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Chronic pulmonary aspergillosis — SCE Respiratory MCQ

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HardRespiratory InfectionsChronic pulmonary aspergillosisSCE Respiratory

A 64-year-old man with COPD and prior TB has 4 months of weight loss, cough and fatigue. CT shows pleural thickening, a right upper-lobe cavity and adjacent fibrosis; Aspergillus IgG is raised and sputum culture grows Aspergillus fumigatus. What is the most appropriate management?

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Correct answer: B — Start prolonged oral triazole therapy with monitoring

Chronic pulmonary aspergillosis is treated with prolonged oral triazole therapy with therapeutic drug, liver and interaction monitoring. Fluconazole has poor Aspergillus activity. Surgery is reserved for selected localised disease or severe haemoptysis, not routine initial management.

Reference: ERS Chronic Pulmonary Aspergillosis Guideline; BNF Antifungals