European Respiratory Society Presents Clinical Guidelines for Chronic Fungal Lung Infections

The world’s first guidelines for chronic fungal lung infections for physicians and laboratories have been presented recently, by the European Respiratory Society (ERS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID).download (1)

These guidelines are released in the European Respiratory Journal and explain the essential features of this disease and offer comprehensive therapy suggestions.

Chronic pulmonary aspergillosis (CPA) is a subtle and insidious issue in sufferers with diseased lungs. It kills around 80 percent of patients over 5 years, unless diagnosed and treated with long-term anti-fungals. Throughout Europe, an approximated 240,000 individuals have CPA, and globally about 3 million. The final stages of CPA (aspergilloma) are familiar to respiratory experts, but the early features are usually missed.

Major developments in understanding this devastating and ultimately fatal problem have resulted from studies carried out in Europe, India and Japan over the past decade. On the other hand, no treatments are accepted by the European Medicines Agency (EMA) for therapy, and very few diagnostic assessments and treatments have been compared. In many areas of the world, the basic assessments needed are not yet available.

Professor David Denning who lead the CPA guidelines group, stated: “The UK National Health Service identified the difficulties posed by these sufferers by establishing the National Aspergillosis Centre and its related laboratory the Mycology Reference Centre in 2009. The experience obtained from seeing hundreds of sufferers has provided to the quality of care, even though many more studies and new oral antifungal medicines are needed to decrease the marked disability triggered by CPA.”

65 years old patient Michael Miller, described his experience: “I had aspergillosis in 2006, which improved with a lengthy course of antifungal capsules. In 2012, i started to get worse and worse, and it had taken 3 years to identify recurrence of my aspergillosis. By this time, i was so breathless and my x-ray was much worse.”

ESCMID President Professor Murat Akova said: “I am pleased that this ground-breaking clinical guideline has been released; the management of chronic fungal infection, notably CPA, is challenging, needing a high level of laboratory and clinical expertise.”

European Respiratory Society Guidelines Director, Dr Marc Miravitlles, stated: “We welcome the publication of this guideline, which offers key information into the main features of the condition and therapy suggestions. By setting up this expert consensus on the issue, we target to enhance the early diagnosis of CPA and improve recognition of the condition to eventually enhance outcomes for sufferers.”

The guidelines are a product of a two-year alliance among ESCMID and ERS. In parallel to these CPA suggestions, ESCMID is presently establishing wider guidelines for invasive aspergillosis in general, which will be released in due course. The latter are developed by Professor Andrew Ullmann, chairman of ESCMID’s fungal infection study group EFISG.

Andrew Ullmann stated: “This is an initial guideline on chronic pulmonary aspergillosis globally. It is the outcome of one more combined effort of ESCMID and ERS professionals who, in a truly interdisciplinary alliance, prepared and published guidance for colleagues on a group of complicated diseases that are challenging to deal with. Aspergillosis is above chronic lung infection and a larger document addressing all factors of Aspergillosis infections is under preparation by EFISG.”