Koa wilt it starts to produce microconidia, eventually clogging the xylem. Once the Koa tree dies, the fungus invades all tissues and, upon reaching the dead plant surface, sporulates profusely producing macroconidia and chlamydospores. The fungus can survive saprophytically in the soil, as either mycelium or as any of its three spore types mentioned. The chlamydospores, as the resting spores, survive the longest in the soils, usually under cold conditions. Koa trees occupy dry to mesic areas on the islands of Kauaʻi, Oʻahu, Molokaʻi, Lānaʻi, Maui, and Hawaiʻi in elevations of 80 to 8,000 feet with 0 to 100 inches of rain.
Nin Jiom Pei Pa Koa in 1962, and continue to manufacture and sell the product worldwide. "Pei pa koa" had annual sales of HK$350 million in 2014. A study at the China Academy of Traditional Chinese Medicine published in a 1994 article, "Pharmacological studies of nin jion pei pa koa", states that Nin Jiom Pei Pa Koa had significant cough relieving and sputum removing effects. In four acute or sub-acute inflammatory models, the anti-inflammatory effect was marked.." "Pei pa koa" is made up of a blend of herbal ingredients including the fritillary bulb ("Bulbus fritillariae cirrhosae", 川貝母), loquat leaf ("Eriobotrya japonica", 枇鈀葉), ladybell root ("Adenophora