Chronic pulmonary aspergillosis encompasses a spectrum of progressive lung diseases that commonly arise in patients with prior structural lung damage. This article outlines current diagnostic criteria, highlights distinctions between aspergilloma and chronic cavitary forms, and summarizes the roles of medical therapy and surgery. Surgical resection remains the gold standard for symptomatic aspergilloma and selected cases of localized, treatment-refractory disease, with low mortality but notable morbidity. Nonsurgical options such as bronchial artery embolization and intracavitary antifungal therapy are valuable for high-risk patients. Multidisciplinary evaluation is essential to optimize outcomes and reduce disease-related morbidity.