World’s first clinical guidelines for chronic fungal lung infections

The world’s first guidelines for chronic fungal lung infections for doctors and laboratories have been published today, by the European Respiratory Society (ERS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).

These new guidelines describe the important features of this disease and provide comprehensive treatment recommendations.

Chronic pulmonary aspergillosis (CPA) is a subtle and insidious problem in patients with already damaged lungs. It kills about 80% of sufferers over five years, unless diagnosed and treated with long-term antifungals. Across Europe, an estimated 240,000 people have CPA, and worldwide around 3 million. The late stages of CPA (aspergilloma) are familiar to respiratory specialists, but the early features are often missed.

Major improvements in understanding this debilitating and ultimately fatal disorder have resulted from research undertaken in Europe, India and Japan over the last 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.

Management of chronic fungal lung infections requires a high level of expertise

Professor David Denning of the University of Manchester who lead the CPA guidelines group, said: “The UK National Health Service recognised 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 both required to reduce the marked disability caused by CPA.” 

ESCMID President Professor Murat Akova stated: “I am delighted that this groundbreaking clinical guideline has been published; the management of chronic fungal infection, notably CPA, is difficult, requiring a high level of laboratory and clinical expertise.”

The guidelines are a product of a two-year collaboration between ESCMID and ERS. In parallel to these CPA recommendations, ESCMID is currently developing wider guidelines for invasive aspergillosis in general, which will be published in due course.