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.

As Flu Activity Increases, It’s Not Too Late to Get Vaccinated

Influenza activity has continued to markedly increase in the United States, reaching epidemic levels. Since October 1, 2016, a total of 4,317 laboratory confirmed influenza-related hospitalizations have been reported to the Centers for Disease Control and Prevention (CDC). This number represents a rate of 15.4 hospitalizations per 100,000 U.S. residents, which is significantly higher than last year’s rate of 2.5 hospitalizations per 100,000 in the same time frame. A positive factor is that a majority of all the reported flu cases were caused by an influenza type A virus, a strain found in the 2016-2017 vaccine. However, the CDC estimates that as of early November 2016, only two of every five children and adults in the U.S. had received the flu vaccine.

In Pennsylvania, flu activity for this period closely mirrors the national picture. A total of 14,932 laboratory confirmed cases have been reported to the Pennsylvania Department of Health. The southwestern portion of the state has been strongly affected, with the Allegheny County Health Department reporting 1,869 lab confirmed cases, as compared to 62 confirmed cases reported at this time last year.

Flu season generally spreads from November to March. Even though it takes about two weeks for protective antibody levels to fully develop, it is not too late to get a flu shot. It is especially important for those at high risk, such as people with chronic lung conditions, to be vaccinated since they are at greater risk of experiencing serious illness or death as a result of the flu.

Improving the Air Quality in Your Home

Every time you empty a sweeper, imagine that same amount of dirt can be found in your home’s ductwork.

This accumulated dirt clogs the heating system, lowering heating efficiency and requiring more energy and money to heat your home.

More importantly, this accumulated dirt is rebroadcast throughout your home, which is a concern to all of us at Breathe Pennsylvania. We all have different thresholds to different allergens, and if they’re present in higher concentrations, our sensitivities most likely will react to them.

Not surprisingly, there is no standard recommend by the Environmental Protection Agency regarding how often ducts should be cleaned. Some professional duct cleaning companies encourage cleaning every year. Such is probably not necessary, but I am sure there are exceptions based upon system design, age, environmental dirt, number and age of occupants just to name a few.

Duct cleaning doesn’t have to be done professionally. In fact, it can be a fairly easy DIY project, though you probably won’t be able to get to every inch of the duct work. Professional companies may have an advantage here with telescoping tools that enable them to reach every bend.

In addition to cleaning your ducts, change air filters regularly. It might take some time for you to figure out how often filters should be switched out. If you change your filter every six months and the filter is falling apart,  it should be changed it more often. If you live alone in a small home and the filter is fairly clean, then it can be changed less often. Keeping a list next to the furnace can help you develop a routine.

Additionally, dirt will build up around returns. These should be checked every time you vacuum near them, and cleaned when necessary.

Giving your system a little sweep can potentially improve your air quality, and that is a start to good breathing.

About Respiratory Syncytial Virus Infection (RSV)

Respiratory Syncytial Virus Infection (RSV) is a very contagious virus that affects a majority of infants before age 2, and is most common in late fall to early spring. Most children’s RSV appears as a common cold, but a few infant’s RSV can cause serious problems such as an infection in the small airway of the lungs (Bronchiolitis) or pneumonia.

According to the CDC, higher risk is found with:

  • Babies born prematurely
  • Children younger than 2 who were born with heart and lung disease
  • Infants and young children whose immune systems are weakened due to illness or medical treatment
  • Infants under 8 to 10 weeks old

With RSV, most of the time it will present as a common cold—cough or runny nose which will last about one to two weeks.  More serious issues will present differently and your child’s doctor needs to be called immediately is the following symptoms occur:

  • Difficulty breathing
  • Cough that is producing mucus that is green, yellow or gray in color
  • Child is unusually upset or inactive
  • Child refuses to bottle or breast feed
  • Dehydration— lack of tears when crying, a dry diaper for longer than 6 hours or dry skin.

If your child is very tired, breathing quickly or has a blue tint to lips or finger nails, immediate medical attention is needed. 

There is no vaccine for RSV, but simple steps can be taken to help prevent RSV:

  • Wash hands with warm soapy water.
  • Clean and disinfect hard surfaces.
  • Wash objects that a child may touch or hold.
  • Keep your baby away from crowds and allow people to only hold the baby after washing their hands.
  • Avoid kissing a child if you have cold like symptoms present.
  • For children who have heart or lung disease, limit their time in a daycare setting during times when RSV is most common.
  • Keep family, including siblings, away from an infant if they have signs of a cold.
  • Never let people smoke near your infant.

Even though there is a medication that helps prevent high risk infants from getting RSV, there is no drug available to treat the actual virus if an infant is infected. Treatment must focus on the infection and the respiratory symptoms.

In home treatments that work best include:

  • Keeping nasal passages clear of mucus with a bulb syringe and saline drops.
  • Using a cool mist vaporizer.
  • Keeping infants hydrated.
  • Non-aspirin fever reducers (ask your child’s doctor before use)

While RSV is usually identified as a virus in infants, recent studies have found that older adults are also considered high risk. Adults with RSV may also present the illness as a common cold but older adults with compromised lung disease are considered high risk. RSV in adults can cause pneumonia, or an exacerbation of COPD or congestive heart failure.

Adults can follow the same prevention steps above to help avoid RSV, but need to be aware of changes in health and notify their doctors immediately.

RSV may only be noticed as a common cold in your house but watching for serious signs and symptoms is very important to the health and well-being of your infant and elderly family members. Understanding RSV and using easy steps to prevent it is the first line of defense.

How did you sleep last night?

A good night’s sleep is vital for our survival, and proper sleep hygiene can help you get the Zs you need.  I spend my nights listening to my husband snoring, with a cat on my chest, and half way through the night my 5-year-old catapults herself into my bed and moves around like she is competing on “Dancing with the Stars.”  Whatever your story is, a good night’s sleep is sometimes hard to get.

Sleep hygiene is a variety of different practices to help us get the best night’s sleep and full daytime alertness.  Some best practices are as follows:

  • Avoid napping during the day. Napping disrupts our normal sleep pattern a night.
  • Avoid staring at bright lights such as a smart phone or tablet before bed. Some devices have a “night shift” mode that decreases the brightness of the phone or tablet at a set time.
  • Make sure you have a good exposure to natural light. This exposure helps regulate your “sleep-wake cycle.”
  • Reading emails or social media before bed can keep the brain active and not allow it to rest properly.
  • Large meals before bed can disrupt sleep, and if you’re having sleeping problems, that is not the best time to start trying new foods.
  • Avoid caffeine, especially at night before bed. Sometimes a warm drink, such as decaffeinated hot tea, can help you calm yourself before sleep.
  • Proper exercise can help promote a good sleep cycle. Engage in vigorous exercise during the day and calming exercise like yoga at night as a pre-bedtime routine.
  • Create a calming bedtime routine, leaving negativity behind and out of the bedroom. Your bed should only be associated with sleep and be a pleasant and comfortable nightly retreat.
  • Remove triggers in the bedroom that cause you to wake up or stop you from sleeping.

When we establish proper sleep hygiene, we are going to sleep better.  The better we rest, the more alert and ready we are for the next day.  Sleep is important for proper health, so take the time out every night and give yourself what you deserve—a good night’s sleep.

January is Radon Awareness Month

January is Radon Awareness Month, and Western Pennsylvanians should take the time to learn about it.  Radon comes from the breakdown of trace amounts of uranium in our soil.  As a gas, it moves up into our homes where it is trapped and presents a danger to us in the form of lung cancer.  Even at levels below the recommend remediation level of 4 picocuries per liter of air (pCi/L), radon can still be a danger; however, zero radon is considered impossible to achieve through modern remediation technology.

Pennsylvania measures high in radon levels when compared to other states.  According to the Pennsylvania Department of Environmental Protection, 43% of the homes in Allegheny County, 51% in Butler and 58% in Beaver measure high in radon.   Because of the high levels of radon in Pennsylvania, lung cancer is usually found and diagnosed later in the disease progression.

What can you do?  Test your home.  Licensed Measurement Technologists can be found on the state DEP web side.  Self-test kits can be found at some local hardware stores, and you can even get one at the Breathe Pennsylvania online store.

Additionally, when you buy a home make sure it is tested.  You can’t be forced to buy a home with high radon in Pennsylvania.  It is a great opportunity to have a home remediated before you move in.  When you are selling a home, please make sure testing protocols are followed.  Most home sellers do abide by what is requested of them, but as a former licensed tester I have encountered home owners who cheat to get a positive result.

If you find high levels of radon, immediately call the state DEP for a list of qualified mitigation contractors who can help. If you ignore it or try to fix it yourself, you potentially put your life or someone else’s in danger and you might actually increase radon levels in your home. Knowingly tampering with an ongoing radon test also is illegal. In the end radon can be remediated, and dong so not only benefits present owners, but future ones as well.