenties and mild COPD. He noticed he’d been losing
weight without trying and felt tired all the time. His cough, which he’d always blamed on “being a former smoker,”
became more productive, with occasional streaks of blood.

His doctor ordered a CT scan that revealed lung cavities, one of which contained a dense mass suggestive of a
fungus ball. Additional tests showed antibodies to Aspergillus and chronic inflammation. Robert was diagnosed with
chronic pulmonary aspergillosis with an aspergilloma.

His treatment plan included long-term oral antifungals, careful monitoring of liver function and drug levels, and
follow-up imaging. Because he wasn’t having major bleeding, surgery could be deferred. Over several months, his
weight stabilized, the cough lessened, and he was able to return to gardeningwith a good mask and a promise to
avoid turning compost piles himself.

Lisa: A reminder that fevers in immunocompromised patients are never “just a bug”

Lisa, 52, was undergoing chemotherapy for leukemia. She developed a fever and a cough. Initial chest X-rays weren’t
dramatic, and she started broad-spectrum antibiotics. But her fever persisted, and her breathing worsened.

A chest CT showed new nodules with a halo-like appearance. Blood tests suggested an invasive fungal infection, and
her team started antifungal treatment immediately while continuing diagnostic work-up. She was ultimately diagnosed
with invasive pulmonary aspergillosis.

The first few weeks were rough, but early suspicion and aggressive treatment gave her a fighting chance. Lisa’s
story underscores a key principle in cancer and transplant care: when an immunocompromised person has unexplained
fever and respiratory symptoms, doctors take it very seriouslyand Aspergillus is high on the list of suspects.

What patients often say they wish they’d known

Many people living with pulmonary aspergillosis share similar takeaways:

• “Listen to your body.” If your asthma suddenly becomes harder to control, or your “usual cough”
  changes character, it’s worth asking whether something newlike Aspergilluscould be involved.
• “Don’t ignore blood in your sputum.” It may be minor, but it can also be a warning sign of
  aspergilloma or CPA that deserves a prompt evaluation.
• “Long-term medications are a marathon, not a sprint.” Taking antifungals for months can be
  frustrating. Setting reminders, tracking side effects, and having honest conversations with your healthcare team
  about what’s realistic can help.
• “Being cautious isn’t the same as being fragile.” Wearing a mask while gardening or avoiding
  moldy barns is not a sign of weaknessit’s a smart adaptation for a body that needs a bit more protection.

Above all, people often say that finally getting an accurate diagnosisputting a name to the moldy mystery in their
lungsis strangely empowering. It opens the door to real treatment, better symptom control, and a plan for living
as fully as possible with or after pulmonary aspergillosis.

If any of the symptoms described here sound familiar, especially if you have asthma, chronic lung disease, or a
weakened immune system, talk with your healthcare provider. Early evaluation can make all the difference.