Retired anesthesiologist - ABPA

Question

In 2019/20, my 49-year-old son was on the verge of being listed for a lung transplant due to hemoptysis when Trikafta arrived and turned the situation around. He has also had ABPA since the age of six and received high doses of cortisone for it as a child. He has type 3 diabetes and grade II fatty liver.
Now, his IgE levels—which had been elevated for decades—have risen further, and he has felt somewhat less physically capable, though this coincides with recurrent viral infections accompanied by bacterial superinfections (e.g., *H. influenzae*). His lung function has declined slightly over time. Unfortunately, I cannot provide specific figures because I have stepped back from monitoring his treatment and diagnostics. However, I am now alarmed because he is undergoing oral steroid treatment combined with antifungal therapy and a reduction in his Trikafta dosage. Wouldn't corticosteroid therapy alone be sufficient, if treatment is needed at all? A suspicion was also raised that *Pseudallescheria* might be the trigger, though this could simply be a case of colonization. Thank you very much for your dedication!

Answer

Good day,
ABPA is better managed when prednisolone and an antifungal agent are administered, especially if *Pseudoallescheria* might also be present. This can also be done using modulators—while monitoring liver function values—and is generally very well tolerated.
(The dosages of the modulators are adjusted accordingly depending on the specific antifungal agent and the modulator used.)

Best regards,
Fischer

29.06.2026