The world’s first guidelines for chronic fungal lung infections for doctors and laboratories have been published by the European Respiratory Society (ERS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in the European Respiratory Journal.
The new guidelines describe the features of chronic pulmonary aspergillosis (CPA) and provide comprehensive treatment recommendations.
Major improvements in understanding CPA have resulted from research undertaken in Europe, India and Japan over the past 10 years. However, no therapies are approved by the European Medicines Agency (EMA) for treatment, and very few diagnostic tests and therapies have been compared. In many parts of the world, the basic tests required are not yet available.
Among other recommendations, the guidelines note: “The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients.”
The guidelines also recommend “surgical excision of simple aspergilloma,” and “long-term oral antifungal therapy is recommended for chronic cavitary pulmonary aspergillosis to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression.”
David Denning of the University of Manchester, who lead the guidelines group, said in a press release: “The UK National Health Service recognized the challenges posed by these patients by setting up the National Aspergillosis Centre and its associated laboratory the Mycology Reference Centre in 2009. The experience gained from seeing hundreds of patients has contributed to the quality of care, although much more research and new oral antifungal drugs are required to reduce the marked disability caused by CPA.”
The guidelines are a product of a two-year collaboration between ESCMID and ERS. In parallel to these recommendations, ESCMID is currently developing wider guidelines for invasive aspergillosis in general.
1. Denning DW, Cadranel J, Beigelman-Aubry C, et al. Chronic pulmonary aspergillosis: rationale and clinical guidelines for diagnosis and management. Eur Respir J. 2015; DOI: 10.1183/13993003.00583-2015.