Mold: How it Can Affect Your Breathing

How does mold affect us?  Most people have a natural resistance to mold.  However, high levels of certain kinds of molds can cause people to have reactions.  This is especially true for toxic molds.

Different people have different susceptibilities, but most reactions are similar to hay fever:  sneezing, watery eyes, coughing and difficulty with breathing.

Mold is a very small “plant” that grows through the transmission of spores.  These spores are let go and then attach themselves to nearby surfaces and continue to grow as new plants.

Many molds are black, so when people see or talk about “black mold” they may not be seeing the toxic mold known as “stackybotrous.”

Unlike the plants that we are familiar with, molds do not get their energy from the sun.  They give off mycotoxins which help break down the organic material they attach themselves to.  They receive their energy through consumption of these organic materials.  Mold needs two things to live: an organic sub-straight to feed off of and water.  It gets its water from the air through high humidity.  This is why basements – especially those in Western Pennsylvania– tend to have mold, as the humidity there is higher than the rest of the home.

If you suspect that there is mold in your house and you have an asthma condition, the best option – as always – is to test.

The Importance of Getting The Flu Shot

Each flu season, many people debate whether or not they should get a flu shot. However, when we are deciding what is the best thing to do for our children/adolescents with asthma, we need to have a better understanding of the facts and fears we have towards the flu vaccine. Immunization each year is the best way to protect yourself and your children/adolescents with asthma from the flu.

Flu is an infection of the nose, throat, and lungs caused by the influenza virus. Symptoms can be mild to severe, especially in children younger than 5 who have asthma. These children are at a greater risk for complications from the flu such as pneumonia, bronchitis, and ear infections. These complications can lead to a stay in the hospital and even death. In 2017, there were 72 pediatric deaths from flu complications–74% occurred in unvaccinated children ages 6 months to 17 years old.

In 2016-2017, the live attenuated influenza vaccine (LAIV) or the nasal spray was not recommended due to concerns of it effectiveness. Centers for Disease Control and Prevention noted that in 2015-2016, the nasal spray had no protective benefit for children ages 2 to 17 whereas the children who got the flu shot were 63% less likely to get the flu compared to those who weren’t vaccinated. CDC will review this recommendation for 2017-2018.

CDC also recommends that everyone 6 months and older should be vaccinated every year by the end of October. However, you can still get your shot through January or later.

In this past year, the recommendations for people with egg allergies were updated. If you only get hives after exposure to eggs, you can get the flu shot. However, if you have additional symptoms, you can still get the flu shot as long as it is administered and supervised by your doctor who can manage severe allergic conditions. People with egg allergies no longer need to wait 30 minutes after the vaccine has been administered. People who are high risk can also be treated with antiviral drugs. It is most effective if started within 48 hours.

So this October, don’t be the one who “should have, could have, would have” gotten the flu shot. Remember children and adolescents with asthma experience more asthma attacks if they get the flu. To learn more about asthma management, as well as Breathe Pennsylvania’s programs and services, visit us at www.breathepa.org.

Whooping Cough Remains a Public Health Concern

It’s National Infant Immunization Week, which serves as a good reminder for parents and all adults to check with their doctors to make sure that their pertussis vaccination, as well as all recommended immunizations, are up to date.

Pertussis, a highly contagious respiratory disease known as whooping cough, is caused by the bacterium Bordetella pertussis. The disease is usually spread by coughing or sneezing, or when sharing breathing space with someone who has it. The cough can last up to 10 weeks or longer. The disease may cause serious illness, and can even be life-threatening, especially in babies.

Approximately half of the babies who are younger than 1 and have whooping cough need to be hospitalized.

In 2015, 20,762 cases of whooping cough (and 6 deaths) in the United States were reported to the Center for Disease Control and Prevention (CDC). Of this number, 2,709 cases occurred in children younger than 1 year. Worldwide, there are an estimated 16 million cases of pertussis and some 195,000 deaths annually.

There are currently two vaccines for whooping cough, and they are effective against Diphtheria, Tetanus, and Pertussis. DTaP is licensed for children up to 6 years of age. One dose is to be administered at 2, 4, 6, 15-18 months and again at 4-6 years.  Additionally, a single dose of the Tdap vaccine is recommended for people ages 11 through 64.

So why are we still seeing whooping cough in the population when effective vaccines exist? There are several reasons. First, it is thought that there may be a waning vaccine immunity which takes place over time in adults who had been immunized as children. Babies, especially those younger than 6 months of age who have not yet built up vaccine immunity, can be infected by older siblings, parents, or caregivers who might not even know that they have the disease. For this reason, it is very important that pregnant women, healthcare providers and caregivers of children younger than 1 year of age be vaccinated with Tdap.  It is possible that vaccinated children and adults may still contract pertussis, however, the disease is typically much less severe in vaccinated people.

Make sure to get vaccinated, and protect yourselves, your families, and the community from vaccine preventable diseases.

Reference: https://www.cdc/pertussis

Rest and Relax on Vacation, Even with Asthma and Allergies

Summer is a few short months away, and if you’re a planner, you’ve probably already stated making arrangements for vacation. In all the fun of booking, preparing and going on vacation, I always forget one thing—I have asthma and allergies.  This might not seem like a big deal to some, but I am leaving the comfort zone of my allergy controlled home to go to a place that could be filled with triggers. I clean my home to help my asthma and allergies but will my hotel room offer the same amount of relief and comfort so I can enjoy vacation?

While preparing for a recent trip to Disney World, I set forth to see what I could find to make my stay a little better for my own asthma and allergies.

The night before we left for Florida, we stayed at the local airport Hyatt in a Certified Pure® room.  It was a few dollars more than a standard room, but well worth it. I could tell as soon as I entered the room it was different than other hotel rooms I stayed in. It felt very clean. The carpets were specially cleaned, there was an air purification system in the room, and the mattress and pillows were encased in dust mite free covers. The bathroom soaps were all Hypo-allergenic and the room had a very light scent of Tea Tree Essential Oil, which is known to destroy airborne pathogens that cause allergies. This room was very well taken care of and really helped me feel the comfort that I was looking for.

The main hotel chains that offer Certified Pure® rooms are:

  • Hilton
  • Hyatt
  • Residence Inn
  • Doubletree

To find a Certified Pure® room for your next trip, visit www.pureroom.com.

The good news didn’t stop there. Walt Disney World resorts offer an allergy friendly cleaning process, but it is important to make the request at time of booking or a few weeks prior to arrival to allow the cleaning staff enough time to prepare for your arrival. Here are a couple of allergy friendly services offered:

  • The resort can provide deep dry cleaning with additional shampooing of carpets, upholstery and drapes as long as the guest notifies the staff in advance.
  • Housekeeping can be asked to use only vinegar and baking soda to clean the hotel room during the guest’s stay, avoiding the harsh scents of regular heavy duty cleaners.
  • Steaming with hot water of any hard surfaces and bathroom and patio floors.
  • Guest room air conditioning filters can be changed.
  • Fragrance free soaps and hypoallergenic pillows are available.
  • Bed linens and towels can be sent out and laundered with special hypo-allergenic soaps.

Leaving the comforts of your own home for a vacation can be a great adventure or an exacerbation waiting to happen, but proper preparation before leaving can make your vacation one to remember.  Don’t be afraid to ask the resort, hotel, or realty company you’re working with if they offer special allergy friendly cleaning. Taking this extra step can make for a happy healthy vacation.

   

Do You Have Overlap Syndrome?

Overlap Syndrome refers to diseases that overlap each other where the combined effect is worse than either disease alone. Two conditions that often overlap are COPD and Obstructive Sleep Apnea (OSA).

COPD is not a new disease, as it existed but was ignored long before cigarette use was widespread. Though OSA is associated with obesity, it’s not limited to obesity and 22 million people are diagnosed in the U.S alone.

The most common factor of both conditions is low oxygen in the blood (hypoxemia), and with the overlap, a person can have 30 times more episodes of desaturations at night. This puts a strain on the right side of the heart, which can lead to pulmonary hypertension.

People with Idiopathic Pulmonary Fibrosis might also fall victim to Overlap Syndrome because studies show that more than 80% also have OSA.

Treatment of Overlap Syndrome is the same as if treating each disease individually, with the primary emphasis on maintaining normal oxygen saturation levels. The main treatments are inhaled bronchodilators and CPAP to treat sleep apnea.

If you have COPD or Pulmonary Fibrosis and find yourself having difficulty sleeping, you should ask your physician about being tested for OSA. Having the right treatments for all conditions can significantly help to avoid problems that can be a result of Overlap Syndrome.

Using Asthma Medications When You Have A Milk Allergy

Can inhaled asthma medications containing lactose cause an allergic reaction in someone with a cow’s milk protein allergy? First I think it is important to clarify we are talking about two different issues:

 A milk allergy is a true food allergy caused by an allergic reaction to the protein in milk. This allergy usually shows up early in life.

“Lactose intolerance,” is when there is not enough of the enzyme lactase needed to break down lactose. Lactose is the sugar in milk and other dairy products. This is more common and not as severe as a milk allergy. It may take longer to develop, and it can happen at any time.

As I researched this, I found different views. One side recommended those who have a “cow’s milk protein” allergy not use dry powder inhalers (DPIs) with lactose. The concern is that it may trigger a severe asthma attack for individuals who are “severely allergic” to cow’s milk, inhaling being far more dangerous than ingesting the same amount of milk protein. Pharmaceutical grade lactose contains small amounts of milk protein.

The other side of this issue is that lactose in DPIs is not likely to be a problem. For example, Advair diskus contains 12.5 mg lactose but 3,000 mg are needed to provide symptoms. You need to take into consideration how many times you ingested medications containing lactose along with anything else that may have been mistakenly ingested. Lactose intolerance symptoms are more likely if you have ingested multiple medications ingested.

The good news is that all pressurized, spray inhalers (MDIs) are lactose free.

Dry powder inhalers (DPIs) that do contain lactose include: Advair diskus, Flovent diskus, Foradil aerolozer capsules, Oxeze (long-acting bronchodilator) turbuhaler, Spiriva capsules, Symbicort turbuhaler, and Ventolin diskhaler, diskus, and rotacaps.

Two DPIs that are lactose-free include: Bricanyl (bronchodilator) and Pulicort (inhaled corticosteroid).

It’s important to take note: Advair diskus monograph now states “contraindicated in patients with IgE-mediated allergic reactions to lactose or milk.”

This is a good topic to bring up with your allergist! If there are comparable lactose-free alternatives, it does not hurt to choose the safer route.

2017 National Kick Butts Day

Did you know that tobacco use is the number one cause of preventable death? The costs of tobacco use are measured in lives and dollars and reach our families, communities, businesses and the government. Today, March 15, is National Kick Butts Day, a day when the youth and youth leaders and educators are encouraged to speak out and bring attention to the dangers of tobacco use in their communities.

In honor of National Kick Butts day, here are a few facts about tobacco use in the United States:

  • Every day, 3,200 people younger than 18 years start smoking.
  • 5.6 million are expected to die early because of tobacco and nicotine use.
  • Currently, one person dies every six seconds from a tobacco-related disease.

It is hard to quit smoking, but you can do it. To have the best chance of quitting, you need the facts, what your options are and where to go for help.

Breathe Pennsylvania has become Western Pennsylvania’s premier provider of tobacco education, cessation, and prevention programs. For more information on Tobacco Cessation, Education and Prevention programs, contact us at 724-772-1750 or rkishlock@breathepa.org.

Asbestos, Radon and Mold: Testing is the Only Way to Know

The real estate season is upon us, and having a home inspection can be an effective way to deal with lung related issues.  Information on home inspection reports mainly relates to the structures systems, but there are three common dangers to lung health that a report might comment on.

  1. Asbestos —Most uses of asbestos were outlawed in 1978. Many products with asbestos are not recognized during an inspection, and inspectors are not required to comment on any of them.  But, most Home Inspectors will call out some of these common asbestos products:  asbestos roofing and siding, flooring tiles, asbestos wrapped pipes or electrical items.  Be sure to ask about asbestos if the home was built before 1978.  As a side note, 1978 is also when lead in paint was outlawed.  It is a good date to know when buying an older home.
  1. Radon —A radon test is not required, but it’s worth the extra cost to get one considering Pennsylvania measures high in radon levels when compared to other states. According to the state Environmental Protection Agency, once a house tests high, it will always test high.  Ask your agent if the home has been tested before.  If they know, they have to tell you, and they have to give you the results.
  1. Mold—People have different sensitivities to mold. Some have no reaction, while others have severe reactions.  If a buyer knows they have an asthmatic condition, or they knowingly react to mold, then having additional testing done is strongly advised.  In such a case, one should ask for an inspector who is a certified indoor air professional that can do comprehensive testing with recommendations.  Relying on a single swab sample might not give the whole picture.

A final thing to watch out for is a sale where the deal fell through.  There are many reasons, unrelated to the three previous issues, for a deal to fall through.  However, all three of these issues are common reasons for a buyer to walk away.  You can always ask.  Check the disclosures before you make an offer.  Such issues, if known, are required to be listed there.  However, these are also common areas for people to turn the other cheek. Proper testing is the only sure way to know.

Tuberculosis in Children

Tuberculosis (TB), an infectious airborne disease caused by the bacterium Mycobacterium tuberculosis, is of vital public health concern when it occurs in any segment of the world’s population. Why is it that TB in children is of particular interest to the worldwide healthcare community? There are several reasons:

  • Tuberculosis in children is a marker for recent exposure to an active case of the illness, since children, once infected, are more likely to get sick with TB disease, and to get sick more quickly.
  • Many children with TB do not develop the classic symptoms and, therefore, it might be difficult to diagnose.
  • It is difficult to collect sputum specimen from young children and infants. Additionally, the laboratory tests used to find TB in sputum are less likely to have a positive result in children due to the fact that children are more likely to have TB disease caused by a smaller number of bacteria.
  • Infants and young children are more likely than adults to develop life threatening forms of the disease, such as disseminated TB and TB meningitis, the most serious complication in children that is fatal without treatment.

Given these issues, it is very important that health care providers be aware of current recommendations for the management of TB infection and TB disease in children and adolescents, and that they be knowledgeable on how to properly identify children and adolescents who should be tested for tuberculosis infection.

Learn more

On March 24, 2017, at Breathe Pennsylvania’s Tuberculosis Education Conference, Dr. George D. McSherry will address the topic of “Tuberculosis in Children and Adolescents.” Dr. McSherry is Professor, Department of Pediatrics, Pennsylvania State University College of Medicine, and Chief, Division of Pediatric Infectious Diseases, Penn State Children’s Hospital. He has more than 20 years’ experience treating children with tuberculosis.  Dr. McSherry also serves as a childhood tuberculosis consultant to multiple state and local health departments including the Pennsylvania Department of Health Tuberculosis Control Program.

The conference will be held at The University Club in Pittsburgh’s Oakland neighborhood. To enroll for the conference, please visit www.breathepa.org.

E-Cigarettes: Risks Outweigh Any Benefits

While it might seem like introducing unidentified “vapors” into your lungs via an electronic cigarette can in no way be healthy, there is still a lack of consistent evidence. There are more than 500 brands of e-cigarettes, making it difficult to gather data.

However, information presented at the 17th World Conference on Lung Cancer suggests that there are, indeed, a number of respiratory problems directly related to the use of e-cigarettes and the unregulated chemicals in the fluid/vapor.

While some cigarette smokers use e-cigarettes as an aid to quitting tobacco products, 8 out of 10 vapers continue to smoke tobacco products, adding the unknown on top of an already dangerous habit.

E-cigarettes deliver a vapor that consists largely of propylene glycol, which is an active ingredient in antifreeze, and glycerin, in addition to nicotine with more than 8,000 flavors containing chemical additives.

Many of the flavors are approved for oral intake, but not for inhalation as a vapor. For example, diacetyl, which is found in 75% of e-cigarette samples, has been approved for safe use as a food sweetener, but is known to cause bronchiolitis obliterans in workers exposed to it via inhalation. Fluid/vapor extract is shown to cause changes in lung tissue cells and inflammatory changes.

A study of more than 45,000 Chinese students found e-cigarette use to be associated with significant increases in respiratory symptoms, physician diagnoses of asthma, chronic cough, mucus production and bronchitis symptoms.

While there is much to be learned about the effects of e-cigarettes on long-term health there is already plenty of evidence that using them is harmful. Your best bet is not to smoke anything.