The Silent Fungal Lung Infection Most People Have Never Heard Of: Aspergillosis

Aspergillosis is a fungal lung infection that mostly goes unnoticed or is misdiagnosed, despite affecting millions across the world every year. Caused by Aspergillus, a common mould found in soil, dust, decaying vegetation, and indoor environments, the condition can also be life-threatening. Most people inhale Aspergillus spores daily without falling ill, as a healthy immune system clears them efficiently. Problems arise, however, when immunity is weakened or the lungs are already damaged. Globally, aspergillosis is a major but under-recognised health concern, particularly among people with chronic lung diseases or compromised immunity. In India, the burden is especially high due to the widespread prevalence of tuberculosis (TB), chronic obstructive

pulmonary disease (COPD), asthma, and bronchiectasis. These conditions can leave behind lung scars or cavities, creating an environment where the fungus can settle and grow, leading to chronic pulmonary aspergillosis. “Urban lifestyles may be contributing to increased risk. Rapid construction, air pollution, damp indoor environments, air-conditioning systems, and prolonged exposure to dust can increase fungal spore exposure, especially in densely populated cities,” said Dr Swapnil Mehta, senior consultant, pulmonology, Dr L H Hiranandani Hospital.

Why does aspergillosis get missed frequently?

According to Dr Mehta, one of the main reasons why aspergillosis gets missed often is that its symptoms often resemble those of other respiratory illnesses. “Persistent cough, breathlessness, chest discomfort, fatigue, and occasional coughing up of blood may be mistaken for TB relapse, uncontrolled asthma, or worsening COPD. Without timely diagnosis, the infection can slowly progress, causing long-term lung damage and reduced quality of life,” he said. Rapid construction activity releases large amounts of dust containing fungal spores into the air. Air pollution, poorly ventilated homes, damp indoor spaces, and prolonged use of air-conditioning systems can further promote fungal growth indoors. “In densely populated cities, continuous exposure to dust and mould spores becomes more likely, particularly for people spending long hours indoors,” added Dr Mehta.

Can healthy people get aspergillosis?

Dr Mahavir Modi, consultant pulmonologist, Ruby Hall Clinic, says, “Most healthy individuals inhale Aspergillus spores daily without falling ill, as a normal immune system clears them effectively. However, some forms of aspergillosis can still occur in otherwise healthy people.” Allergic aspergillosis can develop in individuals with asthma or other allergic tendencies. Chronic forms may appear in people with old lung scars or cavities, even if they are otherwise healthy. “Severe invasive aspergillosis, however, almost always affects people with weakened immunity, such as cancer patients, transplant recipients, those on long-term steroids, or critically ill individuals,” added Dr. Modi.Also read: World Epilepsy Day 2026: When ‘Daydreaming’ in Children Is Actually a Seizure Warning

What treatment options are available today?

According to Dr Modi, treatment of aspergillosis is individualised and depends largely on the type of infection, its severity, and the patient’s underlying health condition. Because aspergillosis can range from mild allergic reactions to life-threatening invasive disease, management often requires a carefully tailored approach. Antifungal medications form the cornerstone of treatment for most patients. These drugs are especially important in chronic pulmonary and invasive aspergillosis, where they help control fungal growth, reduce symptoms, and prevent further lung damage. In cases of allergic aspergillosis, the primary problem is an exaggerated immune response rather than direct tissue invasion. Here, corticosteroids are commonly prescribed to reduce inflammation and control allergic symptoms, often alongside antifungal therapy to lower the fungal burden and prevent recurrence. Surgical intervention is reserved for selected situations. It may be necessary when a fungal ball (aspergilloma) causes repeated or severe bleeding, or when the disease is localised and does not respond adequately to medication. Surgery can be life-saving in such cases, but it is carefully considered based on overall lung function and patient fitness. Above all, early diagnosis is critical. Identifying aspergillosis at an early stage significantly improves treatment success, reduces complications, and helps prevent irreversible lung damage.

How do you prevent recurrence?

Preventing recurrence requires a long-term, multi-pronged approach which includes:

• Completing the full course of prescribed antifungal treatment
• Regular follow-up with imaging and blood tests to detect early relapse
• Good control of underlying conditions such as asthma, COPD, or post-TB lung disease
• Reducing exposure to environments with high fungal loads, such as construction sites, dust, and damp indoor spaces
• Careful use of steroids and immunosuppressive drugs under medical supervision
• With proper monitoring and adherence to treatment, many patients can successfully manage the disease and prevent repeated flare-ups.