Allergic bronchopulmonary aspergillosis (ABPA)
Allergic bronchopulmonary aspergillosis (ABPA) is treated using corticosteroid tablets (oral corticosteroids).
Corticosteroids suppress the immune system. This is to help prevent the allergic reaction that ABPA can cause.
Most people require 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:
- osteoporosis (thinning of the bones),
- high blood pressure (hypertension),
- diabetes,
- weight gain,
- cataracts and glaucoma (eye disorders),
- thinning of the skin,
- bruising easily, and
- muscle weakness.
The following advice may help minimise these side effects:
- Eat a healthy, balanced diet that includes plenty of calcium. Foods that are high in calcium include dairy products, spinach, salmon, beans and rhubarb.
- Maintain a healthy body weight.
- Do not smoke.
- Do not drink more than the recommended daily limit of alcohol (three to four units a day for men; two to three units a day for women). A unit of alcohol is equal to about half a pint of normal strength lager, a glass of wine or a single shot of spirit (25ml).
- Take regular exercise.
You will also need regular appointments to check for high blood pressure (hypertension), diabetes and osteoporosis when taking corticosteroids.
Aspergilloma
To treat aspergilloma, you may be given injections of an anti-fungal medication called amphotericin B. This can stop haemoptysis (coughing up blood).
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. Many people experience side effects one to two hours after having an injection. These include:
- a high temperature (fever) of 38°C (100°F) or above,
- shaking,
- chills,
- dizziness,
- loss of appetite,
- nausea,
- vomiting,
- headache, and/or
- rapid breathing.
These side effects are usually more severe when taking the initial doses, and get better as your body gets used to the medication.
Once haemoptysis (coughing up blood) is controlled, you may be given an additional anti-fungal medication called itraconazole. This is usually given in tablet form.
The length of time that you will have to take itraconazole depends on how well your symptoms react to the medication. Side effects of itraconazole are rare, but may include:
- headache,
- nausea,
- vomiting,
- skin rash, and
- hair loss.
Chronic necrotizing aspergillosis (CNA) and invasive pulmonary aspergillosis (IPA)
Due to the similarities between the causes of chronic necrotizing aspergillosis (CNA) and invasive pulmonary aspergillosis (IPA), both of 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 anti-fungal medication called voriconazole.
Common side effects of voriconazole include:
- visual disturbances (changes in vision),
- a high temperature (fever) of 38°C (100°F) or above,
- a rash,
- nausea,
- vomiting,
- diarrhoea,
- headache, and
- stomach pains.
Rarer side effects of voriconazole include:
- flu-like symptoms such as joint and muscle pain,
- changes in mental state, such as depression or anxiety,
- dizziness,
- hallucinations (seeing or hearing things that are not real),
- breathing difficulties,
- jaundice (yellowing of the skin and the whites of the eyes), and
- swelling of the lips or face.
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.
Another medication that can be used to boost the immune system is called interferon gamma, which 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:
- a high temperature (fever) of 38°C (100°F) or above,
- chills,
- joint and muscle pain,
- headache, and
- nausea.
Surgery
Surgery may be required for cases of CNA, IPA and aspergilloma that fail to respond to anti-fungal treatment, or if the symptoms of haemoptysis (coughing up blood) are thought to be life threatening. Extensive haemoptysis can cause the lung tissue to become filled with blood, leading to asphyxiation (suffocation).
Surgical resection
With severe CNA, IPA and aspergilloma, one of the treatment options is the surgical resection of the lung, to remove the infected piece of lung tissue.
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, or
- a pneumonectomy, where the entire lung is removed.
Many people who have 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 life-threatening haemoptysis (coughing up blood). Haemoptysis is caused when one of the major blood vessels in the lungs, the bronchial arteries, are weakened by infection. The weakened artery ruptures (splits), releasing blood. The aim of a BAE is to block the flow of blood out of the artery.
During a BAE, a small, flexible tube (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 gelatine (jelly-like) solution is passed down the catheter. This is to block the site of the rupture and prevent further bleeding.
