ABPA and horse riding

Question

Dear expert team,
I am 29 years old and suffer from CF with a quite stable FEV1 value of 65%. In the last years, there was two times the suspicion of ABPA, as I had dyspnea, but no antibiotic helped. The blood values were never really clear, but since then I take 5mg cortisone daily, have Aspergillus in the sputum in spite of this but no special problems with ABPA anymore.
Already since childhood, I have the great wish to learn horse riding and would now like to really learn it.
Do you consider this to be too dangerous regarding the ABPA? If yes, is it possible under certain constraints (e.g. not to clean the stable)? I have even looked for a stable, where one can enter each horse box from the outside and where one does not need to pass the narrow stable ways, so that I would be as much as possible outdoors. What else do I have to pay attention to?
If I should realize that I suffer from dyspnea in connection to horses, I would of course stop it immediately. Could I then expect, that after a possible cortisone therapy everything returns to be as before or is there a great chance that irreversible damage occurs?
Many thanks in advance,

Answer

Hello,
the fungus Aspergillus fumigatus, that can cause ABPA is everywhere in the environment. A total protection is therefore not possible. The concentration of fungus spores, however, is a risk factor for the development of ABPA. Therefore it is not recommendable to stay in areas with a high fungus spore load. The riding stable, and here possibly especially the horse box, stable ways and riding hall, can have a high load with fungus spores.
These arguments are on the one side, and on the other are the special conditions of the stable, that you already found. You could mostly be outdoors. It would be favorable that you should not do the cleaning. You have the great wish to learn horse riding, the sport would be favorable.
The severity and the course of an ABPA are not predictable and can vary between light symptoms with a good therapeutic response and a severe course.
In the end, your personal weighing of possible benefits of the riding sport on the one hand and on the other hands the potential risks plays an important role.
Best regards,
Dr. Christian Hügel

16.07.2016