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Chronic Pulmonary Aspergillosis — SCE Infectious Diseases MCQ

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ModerateFungal InfectionsChronic Pulmonary AspergillosisSCE Infectious Diseases

A 55-year-old man develops chronic cavitary pulmonary aspergillosis (CCPA). CT chest shows a slowly enlarging cavity with a thickened wall and adjacent pleural thickening. Aspergillus IgG is strongly positive. He has underlying COPD. Sputum culture grows A. fumigatus. What is the recommended first-line antifungal?

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Correct answer: C — Oral Itraconazole 200 mg BD with TDM (target trough >1 mg/L)

CCPA (a subtype of chronic pulmonary aspergillosis — CPA) is treated with long-term oral azole therapy. Itraconazole 200 mg BD is first-line per NICE and ERS/ESCMID guidelines. TDM is essential (target trough >1 mg/L) due to variable absorption (take with food/acidic drink). Voriconazole is an alternative (trough 1–5.5 mg/L). Treatment duration is typically at least 6 months and often years — CPA is a chronic condition requiring long-term suppression rather than cure. Surgery is considered for localised disease with adequate lung reserve.

Reference: NICE 2024 – CPA; ERS/ESCMID 2016 – CPA guidelines; BTS 2017