Damp, Moldy Homes Are Associated with Sinus Problems and Bronchitis

Damp, Moldy Homes Tied to Respiratory Symptoms

Background: Many individuals believe that exposure to mold in their apartment or house contributes to breathing complaints, including cough, shortness of breath, and chronic bronchitis. Although dampness at home has been associated with respiratory conditions in children, there is little information about damp, moldy homes and chronic respiratory symptoms in adults.

Evidence of damp, moldy homes

Mold on wall behind couch

Study: Dr. Caroline Pind and colleagues at Uppsala University sent questionnaires to residents of four cities in Sweden about respiratory symptoms, smoking, education, and environmental exposures. The questionnaire identified dampness by asking about visible water damage, floor dampness, or visible mold in the home during the last 12 months. The study results were published on-line on July 11, 2017, in the journal Clinical & Experimental Allergy (DOI:10.1111/cea.12976).

Evidence of damp, moldy homes

Black mold on ceiling due to leaky roof

Results: Over 26,000 adults living in Sweden answered the questionnaire. Overall, 11% reported signs of dampness. Dampness was more common in humid or mild climates compared with areas of the country with longer, colder winters. Compared with non-smokers with no signs of any dampness, 90% of non- smokers with any dampness in their home were more likely to have nighttime shortness of breath, while 67% were more likely to have chronic bronchitis. There were higher rates of wheezing, nighttime coughing, and asthma in the group with signs of dampness at home.

Conclusions: The study showed an association between dampness at home and chronic respiratory symptoms in adults. The authors suggested that these findings support reducing indoor dampness. Dr. Jouni Jaakkola of the University of Oulu in Finalnd commented that, “I found it interesting and alarming that the adverse effects were stronger among people of low socioeconomic status due to limited possibilities for moving to a better home or making needed renovations.”

My Comments: This study points out the ill health effects of exposure to mold where you live. It is important to locate moisture problems, removing molds, and controlling excessive water and condensation at home. Leaky pipes and roofs are often the problem. The U.S. Environmental Protection Agency has information on controlling mold on-line: EPA.gov(bit.ly/29fx)4Y) as does the U.S. Centers for Disease Control and Prevention on CDC.gov (bit.ly/2lxArWu).

N-acetylcysteine (NAC) Reduces Exacerbations

Meta-analysis Shows Benefit of n-acetylcysteine (NAC)

Dr, Mario Cazzola and colleagues published a review of 13 studies which examined the effects of n-acetylcysteine (abbreviated NAC) in preventing COPD exacerbations. Exacerbations are worsening of COPD symptoms usually shortness of breath and cough typically due to a chest infection (acute bronchitis or pneumonia). The review was published in September 2015 issue of the European Respiratory Review (volume 24; pages 451-461).

Dr. Mario Cazzola

Dr. Mario Cazzola of the University of Rome Tor Vergata

What is NAC? It is a antioxidant that is available as a health supplement in the United States, typically in capsule form. Antioxidants are widely used to protect cells from damage induced by reactive oxygen species.

Results: Those with COPD who had chronic bronchitis (coughing up mucus most days) had significantly fewer exacerbations with NAC compared with placebo (inactive).  There was a 35% reduction in exacerbations for 635 patients based on four studies at a dose of at least 1,200 mg of NAC each day. The authors states that NAC was well tolerated.

 

My Comment:  This report is called a meta-analysis which means it combines all published studies on a particular topic.  Why do this?  Many individual studies may not include enough subjects to show a difference in treatment. However, a meta-analysis includes a larger group although the studies are not usually identical in design.

NAC is not a prescription medication. It is typically available at health food stores or can be ordered on line. Based on this meta-analysis, a dose of 600 mg capsules taken twice a day is recommended IF you have the chronic bronchitis type of COPD. Certainly, you should discuss the use of NAC with your health care provider before starting this supplement. There is no evidence that NAC will help those with the emphysema type of COPD.

Example of one product of n-acetylcysteine

Example of one product of n-acetylcysteine

 

Another NAC product

Another NAC product

NAC is also used to treat an overdose of acetaminiphen (Tylenol) and to loosen thick mucus as can occur in those with cystic fibrosis and COPD.

What are Chronic Bronchitis and Emphysema?

Dear Dr. Mahler:

I was recently diagnosed as having COPD by my primary care doctor. She mentioned both chronic bronchitis and emphysema, but I didn’t quite understand what she meant by these terms. Can you explain?

Jack from Tacoma, WA

Dear Jack,

I assume that you had breathing tests (called pulmonary function tests) in order for your doctor to diagnose COPD. COPD consists of two types: chronic bronchitis and emphysema. The figure below shows that the breathing tubes (airways) divide many times and end in air sacs (alveoli).

The breathing tubes (bronchus) divide many times and end in air sacs (alveoli).

The breathing tubes (bronchus) divide many times and end in air sacs (alveoli).

If inhaling cigarette smoke and other irritants mainly damages your breathing tubes, then the airways become red and swell (inflammation) and glands that line the inner lining of the tubes produce a thick substance called mucus. It is usually white or gray in color. Most people with this condition cough up mucus most days, especially in the morning. This is called chronic bronchitis. It is diagnosed if you report coughing up mucus most days for three months over a two year period. A cough productive of mucus is a common complaint or symptom.

Views of the inside of a normal breathing tube on left and of chronic bronchitis on the right. Note the white-yellow mucus lining the inside of the airway in chronic bronchitis.

Views of the inside of a normal breathing tube on left and of chronic bronchitis on the right. Note the white-yellow mucus lining the inside of the airway in chronic bronchitis.

If inhaling cigarette smoke and other irritants mainly damages your air sacs (alveoli), these areas are destroyed. This is called emphysema. It is usually diagnosed by a specific type of breathing test called diffusing capacity. In emphysema, the diffusing capacity is lower than normal. Emphysema can also be diagnosed if you have a CT scan of the chest that shows typical changes. Shortness of breath with activities is the most common complaint or symptom.

Microscopic view of the air sacs (alveoli) in the top right showing emphysema (destruction and enlargement).

Microscopic view of the air sacs (alveoli) in the top right showing emphysema (destruction and enlargement).

It is possible that you have a combination of both chronic bronchitis and emphysema which is quite common.

At the present time, treatments for COPD are the same whether you have chronic bronchitis or emphysema.

I suggest that you ask your doctor the same question that you asked me for more specific information about your condition.

Sincerely,

Donald A. Mahler, M.D.