Treatment outcomes in chronic pulmonary aspergillosis (CPA) – a monocentric retrospective analysis

Background: The term chronic pulmonary aspergillosis (CPA) encompasses a range of syndromes whose phenotype is determined by pre-existing lung damage and immune response to Aspergillus species, most commonly Aspergillus fumigatus . The most severe forms include cavitary chronic cavitary pulmonary aspergillosis (CCPA), chronic fibrocavitary pulmonary aspergillosis (CFPA), and subacute invasive pulmonary aspergillosis (SAIA). The objective of this study is to retrospectively document cases of CPA that were managed at Evangelische Lungenklinik Berlin and assess treatment outcomes. Methods: The hospital database was screened for cases of pulmonary aspergillosis (ICD-10 code) between 2018 and 2025. Cases that met the ESCMID/ERS criteria (2016) of CPA were identified and comprehensively reviewed. A survival time analysis of patients treated for CCPA, FCPA, and SAIA was conducted using the Kaplan-Meier method. Results: A total of 235 patients with an ICD-10 code indicating aspergillosis (B44.0–B44.9) were identified. Of these, 54 satisfied the diagnostic criteria for CPA. The outcome evaluation did not take into account instances of simple aspergilloma (n=12) or Aspergillus nodules (n=3). Thirty-nine patients (CCPA: n=28; CFPA: n=7; SAIA: n=4) were primarily treated with triazoles. The median age of the participants was 63 years (range: 30–87 years), and 64% were male. The follow-up period ranged from 0.07 to 5.6 years, with a median duration of 1.68 years. In nearly 25% of cases, modifications in therapeutic regimens were deemed necessary due to poor tolerability. However, the majority of patients completed at least six months of antifungal therapy, and more than 70% exhibited overall treatment response after three to six months, according to clinical and radiological criteria. The estimated median survival time for this cohort was 3.5 years. However, in the event of death (n=16), the median time to this event was 10.2 months after diagnosis of CPA. Conclusion: Despite an initial positive response to triazole treatment, a negative treatment outcome was common in this cohort, suggesting that underlying lung disease and comorbidities are the major adverse prognostic factors. Antifungal medications with improved tolerability are needed. Publication History Article published online: 04 March 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany