What are the recommended first-line treatment options for patients diagnosed with chronic pulmonary aspergillosis?

For patients diagnosed with chronic pulmonary aspergillosis (CPA), the recommended first-line treatment is sustained antifungal therapy aimed at suppressing the infection, particularly when there is evidence of declining pulmonary status or clinical deterioration. Treatment should be guided by specialist microbiological advice to select the most appropriate antifungal agent, with regular assessment to determine efficacy and the need to stop or switch therapy if no benefit is observed. This approach aligns with UK clinical guidance emphasizing individualized antifungal treatment in CPA cases with worsening lung function or symptoms ¹.

Recent literature supports this strategy, highlighting optimized antifungal regimens that improve clinical outcomes in CPA by tailoring therapy based on patient response and fungal susceptibility (Yagi et al., 2024). The integration of specialist input and monitoring is critical to balance treatment efficacy against potential drug toxicity and resistance development (Yagi et al., 2024).

In summary, first-line treatment for CPA involves sustained antifungal agents selected with specialist advice, focusing on clinical benefit and pulmonary function stabilization, consistent with UK guidelines and reinforced by recent evidence advocating for optimized, individualized antifungal therapy (Yagi et al., 2024) ¹.