Fungal lung disease encompasses a wide spectrum of organisms and associated clinical conditions, presenting a significant global health challenge. The type and severity of disease are determined by underlying host immunity and infecting fungal strain. The most common group of diseases are associated with the filamentous fungus Aspergillus species and include allergic bronchopulmonary aspergillosis, sensitisation, aspergilloma and chronic and invasive pulmonary aspergillosis. Fungal lung disease remains epidemiologically heterogenous and is influenced by geography, environment and host comorbidities. Diagnostic modalities continue to evolve and now include novel molecular assays and biomarkers; however, persisting challenges include achieving rapid and accurate diagnosis, particularly in resource-limited settings, and in differentiating fungal infection from other pulmonary conditions. Treatment strategies for fungal lung diseases rely mainly on antifungal agents but the emergence of drug-resistant strains poses a substantial global threat and adds complexity to existing therapeutic challenges. Emerging antifungal agents and increasing insight into the lung mycobiome may offer fresh and personalised approaches to diagnosis and treatment. Innovative methodologies are required to mitigate drug resistance and the adverse effects of treatment. This state-of-the-art review describes the current landscape of fungal lung disease, highlighting key clinical insights, current challenges and emerging approaches for its diagnosis and treatment.

真菌性肺病涵盖广泛的生物体和相关临床病症，构成了重大的全球健康挑战。疾病的类型和严重程度取决于潜在的宿主免疫和感染的真菌菌株。最常见的疾病组与丝状真菌曲霉属有关，包括过敏性支气管肺曲霉菌病、致敏性、曲霉球以及慢性和侵袭性肺曲霉菌病。真菌性肺病在流行病学上仍然存在异质性，并受地理、环境和宿主合并症的影响。诊断方式不断发展，现在包括新的分子检测和生物标志物;然而，持续的挑战包括实现快速准确的诊断，尤其是在资源有限的情况下，以及区分真菌感染与其他肺部疾病。真菌性肺病的治疗策略主要依赖于抗真菌药物，但耐药菌株的出现构成了巨大的全球威胁，并增加了现有治疗挑战的复杂性。新出现的抗真菌药物和对肺分菌组的日益了解可能会为诊断和治疗提供新鲜和个性化的方法。需要创新方法来减轻耐药性和治疗的不良反应。这篇最先进的综述描述了真菌性肺病的现状，突出了关键的临床见解、当前的挑战以及其诊断和治疗的新兴方法。