The Importance of Pulmonary Rehab

At Breathe Pennsylvania, we are big proponents of pulmonary rehab. It is a drug-free intervention that teaches individuals with respiratory disease how to safely exercise while maintaining control of their breathing. Individuals who attend pulmonary rehabilitation not only reduce their breathlessness and improve stamina, but learn about exercise options that can be implemented long-term, even when the formal pulmonary rehabilitation program ends.

Pulmonary rehabilitation is a multidisciplinary program and should be considered as part of a care plan for patients with respiratory disease. The supervised exercises, education, training, and assessments can help improve your quality of life. What are you waiting for? Talk to your lung doctor about pulmonary rehabilitation. A list of pulmonary rehabilitation facilities near you can be found at www.livebetter.org.

Air Quality and Your Lungs

Recently in western Pennsylvania, there has been a lot of discussion about air quality, pollution, and the importance of protecting your lungs when you are considered part of a “sensitive” population. However, the terminology and classification may be confusing. What does it mean to be “sensitive” to dips in air quality, and how would someone know that they need to protect their lungs?

The Clean Air Act is a law that mandates that the Environmental Protection Agency’s (EPA) Office of Air Quality Planning and Standards (OAQPS) set national ambient air quality standards (NAAQS). These standards evaluate pollutants that are considered harmful to people and the environment, and include six criteria:
• Ground-level ozone
• Particulate matter
• Carbon monoxide
• Lead
• Sulfur dioxide
• Nitrogen dioxide

In order to communicate these pollutant levels to the public, the EPA has established an Air Quality Index (AQI), which quantifies local air quality levels using five of the six pollutants previously mentioned (lead is excluded). The AQI ranges from 0-500, and is color-coded for ease of communication to the public. The AQI alerts individuals about when they should take actions to protect their lungs.

Some individuals are considered to be part of “sensitive populations.” This terminology means that it would be harder for an individual to protect themselves—and recover from—dips in air quality. The elderly, children, individuals with lung disease, and individuals with heart disease are included in this classification. Therefore, when pollutant levels rise, they tend to feel the effects before the rest of the population does.

It is important for individuals from sensitive populations to be aware of the air quality levels in their community, so that they may take steps to protect their lungs. You may register online at www.enviroflash.info for daily AQI email alerts, or visit www.airnow.gov to review current air quality levels.

Exposure to pollutants can reduce the ability for the lungs to function normally. This is particularly true for sensitive groups. To protect your lungs when the AQI level is high, reduce the amount of time you spend outdoors, and limit your exertion levels outdoors. For more information on the Clean Air Act, visit www.epa.gov/sites/production/files/2015-08/documents/peg.pdf.

1. Environmental Protection Agency (2016). Air quality. Retrieved from https://www3.epa.gov/airquality/cleanair.html
2. Environmental Protection Agency (2016). Air quality index (AQI) basics. Retrieved from https://airnow.gov/index.cfm?action=aqibasics.aqi

The 10 Worst Jobs for Your Lungs

It is estimated that up to 17% of adult asthma cases may be caused by exposure to inhaled irritants in the workplace, making people with COPD at even greater risk from these types of jobs. Occupational lung diseases are preventable using a little common sense and control measures. Here are 10 fields that can cause you problems over time:

  1. Construction: Inhaled dust can cause mesothelioma, asbestosis and lung cancer.
  2. Firefighting: Inhaled smoke and chemicals caused by burning structures as well as asbestos exposure after the fire has been extinguished can be harmful over time.
  3. Textiles: Byssinosis is common among those who make upholstery, socks, towels and clothes who have inhaled cotton dust or other materials.
  4. Automotive Repair: Spray-on paints can irritate skin and the lungs causing severe breathing problems.
  5. Transportation: Delivery truck drivers, railroad workers and those who unload materials on loading docks can be at risk for COPD. Diesel exhaust is the culprit.
  6. Manufacturing: Factory workers are exposed to myriad of irritants such as dust, chemicals and gases. Diacetyl, a flavoring agent used in microwave popcorn, is linked to bronchiolitis obliterans, a relative of COPD.
  7. Health Care: Up to 12% of health care workers are allergic to latex. This can cause a severe airway reaction. Many places have switched to latex-free gloves.
  8. Baking: Exposure to flour dust and enzymes used in dough-making can lead to developing of an allergic sensitization. Also a danger are allergens shed by insects that are found in flour.
  9. Mining: Dust exposure from coal, rocks, minerals, and sand can lead to black lung and silicosis.
  10. Bartending: Smoke-filled bars and restaurants put workers at high risk for developing lung disease.These days most states have banned smoking which has helped immensely.

What should you do if you work in these high-risk fields? First, if you smoke, stop! Use a mask or respirator, make sure the room is well-ventilated, and use gloves and goggles if needed. Don’t think that because you are young you don’t need to be concerned. Lung damage takes place over time so start now to protect yourself.

Reference: Time Health Winter 2018

Exposure to Radon is a Preventable Health Risk

January is National Radon Awareness Month. 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. Radon is considered the second leading cause of lung cancer after smoking.

As a former radon measurement technician, I know about the importance of testing your home, and the effects of radon really hit close to home a few years ago. I was in the same neighborhood that my grandmother lived in about 25 years prior. I was there to pick up a radon test, and my equipment indicated a level of about 17.0 picocuries per liter of air (pCi/L) – the recommended remediation level is 4 pCi/L, so this measurement was clearly extremely high.

After leaving the house, I cruised through the old neighborhood and I noticed many houses that had radon remediation systems.    Their white PVC piping terminating above the roofs and fan housings near foundations were an obvious give away.  It’s possible that there were probably just as many on the opposite side and rear of the houses that I could not see.

It got me thinking.

My grandmother died of lung cancer, and her death was a little perplexing because she was never a smoker.  My parents just assumed it was related to her growing up in the “smoky city” that Pittsburgh has been known for. She grew up near the old American Bridge Steel facility where my grandfather worked.

Though scientists were aware of the dangers of radon at the time, it had not yet become a common issue to check a home for such during a sale.

My state training has told me that just because one house has high levels of radon, it doesn’t mean the one next door will (and vice versa). I have certainly encountered such situations.

However, after seeing so many houses with radon mitigation systems near and around my grandmother’s old home, I seriously wonder if the reason for her death had more to do with radon than living in the “smoky city.”  In my profession, I have heard people talk about radon testing and mitigation as being an excuse for home inspectors to make a buck on an unnecessary service.  However, I could not think of a more important, lifesaving service for people to have during a home sale and inspection.

Exposure to radon is a preventable health risk. For more information about radon and testing for radon, or to order a radon test kit, visit www.breathepa.org/radon-test-kit.

What is E-Asthma?

Eosinophilic Asthma (E-Asthma), is a severe form of asthma that affects the entire respiratory system. What sets this type of asthma apart from the asthma you might know, is the high levels of white blood cells called eosinophil. These white blood cells are part of your immune system and help to fight off infection.

High levels of eosinophils can cause inflammation (swelling) that affects the sinuses and nasal passages as well as your lower airways. This kind of asthma is often seen in people who are 25-35 years old.

At this time, we are not sure what causes this type of asthma. Scientists are exploring whether or not there could be a genetic link. What they do know is that this particular kind of asthma is not triggered by an allergen.

Here are some of the symptoms a person might experience with E-Asthma:

  • Shortness of breath
  • Wheezing/cough
  • Tightness on the chest
  • Stuffy nose
  • Chronic sinus infections
  • Nasal drainage
  • Nasal polyps
  • Lost sense of smell

It is important to see your doctor if you are experiencing any of these symptoms. This type of inflammation of your airways can lead to permanent damage to your airways and scarring of the lung tissue.

A doctor will be able to decide if you have E-Asthma by measuring the eosinophils in your blood or saliva and by conducting a bronchial biopsy.

There are injectable medications available to treat E-Asthma along with inhaled corticosteroids: Cinqair, Fasenra, Xolair and Nucala. There is also a new oral medication being tested called Fevipiprant. Though still in development, this experimental drug reduced symptoms and improved lung function in studies completed so far. If Fevipiprant is approved, it would be the first new oral asthma drug to be introduced in 20 years. These treatments take place under the direct supervision of a physician.

To learn more visit https://www.verywellhealth.com/what-is-eosinophilic-asthma-4156744

Consider Your Lungs Before You Cozy Up by the Fireplace

Home fireplaces often sit unused for most of the year.  With the holidays coming up, fireplaces might get “fired up” for family get togethers. 

The biggest issue can be old brick and terra cotta liners that can allow flue gasses to escape into the home.  In some older homes, flues have combined uses—such as for the fireplace and hot water heating system. It’s important to know the purpose of a flue is to ensure that dangerous gasses like carbon monoxide aren’t building up in your home.

Even if your fireplace is blocked off and not used, the flue still could be in use by your water heater or your furnace – especially in an older home.  

Additionally, animals like to make their homes in chimneys.  Their nests and fecal material can cause flue gasses to back up into the home. Such venting problems can develop slowly and exacerbate difficult breathing for older people or people with known asthma issues. 

Finally, make sure the flue damper is functional. The flue damper enables you to control how much air flows up your chimney when the fireplace is in use. It should always be open when the fireplace is in use. Otherwise, smoke could fill your home. 

The most likely repair to flue issues is to have the chimney lined.  Most chimney liners can be installed for under $1,000.  As with most issues an ounce of prevention can go a long way. If you’re planning to use your fireplace this winter, it is a good idea to have a certified chimney sweep check it out.

Take Steps to Live Better with COPD

November is National COPD Awareness Month, and as the third leading cause of death in the United States – and the fourth worldwide – it’s the public health crisis that nobody is talking about. Chronic Obstructive Pulmonary Disease (COPD) is a general term that is used to describe diseases such as emphysema and chronic bronchitis, which develop over a long period of time. These diseases cause significant lung destruction and air trapping, and they are irreversible.

In Pennsylvania, more than 6% of adults have been diagnosed with COPD. That means that nearly 700,000 adults in Pennsylvania have been diagnosed and are living with COPD. However, the nature of the disease process causes it to be grossly underdiagnosed, and it is estimated that just as many people have undiagnosed COPD.

As November wraps up, take the steps to live better with COPD:

  1. Quit smoking. If you smoke, make an effort to quit. Quitting smoking will have the greatest impact on changing the natural course of the disease.
  2. Get tested. Pulmonary function testing, or spirometry, will identify airflow limitations and provide your doctor with useful information about your lung health. Many people with COPD attribute their worsening lung function to part of the natural aging process. Measuring lung functions will help determine if that is the case.
  3. Get your vaccinations. The flu shot and pneumonia vaccine are recommended for individuals with COPD.
  4. Take your medications and take them correctly. Take your respiratory medications as prescribed. Use your inhaler with a spacer and follow proper technique to ensure the best medication distribution in the lungs.

 

  1. COPD Foundation, 2018. COPD in the United States: How is your state doing? Retrieved from https://www.copdfoundation.org/Portals/0/
StateAssessmentCards/SAC__PA_2018.pdf
  1. Global initiative for Chronic Obstructive Lung Disease, 2018. Global strategy for the diagnosis, management, and prevention of chronic lung disease. Retrieved from https://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf

Holiday Socializing with Food Allergies

Dealing with food allergies can make life difficult, whether you are navigating your own allergies or those of a loved one. Home is a safe zone for many allergy sufferers.  I prepare my foods and grocery list to meet the dietary needs of my family while also protecting myself. But when it comes to the holidays, visiting family or friends can often be challenging.

Think about what is involved when you meet up with family, or friends…  FOOD. We use food as a socializing tactic, and when you have a food allergy there is fear added to this common-day practice. As an educator, I hear horror stories of family members giving peanut butter cookies to kids with peanut allergies to see if the allergy is real. The thought being they will believe it when they see it. As an adult, it can be very difficult because family has seen you eat a certain food in the past that now is a threat to your well-being and no matter how much you educate them they will not allow this to sink in.

This sense of being ignored can upset you, making family time more difficult, and making it seem as if you don’t trust your family and their cooking.

Even though the holidays are a busy time, you need to make an effort to prepare ahead. Here are a few things you can do to be mindful of your food allergies and make family time less stressful:

  1. Educate family regarding the allergy, what happens when you eat certain foods, and if it is life threatening. When family has a sense of protecting your well-being, they are more receptive to change.
  2. Offer your family a list of acceptable, safe items that can be made.
  3. Bring a safe meal for yourself or your child to eat.
  4. Offer to host the holiday at your own home, where you have full control of the menu and the pans for cooking to prevent cross contact.
  5. If there are unsafe foods at a function, make sure the person with the allergy knows which foods to avoid.
  6. Allow the person with the allergy to plate their food first. This stops cross contact with the use of multiple serving utensils.
  7. Think of alternative ways to celebrate the holidays that do not involve food.

In my own situation, I attend family functions and constantly have to accept apologies from people forgetting that I cannot eat dairy products. Once I started bringing my own foods and removed the burden on others to remember, my comfort level increased so I could safely attend holiday gatherings. My mom now understands and offers dairy free alternatives so I don’t feel left out of the meal.

Holidays are already stressful enough, but following a few quick prep -steps can remove the stress of eating with an allergy so you can enjoy the day with your family.

Home Cleanliness and Internal Air Quality

Cleanliness of a home or building can have an effect on the internal air quality. You have to search deep to ensure that your home is truly clean. Just because you’ve managed to put the clutter away, it doesn’t mean your home is clean. On the other hand, don’t consider yourself a failure at cleanliness if you find that you have a little mold. Cleanliness is hard to quantify, but here are a few rules that can help:

  • Consistent vacuuming –This the single biggest thing a person can do to help remove allergens from a home. Most of the dirt and pollen that enters the home settles in the carpet. Most carpet warranties not only require vacuuming, but a professional cleaning about every 18 months. Additionally, Dust mites also love carpet and because they are microscopic, their presence can be very hard to perceive. If they are suspected then high thread count sheets make it hard for them to live and plant eggs.
  • Cleaning your home’s air ducts and replacing furnace filters– In a home with forced air, dust is pulled in and recirculated through the ductwork. It is recommended to have the air ducts professionally cleaned every three to five years, or earlier if you notice more dust collecting on your furniture with regular cleaning. Replacing furnace filters on a regular basis is recommended to ensure that your furnace is more effective and the recirculated air is as clean as possible. Check your furnace recommendations and replace when you see that the filter is dirty.
  • Cleaning after pets – I love dogs and cats, but four of the five people in my own family are allergic. Most people who have pets are usually not allergic, but sometimes people become “nose blind” to the issue. Vacuuming, wall washing, and regularly grooming your pets will help improve your home’s cleanliness.
  • Testing the humidity level– There are many inexpensive devices on the market that give a humidity reading in a home ($10-$20 at most local hardware stores). Get a good idea what the humidity is in your home – especially in the basement. If it is consistently above 60%, then use a dehumidifier with a condensate pump. This is also a fairly easy DIY job for most people. Controlling the humidity levels can help reduce the growth of mold.

What are you house cleaning tips? We’d love to hear them.

Back to School and the JUUL

It looks like a USB drive, comes in colors like black, rose gold, and turquoise, and it is available in flavors like fruit medley, mango, cool mint, crème brulee, and Virginia tobacco. What else do we know about the JUUL? It has a loyal and growing following among youth.

Over the past few years, teen perception of risks in using electronic cigarettes has decreased, and it’s evident on social media. Youth can be seen touting their use on social media posts by sneaking puffs in classrooms, school bathrooms, and buses. Experts believe its popularity stems from the fact that it’s easy to conceal, the vapor disappears almost immediately, and the odor doesn’t linger.

Some of the facts to keep in mind:

  • The JUUL has two components: the bottom part is the device, which includes the battery and temperature regulation system, and the top part is the e-liquid cartridge that you stick into the device.
  • The JUUL launched two years ago and is currently the most popular e-cigarette on the market. It generated $224 million in retail sales from November 2016 to November 2017.
  • There are over 50,000 posts under the hashtag #Juul on Instagram alone.
  • The nicotine content is 0.7mL (or 59 mg/mL) per pod, which is approximately equivalent to one pack of cigarettes, or 200 puffs.
  • The JUUL device costs between $35 to $50 and a package of four JUUL pods cost $15.99.

The JUUL delivers one of the highest concentrations of nicotine in comparison to any other e-cig on the market. Parents have reason to be concerned about the impact of nicotine, health risks, and addiction.

So how do we have successful conversations with youth about the hazards of vaping?  We learn the facts and start the conversation. Parents, stay informed and talk to your children. Ask them what they know about vaping and follow them on social media. Ask their teachers how kids are using these products and what the school policies are. The more you know, the better informed you will be when talking to your child.

Resources: https://www.cdc.gov/tobacco/infographics/youth/pdfs/e-cigarettes-usb-flash-508.pdf