Chronic pulmonary aspergillosis and sarcoidosis.

PURPOSE OF REVIEW: This review addresses the intersection between chronic pulmonary aspergillosis (CPA) and sarcoidosis, a clinically important but relatively understudied association. While few new sarcoidosis-specific data have emerged, recent advances in CPA research across broader underlying conditions (particularly structural lung diseases) provide updated insights into diagnosis, antifungal therapy, and management strategies that can be extrapolated to sarcoidosis.

RECENT FINDINGS: CPA affects ~2% of sarcoidosis patients in tertiary cohorts and arises from combined structural lung damage, immune dysfunction, and environmental exposure. Diagnosis relies on integrated imaging, Aspergillus-specific immunoglobulin G, and new microbiological tools. Recent data refine therapeutic strategies regarding triazole selection, treatment duration, and salvage therapies. Management of haemoptysis relies on bronchial artery embolization, with emerging adjuncts such as local antifungal therapies and endobronchial valves. In addition, new epidemiological data have better characterized severe forms of CPA and refined estimates of mortality, highlighting a substantial disease burden. Serological markers may help predict relapse, and updated consensus criteria standardize response assessment.

SUMMARY: CPA in sarcoidosis reflects advanced fibrocystic disease with complex host-pathogen interactions. Early recognition, optimized antifungal therapy, careful adjustment of immunosuppression, and structured haemoptysis management are central to care. Prospective sarcoidosis-specific studies are still needed to refine long-term strategies.