Highlight
• Time-normalized changes in anti-Aspergillus IgG levels correlate with clinical and radiological progression of chronic pulmonary aspergillosis (CPA).
• A relative increase threshold of 1.45 in IgG over 3 months strongly suggests disease worsening and warrants prompt reevaluation.
• Lower thresholds improve sensitivity but reduce specificity, emphasizing the need for multimodal monitoring.
• External validation is necessary before routine clinical implementation of IgG kinetics as a biomarker.
