Twenty years ago managing invasive fungal diseases (IFD) of the immunocompromised host such as those being treatment for acute leukemia and recipients of an allogeneic haematopoietic stem cell transplant was straightforward, simple but inadequate poor. The diagnostic tools were limited to direct microscopic examination, culture and histology assuming there was a proper specimen. Moreover, more often than not such material was only obtained after the fact namely at autopsy. In the intervening years several things have changed for the better. We have better means of imaging to detect lesions consistent with invasive fungal diseases, techniques such as bronchoscopy to obtain lavage samples of the lung, indirect means for detecting fungal components such as beta-D-glucan and galactomannan, and PCR for DNA detection and better drugs now belonging to 4 classes. We also have a better understanding of the epidemiology and evolution of invasive fungal disease, have an agreed framework for defining invasive fungal disease and have gathered evidence through clinical trials to allow guidelines to be proposed.Using invasive aspergillosis as a model we can delineate several patterns of the disease, apply the EORTC/MSG definitions more readily and identify more clearly opportunities for intervention. This allows us to explore different strategies for managing IFD which, in turn, can be used to set up integrated care pathways that optimize management such that effectiveness can be balanced against costs allowing for practical management of IFD. There are still challenges but we are now in a much better position to meet them.