Air Cleaners and Indoor Air Quality

People, especially those with lung issues, are often interested in improving their indoor air quality or IAQ.  According to the EPA, one should take a three prong approach to improving IAQ.

The first prong is air cleaning.  Air cleaners alone will not keep your IAQ high, but when used with the other methods, one should be able to keep their air fairly clean.

When buying an air cleaner, think about what you want from it. There are three possible uses—limiting particulate matter, limiting germs or limiting smells.

If a homeowner is trying to limit particulate matter, they may already have an air cleaner in their home.  Most furnace and AC systems have a filter system.  Consistently changing the filter or cleaning the charged plates – if the filter system is electronic – should have a significant effect on limiting particles in the air.  Consult a licensed HVAC technician to verify if you have such a system at home and to instruct on proper usage.

Homeowners that do not have such a system in their home should consider buying a filter-based air cleaning system, and it should be properly sized for the home.

If you’re interested in limiting germs, consider a UV based system.  Ultraviolet light is known to be germicidal, and is commonly used to kill germs in both air and water.  Fortunately, there are many units on the market that claim to do both of these.

Getting rid of smells is a different issue.  Doing both filtration and killing germs can help remove the source of some smells.  However, if smells are a big issue then the best method of removal is carbon filtering.  Free standing carbon filter air cleaners can be purchased, and carbon filters for HVAC systems are also available.

TIP: Make sure that the air cleaner you choose is NOT an ozone air cleaner.

Two additional prongs for improving IAQ that should be used with an air cleaning systems:

Source control involves removing sources that can affect IAQ.  Look for mold-like staining (especially in basements), household chemicals that are no longer used should be thrown out, and remember to test for radon when buying a home.  A good dusting and sweeping routine will always be helpful to IAQ.

Ventilation is easy enough.  The air outside is usually far cleaner then the air inside.  When the temperature is not too hot or cold open the doors and windows and enjoy the fresh air.  However, be aware during alerts for ozone action days or high pollen.

A three prong approach should help keep IAQ good for those interested in keeping lungs healthy, or helping those whose lungs don’t work as well as they should due to various medical issues.

 

Information for this article based from https://learn.allergyandair.com/types-of-air-purifiers/

And the DEP at https://www.epa.gov/indoor-air-quality-iaq/ozone-generators-are-sold-air-cleaners

Have Lung Issues? Stay Away from Ozone Air Cleaners

Ozone is a gas that is comprised of three oxygen molecules and can easily interact with other chemicals.  Simply put, it is bad for our lungs.

According to the EPA “When inhaled, ozone can damage the lungs. Relatively low amounts can cause chest pain, coughing, shortness of breath and throat irritation. Ozone may also worsen chronic respiratory diseases such as asthma and compromise the ability of the body to fight respiratory infections.”  Additionally, when used at safe levels, ozone is ineffective at eliminating indoor particulate matter.

So what does all this have to do with air cleaners?  There are companies who make and market ozone producing devices, and then sell them as air cleaners.  The reason these devices are sold as air cleaners is because ozone, in large amounts, can neutralize strong odors.  This gives the user the feeling that the air is clean.  The assumption is made that the smell is gone so the air must be clean.

In short, if someone has issues with indoor air quality and their lungs they should not use an ozone generator based air cleaner.  How would one know?  Read labels carefully.  They are often marketed with phrasing the same as or similar to “energized oxygen or “pure air”.  According to the makeup of the molecule, Ozone is a different chemical with different “properties” then breathable oxygen.  These people should take other action to clean their air.

Some vendors say that these devices have been approved by the federal government.  In fact, NO federal agency has approved these devices for use.

For more about air cleaners, read this blog post.

 

Source: https://www.epa.gov/indoor-air-quality-iaq/ozone-generators-are-sold-air-cleaners

Peer Pressure and Vaping

The kids are back in school, and as the parent of a teenager, it seems as though one of the biggest fears I have surrounds peer pressure and positive decision making.  As a child enters the teenage years they tend to spend more time with their group of friends. I have no doubt that many friend groups make positive choices but the reality is peer pressure among teenagers is usually associated with risky, negative and impulsive choices.

This school year, our kids are going to be faced with different types of peer pressure and lots of challenging decisions.  Smokeless Saturday, which is a diversionary program for kids that are caught on school property with tobacco products, received over 1,300 referrals in the 2018-19 school year.  About 92% of these referrals were due to Electronics Nicotine Delivery Systems (ex. JUUL and Suorin).  If we have 1,300 kids that got caught with these products, can you imagine how many didn’t get caught?  Do you question how many students posted videos or pictures on social media with these products?  Do you think that your kids are seeing these products on the bus?  At the park?  On Snapchat?

The use of electronic cigarettes has drastically increased which has left school administrators and parents asking what they can do.  I encourage you to learn the current product trends (ex. devices, ingredients) and gather resources.   Then start the conversation with your kids regarding peer pressure, drugs and addiction.

So as we kickoff the 2019-20 school year lets work together on continuing the conversation and educating youth about the risk of using tobacco products.   Encourage your child to create a healthy lifestyle, make good choices and pursue meaningful goals over the upcoming school year.

For additional resources, please visit www.breathepa.org.

 

Sources:

https://www.health.pa.gov/topics/programs/tobacco/Pages/E-cigarettes.aspx

https://www.cdc.gov/tobacco/data_statistics/sgr/2012/pdfs/parent_card508.pdf

Breathe PA Awards Lung Research Grants

Breathe Pennsylvania awarded $40,000 to three individuals for the purpose of conducting research leading to improved care and outcomes of lung disease patients.

Congratulations to the recipients:

Merritt Fajt – “The Impact of Longitudinal Allergy Changes on Asthma and Severe Asthma in Western Pennsylvania”

 

Kathleen Oare Lindell (pictured with Dr. Frank Sciurba) – “Early Integration of Palliative Care for Patients with Advanced COPD and their Caregivers”

 

Brandy Hill – “Asthma Institute Registry (AIR)- environmental health assessment- a pilot study in the Mon Valley”

Loud, Frequent Snoring Could Indicate OSA

When it comes to sleep, I’m not afraid to admit that it’s something I look forward to and enjoy immensely. There’s nothing like getting into your own bed and getting ready for a great night’s sleep. But then it happens- your sleep partner starts snoring. It’s not just a gentle faint snore, it’s the kind of snore that makes the whole house shake! Most may not even realize their partner’s snoring or they snore just as loud themselves. Some may pass this off as an irritating event, but you live with it. Others may have a hard time sleeping at night due to their partner’s snoring.

While we may pass this off, loud and frequent snoring is an indicator of obstructive sleep apnea (OSA), a chronic sleep disorder characterized by pauses in breathing or shallow breaths during sleep that affects as many as 22 million Americans. If you or your partner are a frequent loud snorer, stop breathing throughout the night, experience restlessness at night or are excessively sleepy during the day you may want to discuss your symptoms with your doctor.

If your bed partner decides to speak with a doctor it would be beneficial to track behaviors you have observed from them including details of the time it occurs and how often. Since they are asleep some questions the doctor asks may be difficult for them to answer.

Observable behaviors you may want to record include:

  • Snoring- the intensity and what makes it worse
  • Occasional loud snorting
  • Twisting or kicking legs
  • Choking
  • Pauses in breathing
  • Talking in sleep
  • Wetting bed
  • Getting out of bed when not awake

When breathing pauses in a person with OSA, they are usually moving out of a deep sleep into a light sleep which lessens sleep quality. OSA can also trigger the release of stress hormones, change how your body uses energy, and make you feel tired and sleepy during the day. There is also evidence that OSA leads to a greater risk of high blood pressure, heart attack, stroke, congestive heart failure, atrial fibrillation, diabetes, certain cancers and even sudden death.

There are several potential negative health effects of insufficient sleep, such as weight gain, memory loss, skin aging and more. Treating either condition can decrease these risks. Part of living a healthy lifestyle is getting quality sleep.

Even if the snorer may feel as though the condition is not disrupting their sleep, their bed partner may feel differently. For everyone who is getting nudged or elbowed from a frustrated bed partner or those whose sleep has been disrupted it’s important to know what your partner’s snoring means and a way you both can get back to a good night’s sleep.

Back to School with Asthma

The time has come and kids are heading back to school.

At the top of your list of “must dos,” should be how to prepare for another successful school year supporting the management of your child’s asthma with anyone who interacts with him or her.

Who is on that list? Maybe a few people you hadn’t considered or maybe you have but didn’t know how to get started.

The school nurse, teachers, the school bus driver, and anyone who’s on the “need to know” list set by the school nurse and you. Establishing a good network of care will help to insure your child’s safety as well as encourage him or her to participate in all aspects of the new school year.

The whole process is much easier if roles and responsibilities can be defined for the asthma doctor, the school nurse, teachers, the school bus drive and, of course, for you and your child.

You and your child need to complete an Asthma Action Profile to verify what you do and don’t know about your child’s asthma. It is important your child be included in establishing a current asthma record because you won’t always be there when he/she needs help. Visit www.breathepa.org  or call 800-220-1990 and request an Asthma Action Profile. Make a copy of the one-page Asthma Record for the school nurse.

Next, meet with your physician, so your child and you can discuss, then create an Asthma Action Plan. This plan should cover medications used at home and school, purpose, dose, and what to do if your child has an asthma attack at school. Remember to provide current contact information and provide the needed medication for the school nurse office.

Meet with your school nurse and discuss what information should be shared with teachers and school bus driver. Your school nurse can determine the best way to share this information.

Everyone on the same page will help support your efforts in keeping your child healthy, in school and ready to learn. For additional information or to find out how you can bring an asthma program to your school, contact Jeannie Simms at 412-855-4594.

 

How Vaping Affects Your Asthma

It is widely believed that vaping is “safer” than smoking cigarettes, but that doesn’t mean that it is safe.

E-cigarette aerosol contains harmful substances that could include nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents. There are new concerns that are surfacing regarding secondhand e-cigarette aerosol’s impact on people with asthma — in particular, the correlation between electronic nicotine delivery systems (ENDS) and increased asthma symptoms.

The Chest Journal, official publication of the American College of Chest Physicians, identified a correlation between ENDS and an increase of asthma symptoms in youth, ages 11-17, after doing a study on the impact of second-hand ENDS. This research concluded that healthcare professionals may need to include this type of exposure when working on asthma self-management and action plans as well as in the home environment assessments.

If you have asthma, it is important that you minimize exposure to inhaled irritants, including e-cigarette aerosol. Not only should you not vape, but you should avoid other people’s vapor. Prepare now by walking through a situation in which you find yourself around people vaping. What could you say to help minimize your exposure? Educating yourself on the impact of vaping on asthma is the first step. For more information on asthma and vaping visit www.breathepa.org.

For additional information visit:

Asthma and Type 2 Inflammation

Asthma is characterized by airflow obstruction, increased mucus production, and increased inflammation in the airways. If you’ve ever experienced an asthma attack you know the feeling of struggling to catch your breath and coughing up mucus. But what about inflammation? There is one kind of inflammation, known as Type 2 inflammation, which is an immune system response that causes an intense response to inhaled irritants.

Asthma severity is classified into one of four categories: intermittent, persistent mild, persistent moderate, or persistent severe. Your severity classification is based on your asthma symptoms, its impact on your daily activity, lung function, how often you use your rescue medication, and how often you experience nighttime awakenings due to asthma. There is a link between Type 2 inflammation and increased asthma severity. About 50-70% asthmatics have Type 2 inflammation, along with 50% of individuals with nasal polyps, and 80% of individuals with atopic dermatitis. Type 2 inflammation has also been linked to chronic rhinosinusitis, aspirin-exacerbated respiratory disease, gastroesophageal reflux disease, and sleep apnea.

Controlling inflammation is an important strategy in asthma management. When a person has severe asthma it often requires several layers of medications and it can be hard to manage. If asthma has become difficult to manage and treat, talk with your asthma doctor about Type 2 inflammation. There may be a way to reduce the severity and frequency of symptoms. For additional information on this topic, visit Allergy & Asthma Network.

Patient Perspective: Living with Severe Asthma

Kristin Nowack, a severe asthma patient, contributed this blog post for Breathe Pennsylvania.

Have you been diagnosed with severe asthma?   I have been living with severe asthma and know the trials and tribulations one may face.  Severe asthma is not your typical asthma as many of you know.  Severe asthma as defined by the European Respiratory Society (ERS)/American Thoracic Society (ATS) as “asthma which requires treatment with high dose inhaled corticosteroids (ICS) plus a second controller (and/or systemic CS) to prevent it from becoming ‘uncontrolled’ or which remains ‘uncontrolled’ despite this therapy.”

I was diagnosed with asthma when I was 3.  I was in and out of the emergency department and in high school, I ended up in the ICU for two weeks.  Fast forward a few years and I quickly became steroid-dependent and was diagnosed with steroid-resistant severe asthma.  Those are words you never want to hear.  To say I was scared was an understatement.  I will be the first to tell you I was in denial.  There was no way I was resistant to the mainstay of treatment for severe asthma; corticosteroids!  I felt alone, scared and embarrassed.  I was not going to let my severe asthma take control of my life.  I completed my Doctorate of Nursing Practice on daily high dose IV steroids.  Side effects of high dose steroids are truly awful.  Weight gain, moon face, insomnia, diabetes and extreme emotions are just a few.

Living with severe asthma is a struggle.  Although I don’t look sick, I have an invisible disease and struggle daily to breathe, often not even being able to walk across the room.  I hide my disease very well and don’t want others to know I am having trouble breathing.  I will always tell you, “I am fine,” even if I am not.  I don’t want family and friends to worry.  I don’t want them to cancel their plans because I can’t breathe “again.”  Often times during a severe attack, I tell myself I am not sick enough to go to the emergency department because I am scared.

I have been on typical treatment for severe asthma; however, I did not respond to the medications and my symptoms kept getting worse.  Prednisone is one of my main treatments, but not the typical lower dose that may be required to keep severe asthma symptoms under control.  Every day I take 60mg of prednisone just to keep my symptoms somewhat manageable.  By manageable I mean using my inhaler or nebulizer every two to three hours, while still wheezing and experiencing shortness of breath all day. I use a BiPAP (Bilevel Positive Airway Pressure) machine every night and require supplemental oxygen when I am extremely ill.

If you’re living with severe asthma, always remember:

  1. You are NEVER alone – 5 to 10% of asthmatics suffer from severe asthma.
  2. ALWAYS keep in close contact with your asthma doctor and follow your treatment plan.
  3. You are NOT a burden on others; accept or ask for their help.
  4. ALWAYS have your inhaler within reach. I always have my inhaler and carry prednisone with me.
  5. Reach out to others with severe asthma.
  6. New and effective treatments are available for some severe asthma patients.
  7. If your asthma is uncontrolled, see an asthma expert for up to date treatment.
  8. When in doubt about your breathing; don’t hesitate! Seek emergency treatment immediately.

Some FAQs about COPD

Dr. Tiffany DuMont and the Breathe PA team

Dr. DuMont is a pulmonologist with Allegheny Health Network and member of the Breathe Pennsylvania Board of Directors.

As a pulmonologist, I get a lot of questions from patients. Here are some common questions I hear in the pulmonary office regarding COPD. If you have any questions, please send them to Breathe PA at info@breathepa.org and we will do our best to answer them in a future blog or in the next newsletter.

They told me I had an Exacerbation. What is this?

A COPD exacerbation is defined as worsening respiratory symptoms that requires additional therapy.  There are varying degrees of exacerbations.  They are categorized based on the treatment needed as mild, moderate, and severe.

Ok, so I had an exacerbation… what’s the big deal?  I feel better now.

COPD exacerbations can negatively affect your life, increase your chances of being hospitalized and can cause progression of your COPD.  Your doctor would like to know each time you’ve had an exacerbation especially if it was moderate or severe, as it may change the category of your COPD and change the treatment plan.  A prior exacerbation is a predictor of future exacerbations.  Lung function, how well the lungs move air and process gases, declines as people get older. People who smoked see their lung function decline faster.  Each exacerbation may cause an acute worsening of your lung function and you may not return to your prior baseline.

Come on doctor, can’t you just leave me on steroids all the time for my COPD? I feel so much better when I am on them!  

This is a line I hear in the office all too much.  And although I want my patients to feel their best, chronic steroids are not always the best decision.  Steroids are used short term to treat COPD exacerbations but are rarely recommended for long term use for COPD.  Steroids can cause multiple side effects.  These side effects include, but are not limited to, high blood pressure, osteoporosis (fragile bones), high blood sugar/diabetes, weight gain, cataracts, glaucoma, easy bruising, thinning of the skin, and increased risk of infection.  If you are experiencing frequent COPD exacerbations, there are alternative medications to chronic steroids.  I would suggest talking to your doctor about the alternative options that exist.

If you want to learn more about your disease, have more questions, or want to meet people who are experiencing similar symptoms, join us on the Breathing in the ‘Burgh COPD Cruise on June 21.  We look forward to seeing you!

 

References:

Walters JA, Walters EH, Wood-Baker R Oral corticosteroids for stable chronic obstructive pulmonary disease.
Cochrane Database Syst Rev. 2005

Horita N, Miyazawa N, Morita S, Kojima R, Inoue M, Ishigatsubo Y, Kaneko T. Evidence suggesting that oral corticosteroids increase mortality in stable chronic obstructive pulmonary disease. Respir Res. 2014;15:37. Epub 2014 4 3.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: The GOLD Science Committee Report 2019.  Singh D, Agusti A, Anzueto A, Barnes PJ, Bourbeau J, Celli BR, Criner GJ, Frith P, Halpin DMG, Han M, López Varela MV, Martinez F, Montes de Oca M, Papi A, Pavord ID, Roche N, Sin DD, Stockley R, Vestbo J, Wedzicha JA, Vogelmeier C. Eur Respir J. 2019 Mar 7. pii: 1900164. doi: 10.1183/13993003.00164-2019.