Aspergillus in sputum or bronchoscopy samples
You have one or more respiratory samples growing Aspergillus and need to understand whether this represents transient colonisation, airway disease or active fungal infection.
Consultant Respiratory Physician in London
Fungal lung disease specialist in London
Specialist assessment, second opinions and personalised care for suspected or confirmed Aspergillus-related lung disease, including chronic pulmonary aspergillosis, aspergilloma and allergic bronchopulmonary aspergillosis.
- Consultant respiratory physician
- Experience managing complex lung infections
- Private appointments in London
Specialist fungal assessment
When should you see a fungal lung disease specialist?
An appointment may be helpful when Aspergillus has been found in a respiratory sample, a CT scan shows cavities or a possible fungal ball, allergic fungal disease is suspected, or treatment decisions and monitoring need specialist review.
Suspected or confirmed chronic pulmonary aspergillosis
Persistent symptoms, Aspergillus blood tests and CT abnormalities have raised concern about chronic pulmonary aspergillosis, often shortened to CPA.
A cavity, nodule or fungal ball on CT
Imaging has shown a lung cavity, Aspergillus nodule or possible aspergilloma and you need the scan, symptoms and laboratory results interpreted together.
Possible ABPA or fungal sensitisation
Asthma, bronchiectasis, wheeze, thick mucus or repeated flare-ups have raised concern about allergic bronchopulmonary aspergillosis or another fungal-allergic airway condition.
An antifungal treatment second opinion
You want an independent review of whether observation, antifungal treatment, anti-inflammatory treatment or another approach is appropriate for your type of fungal lung disease.
Treatment monitoring or adverse effects
You are taking an antifungal medicine and need coordinated blood testing, drug-level monitoring, interaction checks or help with possible adverse effects.
A positive Aspergillus culture does not always mean active disease
Aspergillus can be present in the airways without causing tissue infection. Symptoms, immune status, CT appearances, cultures and blood tests help distinguish colonisation, allergy and infection.
Different conditions need different treatment
Which fungal lung conditions can be assessed?
“Fungal lung disease” is an umbrella term. Aspergillus can cause chronic infection, grow within an existing cavity, trigger allergic airway inflammation or affect structurally damaged airways. Correct classification is essential because management differs.
Chronic pulmonary aspergillosis
CPA is a long-term Aspergillus infection associated with compatible symptoms, characteristic imaging and microbiological or immunological evidence. It often occurs in lungs already affected by another condition.
Read about chronic pulmonary aspergillosisAspergilloma
An aspergilloma is a fungal ball that develops within a pre-existing lung cavity. Some remain stable, while others are associated with symptoms such as coughing up blood and require further management.
Aspergillus nodules and cavitary disease
Aspergillus-related nodules and cavities can resemble other infections, inflammatory conditions or cancer on imaging. A structured assessment helps clarify the diagnosis.
Allergic bronchopulmonary aspergillosis
ABPA is an allergic inflammatory response to Aspergillus, most often considered in people with asthma or bronchiectasis. It can cause wheeze, mucus plugging, flare-ups and progressive airway damage.
Read about allergic bronchopulmonary aspergillosisAsthma with fungal sensitisation
Fungal sensitisation can contribute to difficult-to-control asthma even when the full diagnostic criteria for ABPA are not met. Assessment considers allergy results, airway inflammation and asthma control together.
Read about asthma with fungal sensitisationAspergillus airway disease
People with bronchiectasis or other structural airway disease may have Aspergillus-related bronchitis, mucus plugging or recurrent positive cultures that require careful clinical interpretation.
Specialist respiratory care
Why see Dr Ricardo José, a fungal lung disease specialist?
Dr Ricardo José is a Consultant Respiratory Physician who manages bronchiectasis, complex respiratory infections, chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. He provides private assessment for new diagnoses, complex results, second opinions and ongoing care.
Dr Ricardo José
MBChB · PhD · DA · FHEA · FRCP
Consultant Respiratory Physician
GMC registration: 6131510
A connected view of your lung health
Fungal lung disease often overlaps with bronchiectasis, asthma, immune suppression, previous infection, lung cavities or other structural lung damage. Dr José considers these factors together.
Learn more about Dr Ricardo José- Specialist clinical interpretation Symptoms, CT imaging, fungal cultures, Aspergillus antibodies and allergy tests are reviewed as one clinical picture.
- Experience with bronchiectasis and infection Care can address the fungal condition and the structural airway disease or recurrent infections that accompany it.
- Understanding of immune-related risk Assessment considers corticosteroids, cancer treatment, immune deficiency and other medicines that may influence infection risk.
- Individual treatment decisions The potential benefit of treatment is weighed against adverse effects, interactions, monitoring and its effect on daily life.
- Multidisciplinary working Complex care may involve microbiology, radiology, pharmacy, respiratory physiotherapy, infectious diseases or surgery.
- Ongoing specialist follow-up Reviews can monitor symptoms, blood tests, drug levels, imaging, lung function and treatment tolerance over time.
Reaching the right diagnosis
How Dr Ricardo José investigates fungal lung disease
Investigation is personalised. Its purpose is to determine whether Aspergillus is causing allergy, airway disease, chronic infection or colonisation, assess severity and identify factors that influence treatment.
-
Review symptoms, timing and risk factors
Dr José asks about cough, sputum, wheeze, breathlessness, fatigue, fever, weight change, chest pain, coughing blood and how symptoms have changed. Previous lung disease, infections and immune suppression are reviewed.
-
Interpret CT scans and earlier imaging
CT images are assessed for cavities, fungal balls, nodules, pleural thickening, consolidation, mucus plugging and bronchiectasis. Earlier scans help establish whether changes are stable, resolving or progressing.
-
Review fungal cultures and microbiology
Sputum or bronchoscopy results are reviewed for the organism, repeated isolation and relevant susceptibility testing. Further respiratory samples may be requested when the evidence is incomplete or resistance is a concern.
-
Arrange targeted blood tests
Depending on the suspected condition, tests may include Aspergillus IgG, total IgE, Aspergillus-specific IgE, eosinophils, inflammatory markers, immune assessment and baseline safety tests before treatment.
-
Assess lung function and associated conditions
Lung-function testing can assess airflow obstruction and overall respiratory impairment. Asthma, bronchiectasis, immune problems, previous tuberculosis or other causes of lung cavities are considered where relevant.
-
Explain the diagnosis and recommended next step
Dr José brings the clinical, radiological, microbiological and immunological evidence together. You receive a clear explanation of the most likely condition and whether monitoring, treatment or further investigation is recommended.
Useful records for your appointment
- CT images and radiology reports, including earlier scans
- Sputum, bronchoscopy, fungal culture and susceptibility results
- Aspergillus IgG, IgE, eosinophil and other recent blood results
- Lung-function results and details of underlying lung conditions
- A medicine list, including inhalers, steroids and supplements
- Previous antifungal treatment and any adverse effects
Do not delay booking if you do not yet have every record. The practice can advise which information would be most useful.
Personalised management
How Dr Ricardo José treats fungal lung disease
Treatment depends on the exact fungal condition. A positive culture does not automatically require antifungal medicine, while chronic infection, allergic disease and aspergilloma each require a different management approach.
Confirm the disease pattern
The treatment plan is based on whether findings support chronic infection, allergic disease, airway involvement, aspergilloma or colonisation rather than on one test result alone.
Select condition-specific treatment
Management may involve observation, antifungal therapy, anti-inflammatory treatment, asthma care, bronchiectasis treatment or referral for a procedure or surgical opinion.
Support the lungs as a whole
Airway clearance, inhaler treatment, infection management, nutrition and review of immune suppression may remain important alongside treatment directed at Aspergillus.
Monitor response and safety
Symptoms, blood tests, drug levels, interactions, imaging and lung function are reviewed according to the diagnosis and treatment used.
Managing chronic pulmonary aspergillosis
Treatment is considered when CPA is causing symptoms or showing clinical, radiological or functional progression. Oral triazole antifungal medicines are commonly used, but the choice depends on the organism, susceptibility, other medicines, liver function, heart-rhythm considerations and previous tolerance.
Treatment is usually prolonged and requires planned review. Dr José monitors response, adverse effects, interactions and whether drug-level or resistance testing is needed.
Treating allergic bronchopulmonary aspergillosis
ABPA treatment aims to control allergic inflammation, improve asthma or airway symptoms, clear mucus plugging and reduce the risk of further lung damage. Treatment may include anti-inflammatory therapy, antifungal treatment and, in selected cases, a biological medicine.
The plan depends on whether disease is newly active, recurrent, treatment-dependent or in remission, alongside the severity of asthma, bronchiectasis and previous treatment effects.
Observation, procedures and surgery for aspergilloma
Some stable, asymptomatic aspergillomas can be monitored. Symptoms, cavity progression and particularly coughing up blood may change the balance toward treatment, interventional radiology or a thoracic surgical opinion.
Decisions require careful review of disease extent, bleeding risk, overall lung function and whether surgery or another intervention can be undertaken safely.
Managing antifungal adverse effects and interactions
Azole antifungals can interact with many prescription medicines, inhaled or oral steroids, anticoagulants and some supplements. Possible adverse effects vary by medicine and may involve the liver, skin, vision, nerves, digestion, fluid balance or heart rhythm.
Monitoring is planned around the specific treatment and your individual risks. Do not stop or change an antifungal medicine without advice from the clinical team responsible for your care.
Bronchiectasis, asthma and airway-clearance care
Fungal lung disease often co-exists with bronchiectasis or asthma. Treatment may therefore include airway-clearance physiotherapy, inhaler optimisation, sputum surveillance and management of other bacterial or mycobacterial infections.
Read about specialist bronchiectasis care or specialist NTM pulmonary disease care .
Your appointment
What happens at a fungal lung disease consultation?
Your consultation is focused on turning complex scan, microbiology and blood results into a clear diagnosis and personalised plan.
Step 1
Understand your story
Review symptoms, previous lung disease, infection history, medicines, immune risk and the effect of the condition on daily life.
Step 2
Review the evidence
Consider CT imaging, fungal cultures, Aspergillus antibodies, allergy testing, lung function and previous treatment together.
Step 3
Agree the next step
Decide whether further investigation, observation, antifungal treatment, allergic-disease treatment or another specialist opinion is appropriate.
Step 4
Plan monitoring and follow-up
Set out how symptoms, blood tests, drug levels, scans, lung function and possible adverse effects will be reviewed.
Private fungal lung appointment
Get clarity about your diagnosis and treatment options
Book a consultation with Dr Ricardo José for specialist review of suspected or confirmed fungal lung disease.
Frequently asked questions
Questions about fungal lung disease
General answers to common questions. Your own diagnosis and treatment should always be discussed with the clinician responsible for your care.
Does Aspergillus in sputum mean I have a fungal lung infection?
Not necessarily. Aspergillus can sometimes colonise structurally abnormal airways without causing active infection. Symptoms, repeated samples, immune status, blood tests and CT findings help determine the significance of the result.
What is the difference between CPA and ABPA?
Chronic pulmonary aspergillosis is a long-term fungal infection associated with characteristic lung abnormalities. ABPA is primarily an allergic inflammatory response to Aspergillus, usually in people with asthma or bronchiectasis. They require different diagnostic criteria and treatment approaches.
Is Aspergillus lung disease contagious?
Aspergillus is acquired from environmental spores and is not generally spread from person to person through ordinary contact. The condition develops because of the interaction between the fungus, the lungs and the immune system.
Does every fungal lung condition require antifungal treatment?
No. Treatment depends on the condition, symptoms, progression, immune status and likely balance of benefit and risk. Some people are monitored, while others need antifungal, anti-inflammatory, procedural or surgical treatment.
Why do antifungal medicines require monitoring?
Antifungal absorption can vary and some medicines have important interactions or adverse effects. Monitoring may include blood tests, drug levels, interaction review and other safety checks selected for the particular medicine.
Can Dr José review a diagnosis or treatment plan made elsewhere?
Yes. A second-opinion consultation can review CT scans, fungal cultures, blood results, lung function, treatment history and current symptoms. Further tests may be recommended when the available evidence is incomplete.
Appointments and locations
How can I see Dr Ricardo José?
Private fungal lung disease consultations are available at three central London locations. Remote video consultations may also be suitable for second opinions, review of results and follow-up when a physical examination is not required.
Chelsea · South Kensington
Royal Brompton Hospital
Private Outpatients, Old Fire Station, South Parade, London SW3 6LP.
Royal Brompton clinic informationMarylebone · Harley Street
77 Wimpole Street
77–79 Wimpole Street, Marylebone, London W1G 9RU.
Wimpole Street clinic informationMarylebone · Devonshire Place
The London Clinic
5 Devonshire Place, Marylebone, London W1G 6HL.
The London Clinic informationPrivate outpatient and hospital care when needed
The appointments team can help with clinic availability, video consultations, insurance and self-pay questions. If your condition is acute but not immediately life-threatening, contact the team about a prompt private assessment. Dr José has inpatient admission rights at Royal Brompton Hospital and The London Clinic; admission is arranged when clinically appropriate and subject to hospital availability.
Appointments in London
Speak to Dr Ricardo José about fungal lung disease
Arrange specialist assessment, a second opinion or ongoing review of suspected or confirmed Aspergillus-related lung disease.
