Expert: Marc Rubin, RPh Asthma Educator - 1/26/2012

Question
QUESTION: I live in Toronto, Canada.   I have no pets at home.   
My medications: advair 250 discus(once in the morning and once at night), ventillin puffer(once a day).   From 1994 until 2010 I lived in a moldy basement.   From October 2010 until now,..I live upstairs in a completely dry, warm environment.    The winter I moved up there was the first time I was exposed to continual blowing furnace air(while living in the basement, I always used to duct tape the furnace vents),....and my breathing became terrible towards the end of winter.   My right lung felt 75% closed,..and I felt like I was smothering when I was inside amid furnace air.    As the summer came,...I got well again and my breathing was "normal".    But now this winter, dec.24th, my breathing became terrible again.    Warm or hot steam gives me terrible asthma attacks.   I can't take showers(bathe only), not hot steamy coffees or food.   I feel helpless, because when I go to emergency,....they check out my lungs and oxygen,...and tell me I'm fine.     I desparately need to get properly diagnosed,..so I can get some kind of proper treatment.    Do you have any suggestions/help?   Thank you in advance.

ANSWER: Hi Paul,

First of all, I have a series of questions for you:
1) How old are you, and how long ago were you diagnosed with asthma?
2) How old is the home you live in?
3) Is the basement foundation concrete or boulder wall?
4) Has the home been evaluated for mold: basement, bathrooms, heating duct work, attic?
5) Were your asthma meds prescribed by a family physician, or a lung specialist (pulmonologist or allergist)?
6) Were lung functions tests run: spirometry (where you blow into a device, you breath in as deep as you can, then blow out as fast and long as you can, for a minimum of 3 attempts)?
7) Do you have any issues outside of the home: work/school/outdoors?

Asthma control is achieved through a combination of patient testing, education, and medication.

> Testing: blood work: a RAST test which helps identify potential "triggers" which may bring on an episode, skin testing with allergens to see your bodies physical response to other common triggers, spirometry to see if your lung capacity and functionality are normal, and, if lung function is lower than expected, possibly a CBC (complete blood count) to look if one of the elements is elevated..an indication of increased lung inflammation.

> Education: once a diagnosis is correctly made, it is extremely important that the patient learns about the condition, their own personal "triggers", self-evaluation using a few tools, and how the medications works. In many diseases, the patient has the option of being controlled by the illness, or, through education, learning to take control. This is done by, to the best of your abilities, eliminate the trigger sources, and avoid them if not possible to eliminate them. There may be times (like going to someones house that has a cat) that you need to pre-treat yourself to prevent an attack, vs. going there, having an attack, then taking your Ventolin to recover.

> Medication: Depending upon the frequency of attacks, in your case which appears chronic, taking daily medications as you presently are. The problem is, if the triggers are not eliminated, the meds can only do so much. If it discovered that there is mold in the vents, and possibly attic, these situations need to be cleaned up by trained experts. This can be costly(I have a customer who had to have her entire roof replaced: the rafters were covered with mold). It's like living at a zoo, and every day when you come home, you are walking into a lions den.

Get back to me with answers to the above questions, so I can then provide you with tailored guidance.

Sincerely,

Marc




---------- FOLLOW-UP ----------

QUESTION: Thanks for responding Marc.   To answer your questions:  I am 49 and was diagnosed for asthma in 1994.   I am renting, in this home here(i've been here since 1994), the home is about 30 or 40 years old.  I believe the basement foundation in concrete.  I don't believe the home has been evaluated for mold.  My recent asthma med(advair), was prescribed by an ER doctor.   Yes, I did a spirometry test last week when I saw an ashtma specialist(I don't know the result,...but when I blew into a ballon in ER 3 weeks ago,..they said I passed with flying colors).    I have no issues outside of my home.  Just as a note,...my landlord has been working in the basement for the last year and half(on and off)...completely renovating the basement.    New floors, new walls, new electrical wiring, plumbing....., there is dust, sawdust, and other particles there too.   They are putting in all new insulation down there as well.  Perhaps particulates and/or dust....is being sucked up from down there,..and it's going through all the furnace vents throughout the house.   He does have filters in all the vents up here.   I look forward to your return response.   Thanks very much.

ANSWER: Hi Paul,

Typically, asthma that first occurs in middle age is usually associated with irritants vs. allergy response. Often it is triggered by something in the workplace: cleaning chemicals, dust(very common in bakery workers), manufacturing environments, etc.

I have NEVER heard of a balloon test! Peak flow meter, spirometry, full lung function testing...yes. A balloon??? Okay..moving from there, it strongly appears that dust and paint fumes may be the source, although one should not rule out mold, since the construction process may be kicking it into the airflow.

I'm going to take a two-pronged approach: 1) purchase a room HEPA air filter unit to continuously clear the particulate matter from your living space. I checked Consumer Reports, and they liked just 2 units: Whirlpool AP51030K ($300) and the Hunter 30547 ($260). I'd check online for current sales, as well as local home improvement centers. 2) Continue your Advair (is it the Diskus unit or metered dose canister > technique is critical for success), but also talk to your doctor about adding a steroid nasal spray such as fluticasone. If your sinuses are being irritated, they can trigger your lungs into an attack.

Let me know how this works for you. You may find that the HEPA filter may result in a huge improvement, decreasing the necessity of taking more medication. Your landlord may be willing to cover it for you, since his remodeling is causing the problem, and it may be a write-off for him.

Looking forward to hearing back from you soon.

Sincerely,

Marc

---------- FOLLOW-UP ----------

QUESTION: Thanks again for responding Marc.    I don't believe they have done any painting in the basement,..but plenty of re-flooring and drywalling.   I have purchased a hepa filter,....it's scheduled to arrive in about 5 days.   I'm scheduled to attend an asthma clinic(as requested by my asthma doctor in Febuary).    My asthma doctor had me stop taking benapryl since January 16/12, and he also told me not to use the "blue" puffer,...unless I was having an asthma attack(the er. doc told me to use the "blue" puffer 4 times a day).   I was relatively okay for the next week,...but the last few days,...it feels like my right lung(again) is closing and my breathing has been very poor.   Note,....I didn't feel bad while outdoors today,...but when I came home tonight(even though I turned the furnace off),....my breathing got progressively worse and my face was getting redder and redder.   Could I use the "blue puffer" more often, and take benadryl again,...while I'm dealing with this poor breathing episode?     Note,...I see an allergy doctor next Tuesday(Jan. 31/12).    Thanks again.          Pat.

Answer
Hi Paul,

I don't believe the Benadryl is a benefit for you, since the reactions you are having are due to irritants and not allergens. In addition, an issue with Benadryl is that it drys out the lung tissue, making your airways more reactive. When Benadryl is to be used, you must have a significant increase in fluid intake to maintain lung moisture. If the allergist did any blood work, ask if your eosinophyl levels were increased..an indication that it is allergic and less likely irritant sourced. The increased fluids would also be a benefit with the dust exposure.

Do you have a peak flow meter to monitor your lung function? It is an inexpensive device (~$20)  that helps to evaluate how you are doing, and when to take your rescue puffer. Did the allergist put you on a short course of oral prednisone to reduce the lung inflammation? I'd follow his guidance with the puffer. It is usually taken every 4-6 hour AS NEEDED, especially since you are on Advair. Oh, when you take the Advair, do you take a quick deep breath, or a slow draw like with the Ventolin puffer? A dry powder inhaler requires a fast, deep breath in.

Glad you are getting the filter. I think it will help significantly.

Let me know how things go.

Sincerely,

Marc