Conversation with Dr Chris Kosmidis

Can you tell us a bit about yourself? 

I am a doctor specialising in infectious diseases at the National Aspergillosis Centre (NAC) in Manchester (UK). My research focuses on understanding the causes, effects and treatments for chronic pulmonary aspergillosis (CPA). CPA is a long-term lung infection caused by a common fungus that can lead to coughing, chest pain and breathing problems, especially in people with weakened immune systems or lung conditions. 

What is the Chronic Pulmonary Aspergillosis Network (CPAnet) and why did you decide to get involved? 

CPAnet began in 2017 and brings together experts from around the world to study CPA. The network has helped to raise awareness of the disease by creating a registry of clinical cases, defining treatment outcomes and identifying key research priorities. 

CPA is a rare and often under-recognised condition. I decided to join CPAnet as I am a firm believer that we can achieve more effective evidence by working together. My goal is to drive positive change and improve the quality of life for people affected by the condition. 

What are the main symptoms of aspergillosis and when should patients see a specialist? 

Aspergillosis is often caused by breathing in the aspergillus fungus, a type of mould found in the environment. We breathe in lots of mould spores, including aspergillus, every day. In most people, the immune system removes these spores before they cause harm, but this does not happen in people with aspergillosis. 

Aspergillosis can affect: 

• People with a weakened immune system. This includes people undergoing chemotherapy or taking high doses of steroids. This is known as ‘invasive aspergillosis’. It is important that doctors looking after these patients are aware of the risks associated with this condition. 

• People with asthma and other lung conditions. This is known as ‘Allergic Bronchopulmonary Aspergillosis (ABPA)’ and affects around 3% of asthma patients and can also impact those with other lung diseases like emphysema. ABPA can worsen the symptoms for these conditions and make them harder to manage. It also causes inflammation and long-term damage to the lungs. Early treatment with steroids and antifungal medications is important to prevent more damage. 

• People with scarring of the lungs including those with tuberculosis (TB) and emphysema. This is called ‘Chronic Pulmonary Aspergillosis’ and can worsen over time. CPA is often treated with antifungal medication to manage symptoms. Sometimes surgery can be used to remove the affected part of the lung. 

The diagnosis of aspergillosis can take time. What advice do you have for patients going through this process?

Aspergillosis is often difficult to diagnose and this can make symptoms worse. Some patients may have to wait for test results from specialist laboratories which can add to the uncertainty. It is important that we use every opportunity to raise awareness of aspergillosis and improve outcomes for those affected by it. Doctors should also consider the possibility of aspergillosis when treating patients with related symptoms.  

My advice to patients on their diagnosis journey is to learn more about the condition by talking to their doctor. It is also important for people with an existing lung condition to understand how they can keep their lungs healthy (for example, by avoiding smoking and staying active) as this can reduce the risk of aspergillosis. 

Many patients are becoming worried about antifungal resistance. What advice would you have and are there any new treatments being developed?

There is a growing resistance to antifungals as they are being used more often in clinics and the environment. Unfortunately, there are only a handful of antifungal treatments available, so resistance limits our options. 

It is important for patients being treated with antifungals to take them at their recommended doses. Forgetting to take them can make them less effective. In some cases, doctors may need to check blood pressure to make sure the dose of antifungals is correct. 

Fortunately, there are a few new antifungals currently being tested. We hope to have more options available once they are approved.  

What role do you think European organisations like ELF play in ensuring patients across Europe have access to the right information and guidance on aspergillosis?

It is important that we can recognise the signs of aspergillosis so that patients can be diagnosed earlier and have a better quality of life.  We can do this by working together. 

There is a lot of misinformation about the impact of mould on lung health. It is important that organisations like ELF educate the public about how they can protect themselves against conditions like aspergillosis. By bringing patients and experts together in research collaborations like CPAnet, those affected by the condition have a platform to share their experiences and make sure research priorities for the group remain relevant.

We can also do more to improve treatment for aspergillosis. Patient-focused organisations like ELF can contribute to this by raising awareness of ongoing clinical trials as recruiting people for these is often challenging. This can help drive forward treatments for aspergillosis and improve the quality of life for people living with it.