Currently HSE considers the potential for resistance development in the target pest organism during the plant protection product approvals process. Where resistance is known or anticipated, HSE place specific limitations on the use of the product to help mitigate the likelihood and speed of resistance development. There are currently no plans to make changes to the process for regulating plant protection products.

Nevertheless, this Government recognises the dangers of anti-microbial resistance, including cross-resistance from fungicides. Defra is taking action to address the risks of resistance building by empowering farmers to make informed decisions as they manage pests, weeds and diseases. We have funded a roadshow, led by the Agriculture and Horticulture Development Board (AHDB), that is delivering practical advice to help farmers and agronomists to minimise the risk of resistance developing. This will run until March 2026.

In support of antimicrobial resistance (AMR) national action plan commitments, the Environment Agency (EA) actively carries out research into environmental transmission and risks associated with antimicrobial resistance. This includes research on monitoring antifungal resistance and bioaerosols.

The EA recognises the potential human health impacts of bioaerosols, particularly on the respiratory system. The EA actively regulates bioaerosol risks from waste treatment, including open composting of green wastes and digestate fibres. Regulated activities must hold a permit. Higher risk facilities monitor bioaerosol emissions including aspergillus fumigatus. These controls developed from over a decade of research collaboration with the EA, academia and industry.

External crop residue storage (non-waste) at anaerobic digestion (AD) sites does not require a permit. However, Defra has recently concluded a consultation on regulatory reform to include non-waste AD facilities. The reform has potential scope to align non-waste AD with regulated waste AD under the Environmental Permitting Regulations.

Recent studies in Vietnam and India have confirmed earlier evidence that patients who recently recovered from TB can develop pulmonary aspergillosis. In the studies, over 50% of patients who had been cured of TB and had ongoing symptoms developed chronic pulmonary aspergillosis. The studies noted that larger sample sizes were required to assess the true prevalence of chronic pulmonary aspergillosis. We have not made an assessment of the total numbers of people who will develop, or die from, chronic pulmonary aspergillosis after TB.

Whilst the UK does not directly fund diagnosis and treatment of chronic pulmonary aspergillosis, we invest in TB treatment and care through our current £1.4 billion pledge to the Global Fund to Fight AIDS, TB and Malaria, and invests in research to develop new diagnostics and treatments for TB. The UK's focus is to support countries to strengthen their health systems to address all causes of ill health.

The Global Action for Fungal infections has called for improved diagnostic capability for chronic pulmonary aspergillosis. The call notes the difficulties in diagnosing chronic pulmonary aspergillosis and the similarity of symptoms to TB.

Whilst the UK does not directly fund diagnosis and treatment of chronic pulmonary aspergillosis, we invest in TB treatment and care through our current £1.4 billion pledge to the Global Fund to Fight AIDS, TB and Malaria, and invests in research to develop new diagnostics and treatments for TB through our partner FIND (The Foundation for Innovative New Diagnostics). The UK's focus is to support countries to strengthen their health systems to address all causes of ill health.

Data on the incidence of chronic pulmonary aspergillosis is not collected centrally.

However, the following table provides data on the number of finished admission episodes with a primary or secondary diagnosis of chronic pulmonary aspergillosis. Data is held for England only.

Count of finished admission episodes (FAEs)¹ with a primary or secondary diagnosis² of pulmonary aspergillosis³ for the period 2010-11 to 2012-13⁴.

Activity in English National Health Service Hospitals and English NHS commissioned activity in the independent sector

Source: Hospital Episode Statistics (HES), Health and Social Care Information Centre

Notes:

1. Finished admission episodes

A finished admission episode (FAE) is the first period of inpatient care under one consultant within one healthcare provider. FAEs are counted against the year or month in which the admission episode finishes. Admissions do not represent the number of inpatients, as a person may have more than one admission within the period.

2. Number of episodes in which the patient had a primary or secondary diagnosis

The number of episodes where this diagnosis was recorded in any of the 20 (14 from 2002-03 to 2006-07 and 7 prior to 2002-03) primary and secondary diagnosis fields in a Hospital Episode Statistics (HES) record. Each episode is only counted once, even if the diagnosis is recorded in more than one diagnosis field of the record.

3. Clinical Coding

The following ICD-10 codes have been used to define pulmonary aspergillosis:

B44.0D Invasive pulmonary aspergillosis

J99.8A Respiratory disorders in other diseases classified elsewhere

B44.1D Other pulmonary aspergillosis

J99.8A Respiratory disorders in other diseases classified elsewhere

4. Assessing growth through time (Inpatients)

HES figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, changes in activity may be due to changes in the provision of care.

The National Specialised Centre for Pulmonary Aspergillosis has been raising awareness of the condition in the United Kingdom and internationally through the aspergillus website at www.aspergillus.org.uk; through an online health professional education portal called Leading International Fungal Education at www.LIFE-Worldwide.org; and internationally through the Global Action Fund for Fungal Infections at www.GAFFI.org.

The centre also works nationally to improve the understanding of aspergillosis. For example, it addressed the British Thoracic Society’s annual meeting last year. It also works locally with trainee doctors and with hospitals to help them understand more about the condition.