Controlling Asthma

Effectively controlling asthma requires a great deal of self-awareness and discipline. It involves being diligent in controlling one's personal environment to the greatest extent practicable. For example, dust and dust mites are a major source of problems for asthmatics. Eliminating dust in the home, particularly in the areas in which the most time is spent, can greatly decrease the number of asthma attacks.

Here are a few suggestions for limiting asthma triggers in the home:

-vacuum carpets at least once per week

-dust and sweep at least once per week

-enclose pillow cases in an allergen reducing cover

-purchase a portable HEPA air filtration unit for the home

-eliminate clutter in the form of knick-knacks

-use your stove's fume hood when cooking (this reduces the amount of Nitrogen in the air-a common asthma trigger)

-limit the use of air freshening aerosols or candles

Asthma is a chronic respiratory condition, characterized by severe narrowing of the airways upon exposure to air-borne pollutants, or allergens. Anything that sets as asthma attack in motion is called a "trigger."

Read the rest of the article here.

Treatment of Mold Allergies

Molds and fungi are very resilient and can linger even in the most inhospitable environments. Spring to late fall is generally considered "allergy season" since this is when pollen becomes airborne. Mold spores are much smaller than pollen, however, and pervasive in all seasons Whether they are found indoors or outdoors, mold typically grows in moist areas and releases its spores to the air at any time. These spores are tiny enough to enter the smallest airways of the respiratory tract, where they wreak havoc with a person's immuno-response system. Itchy, watery eyes, continuous sneezing, wheeze and breathlessness, all are symptoms of a mold allergy.

Treatment options include:

1. Over the Counter Medications
2. Bronchodilators
3. Corticosteroids
4. Immuno-therapy (allergy shots)

. Anti-fungals

Determining the appropriate treatment for mold allergy begins by obtaining a full diagnosis from a doctor, dermatologist or allergist.

Read the rest of the article here.

Nasal Irrigation

Cystic fibrosis patients are prone to nasal congestion, which can inflame the upper respiratory tract and lead to sinus infections. One of the ways to help keep the sticky mucus from staying trapped in the sinuses is to gently flush them with a saline solution. Such rinses are effective in reducing the inflammation and clearing the symptoms of allergies or rhinitis.

Commercially available sinus rinses and saline sprays are available in different concentrations of salinity. Some kits come with the salt water already mixed, while others require you to add a salt packet to warm water that you put into specifically designed container such as a squeeze bottle.

To make your own saline rinse, you can follow this easy recipe:

Isotonic saline

½ teaspoon of sea salt or kosher salt

1 cup of warm water (or room temperature will do)

½ teaspoon of baking soda

Combine all ingredients in a cup or bowl. Using a bulb syringe, draw the salt water into the bulb.

Proper administration of a saline flush is necessary in order to reap its benefits. A thorough flushing can be a messy process, so it’s best to lean over the bathroom sink or shower when rinsing with it. Start by tilting your head down toward the bowl of the sink. Leave your mouth open. With the filled bulb syringe (or squirt bottle that came in the kit) squeeze firmly into one nostril. The water should flow out the other nostril. If your sinuses are quite congested, some water may flow down the back of your throat and out your mouth. This is normal. Continue rinsing with the other nostril.

Follow up the procedure by gargling with water. This will keep the salt from irritating your throat and causing a cough reflex.

A more aggressive way to flush congested sinuses is to run the saline mixture through a Water-Pik. Don’t use the attachment as is; cut it back about an inch so that the pressure of the water coming out is reduced. This method is quite effective for dislodging stubborn mucus that lingers following a sinus infection. Water-Pik now makes a nasal flush attachment tip that makes flushing your sinuses even easier.

Hypertonic saline is useful in stimulating the linings of the nasal passages to produce some moisture of their own. This helps give the mucus a more slippery surface to slide across, making it easier to clear out any congestion. Hypertonic saline is a saltier concoction and therefore may sting sensitive sinuses. It’s best to slowly increase the salinity (saltiness) of the rinse solution by adding gradually more salt.

CF Patient Preferred Sinus Rinse Products

• Breathe Ease
• Ocean
• Oasis
• Salt-Air

Pets and Asthma

Asthmatics are often discouraged from keeping certain types of pets. Determining whether the pet is a problem for the asthmatic involves knowing specifically which allergens trigger an asthma attack. Asthma attacks are most often brought on by tiny airborne contaminants or allergens, such as pet dander. Some people with asthma have no trouble at all with the animal's fur or dander, however their symptoms may flare up due to what the pet brings into the home.

Pets that have the opportunity to be outdoors inadvertently track in environmental allergens. Small amounts of dust, pollen or spores may cling to the animal's coat. When the pet grooms or is stroked by its owner, these allergens have the potential to bring about bronchospasms.

Indoor pets or low dander animals are recommended for asthmatics. Although no animal can be truly hypo-allergenic, hairless or short-haired breeds of cats and dogs are generally preferred because they do not shed as much. Additionally, certain types of birds, such as the cockatoo, produce a fine powder on their bodies which can aggravate a person's symptoms of asthma or allergies.

An individual's quality of life and the enhancement of joy as a pet owner may take precedence over certain manageable health risks.

Different Types of Coughs

Whether you've got one yourself or are sharing an elevator with someone who has one, a cough is an unwelcome disturbance. But did you know that not all coughs are alike, and not all people who cough are contagious? Let's consider the different types of coughs, ways to remedy them, and how to identify whether a simple cough may be something more sinister.

Whooping Cough

Common mostly in children and toddlers, whooping cough is a highly contagious condition caused by a bacterial infection. It is characterized by a long coughing fit, during which the sufferer cannot draw in an adequate breath. The coughing may be so hard that it causes the person to shake or spasm. In some instances the blood vessels of the eyes may break due to the intense effort of the cough, or the coughing spasm turns into dry heaving or vomiting.

Chronic Cough

People with certain health conditions or diseases such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), emphysema, bronchiectasis, or bronchitis tend to cough involuntarily. This is the body's response to inflamed or otherwise blocked airways, and its attempt to exchange oxygen. A chronic cough may sound dry or raspy as in the case of COPD, or can be wet-sounding and fully of phlegm as sometimes happens for people with cystic fibrosis.

Asthma and Allergies

Asthmatics tend to have a dry, non-productive cough accompanied by a tight wheeze or crackling sound. Asthmatics and allergy suffers alike experience coughing spells when their airways become constricted in response to a trigger such as airborne pollutants, pollen, animal dander, cigarette smoke or products containing fragrance. This is most often remedied with a short acting bronchodilator in the form of an inhaler, or can be treated with longer acting corticosteroids.

Remedies

Determining the appropriate cough remedy depends on the underlying reason for the cough. Cough associated with the common cold is usually caused by post-nasal drip. Throat lozenges and sprays containing menthol are effective in soothing the throat. Over-the-counter (OTC) medications like pseudoephedrine (Sudafed) help dry up the mucus in the sinuses and eliminate post-nasal drip.

Homeopathic remedies such as taking a hot shower with a lot of steam can help thin and loosen mucus in the chest. Inhaling a vapor mist from a humidifier also works well for some people, especially those suffering from a common cold. Sipping hot tea in flavors like vanilla, peppermint, or chamomile is a relaxing and calming way to sooth your throat when you have a cough.

Hydrocodone cough syrup is a strong cough suppressant. Not only does it calm your body's urge to cough, it can relieve the pain of an aching ribcage or strained abdominal muscles that occur with hard coughing. Hydrocodone cough suppressant requires a prescription from a doctor, and should be taken exactly as prescribed. Because it depresses your body’s respiration rate, patients with cystic fibrosis should use products containing hydrocodone with caution.

Other OTC cough syrups or even pills include an expectorant. Expectorants are useful to thin mucus secretions, making them easier to cough out. This is important especially in cases where the cough is a symptom of a respiratory infection. An expectorant combined with a mucolytic is a good option for people with cystic fibrosis not only because it helps break up the mucus, but it makes coughing it out that much easier. Look for products that contain the ingredient guaifenesin. Like hyptertonic saline, it will draw water into the lung tissue, making thick mucus less likely to “stick around” so to speak.

When to Seek Medical Attention

Not all coughs require medical attention. However, there are some serious conditions in which a health care professional should be contacted. These include:

-an atypical cough that lasts longer than 10 days

-a previously diagnosed cough changes in nature

-secretions have changed in color and appear more yellow or green

-blood is present in secretions or only blood is being coughed up (hemoptysis)

-cough is followed by a severe sharp pain on one side of the chest (could be a collapsed lung, i.e., pneumothorax)

Bronchodilators and Nebulized Medications

"Recurrent wheeze and breathlessness are common in people with cystic fibrosis, and bronchodilators are commonly prescribed," according to lead author Clare Halfhide, M.D., of the Royal Liverpool Children's Hospital in England. "Despite their wide-scale and often long-term use, there is limited objective evidence about their efficacy in cystic fibrosis."

Source: Center for Advancement in Health. Article "Little Evidence Behind Bronchodilator Therapy For Cystic Fibrosis"


The findings of that study were published in October, 2005. It is the most current information I can find on the topic. Dozens of health-related news media ran the article, so I'm confident that it's not just a hack study published by some entity with a hidden agenda.

I used to do CPT without a bronchodilator unless my asthma was acting up or I'm fighting infection. Now that I have a ThAIRapy Vest from Respirtech, I always take a puff of my Xopenex HFA inhaler before starting my airway clearance regimen. Xopenex is very similar to albuterol. It is a bronchodilator. Many patients find that Xopenex does not make them as jittery or anxious as albuterol does.

I also use bronchodilators both as a "rescue med" and as part of my preventive maintenance even if I don't do them at the same time as CPT. Bronchodilators are most effective when they are done first in the lineup of "usuals." Below is the proper order of med-neb treatments, as reported by another CF patient's clinic's recommendation:

1. Bronchodilator (albuterol or xopenex)

2. Mucolytics (pulmozyme THEN hypertonic saline)

3. Inhaled antibiotic (TOBI or colistin)

4. Long acting bronchodilator (serevent or foradil)

5. Inhaled steroid (flovent, advair, or pulmicort)

Here's why the order of operations is so important when managing CF.

The bronchodilator helps open up the airways. The more open the airways, the better the chances of inhaling the other medications deeply enough into the lungs where they can be most effective. Mucolytics are "mucus cutting" medications. They help break up the secretions so that they can be coughed up more easily. In CF patients, the mucus and the lungs are typically dry, which is why hypertonic saline is so useful. Hypertonic saline works by adding moisture to the lining of the lungs, resulting in a slippery surface conducive coughing out sputum. Following sputum clearance of the airways, the lungs are further able to take in the nebulized mist of the antibiotics. At this point there is a greater likelihood of the antibiotics taking hold in both small and large airways. The treatment concludes with inhaled steroids which help keep the airways open for an extended period of time (i.e. 8-12 hours when it is time for another treatment.)

The length of time to complete all these steps varies somewhat depending on the type of nebulizer/compressor system being used. Before I had a PARI eFlow to nebulize my tobramycin antibiotic, the process took approximately an hour. Also, when I was not feeling well, or was more congested or taking TOBI, it used to take me as long as 1-1/2 hours to complete the process. Now that I have an eFlow, the process is dramatically faster and takes 45 minutes or less.

Although the article I cited at the beginning of this post says that bronchodilators are shown to be ineffective treatment, bronchodilators used in tandem with the other treatments CF patients need are effective indeed. My opinion is that they are an important piece of the overall treatment. While they may be ineffective on their own, they should not be discounted altogether.

Anti-inflammatory Agent: Corticosteroids

Public domain image courtesy of National Library of Medicine (NLM)

Prednisone is perhaps the most recognizable and most prescribed anti-inflammatory agent for cystic fibrosis patients. This corticosteroid has been proven effective in suppressing inflammation of the lungs. Studies have demonstrated that doses of 60mg are useful in lowering the IgE levels of patients who suffer from allergic bronchopulmonary aspergilliosis (ABPA.)

Despite its success in treating inflammation, many patients who have undergone corticosteroid therapy report unfavorable side effects. The most challenging side effect is the onset of steroid-induced diabetes. Blood glucose levels must be monitored frequently when a patient is being treated with prednisone. Rapid weight gain due to fluid buildup is also common. This can cause something called “moon face” which is when most of the weight makes the patient’s face appear quite puffy and round. Frequent usage of prednisone has been linked to osteoporosis, which is already a co-occurring condition in patients with CF.

A study conducted in 1999 suggested that ongoing treatment with prednisone may have adverse effects on a patient’s growth pattern. This was observed most in male patients who had not yet gone through puberty.

The benefits of corticosteroids are best observed when they are used to treat and control the effects of asthma. For example, oral soluble prednisolone (Prednisone), inhaled budesonide (Pulmicort Turbuhaler) or fluticasone proprionate (Flonase intranasal spray) are helpful particularly in young patients who are wheezy and have associated asthma.

In general, corticosteroids such as prednisone are prescribed when other attempts to reduce inflammation of the airways have failed.

Overview of Inflammation Treatment

The airways of patients with cystic fibrosis (CF) are in constant danger of becoming inflamed. Airborne pathogens such as allergens and pollutants are the leading cause of inflammation. Viral or bacterial infections can also cause the airways to tighten, making breathing more difficult, and reduce a CF patient’s ability to perform mucus clearance maneuvers. It is believed that the lungs of cystic fibrosis patients are prone to inflammation as a result of the malfunction of the CFTR protein.

Repeated infection, especially as a result of mucoid Pseudomonas aeruginosa (PA) can result in lasting damage to lung tissue. PA has also been observed to cause a hyperimmune inflammatory response. In other words, the body reacts to PA even more strongly than it does to other bacterial infections.

Lung inflammation is present even in patients who are not exhibiting signs of active infection. Again, this is due to the body’s inability to utilize the chloride ion transport across cells. Studies conducted on newborns with cystic fibrosis have hypothesized that at birth the lungs are still normal. However, with each subsequent infection, damage to the airways becomes cumulative as the airways continue to narrow. In order to avoid the lasting effects of inflammation, it is important for cystic fibrosis patients to work with their physicians to determine an appropriate preventive maintenance routine.

One of the prevailing treatments to control inflammation includes the use of high dose ibuprofen. Typically this is effective for younger patients who have not yet experienced many pulmonary exacerbations. Other therapies include:

1. Corticosteroids[1]
2. Macrolide antibiotics[2]
3. NSAIDs (non-steroidal anti-inflammatory drugs)[3]
4. Defensins and cathelicidins[4]
5. Leukotriene receptor antagonists[5]
6. Alpha-1-antitrypsin and secretory leukoprotease inhibitor (SLPI)[6]

For more information, talk to your CF specialist or pulmonologist about whether preventive anti-inflammatory agents is appropriate for you or your child.

---

[1] Medications (eg, prednisone) that are related to cortisone, a naturally occurring hormone. Corticosteroids lessen inflammation, swelling, and pain. In some cases, corticosteroids are injected directly into a joint; however, they can have serious side effects - such as damage to bones and cartilage - especially when used over long periods of time.

www.ehealthmd.com/library/osteoarthritis/OSA_glossary.html

[2] The macrolides are a group of drugs (typically antibiotics) whose activity stems from the presence of a macrolide ring, a large lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, are attached. The lactone ring can be either 14, 15 or 16-membered. Macrolides belong to the polyketide class of natural products.
en.wikipedia.org/wiki/Macrolides

[3] Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. The term "non-steroidal" is used to distinguish these drugs from steroids, which (amongst a broad range of other effects) have a similar eicosanoid depressing anti-inflammatory action. NSAIDs are sometimes also referred to as non-steroidal anti-inflammatory agents/analgesics (NSAIAs). ...
en.wikipedia.org/wiki/NSAID

[4] Similar to antimicrobial peptides. These peptides are excellent candidates for development as novel therapeutic agents and complements to conventional antibiotic therapy because in contrast to conventional antibiotics they do not appear to induce antibiotic resistance while they generally have a broad range of activity, are bacteriocidal as opposed to bacteriostatic and require a short contact time to induce killing. A number of naturally occurring peptides and their derivatives have been developed as novel anti-infective therapies for conditions as diverse as oral mucositis, lung infections associated with cystic fibrosis (CF) and topical skin infections. Source: wikipedia

[5] Leukotriene receptor antagonists, such as montelukast sodium (e.g. Singulair tablets) or zafirlukast (e.g. Accolate tablets), treat asthma via a totally different pathway to other available medicines. They work by blocking substances in your lungs called leukotrienes, which cause narrowing and swelling of the airways. Blocking leukotrienes can improve asthma symptoms, including night-time symptoms, and can help prevent asthma attacks. http://www.mydr.com.au/default.asp?article=2700

[6] Acid-stable proteinase inhibitor (elastase, cathespin) against proteinases liberated from liberated from cervical mucus disintegrating leukocytes; from sputum in bronchial infections. source: http://cancerweb.ncl.ac.uk/cgi-bin/omd?antileukoprotease

Understanding Chronic Sinusitis

Sinusitis is a condition in which the sinuses become inflamed in response to infection. The exact causes of sinusitis are not known, but research has shown that in patients with impaired immune systems, or other allergic conditions (e.g. asthma, allergic rhinitis). There are four regions of sinus passages. Swelling of these can cause headaches or nausea depending on severity of the inflammation. People with cystic fibrosis are prone to sinus infections for the same reason they are susceptible to lung infections. The thick, sticky mucus does not move easily through the sinus cavities, and can get stuck.

The 4 sinus regions are:

• Frontal
• Maxillary
• Ethmoid
• Sphenoid

(click on diagram above for larger image with labels)

The sinuses represent the upper respiratory tract. It is not uncommon to misdiagnose chronic sinusitis simply as a common head cold or headache. In people with CF, it is important to make sure that infections in the upper respiratory tract do not linger to the point of infecting the lower respiratory tract.

Since the role of the sinuses is to allow air flow into the body and to allow mucus out, anything that prevents this function can quickly become an uncomfortable, if not painful, problem. Chronic sinusitis in patients with CF is characterized by persistent sinus pain and pressure lasting 8 weeks or longer. Typically, if a doctor suspects sinusitis, he or she will conduct a quick examination that involves pressing on the face in the 4 sinus regions. If pain is indicated by the patient, or if swelling is suspected, the doctor might then order a CT scan and a visit to an ENT (ear-nose-throat specialist.)

Generally, the first course of treatment for sinus infections is prescription of an oral antibiotic. More aggressive CF clinicians may decide to start IV therapy in an attempt to prevent the infection from spreading and resulting in pneumonia. There is also the possibility that chronic sinusitis may be connected to ABPA, which is an allergic reaction to aspergillus, a fungus.

Damp weather and seasonal allergies may trigger episodes of sinusitis. Symptoms of the condition include:

• Fever
• Weakness
• Tiredness
• Coughing during the night
• Nasal congestion

Treating the symptoms and underlying cause of sinusitis can be difficult in cystic fibrosis patients. Products like Sudafed, which are designed to dry out the mucus membranes may cause more harm than good. Nasal steroids can be used to reduce inflammation, and antibiotics are useful in killing off a bacterial infection. In cases of ABPA, an antifungal such as Vfend or Sporanox is used.

A sputum culture may be taken in the doctor’s office. This is a useful tool in identifying bacterial infections. In order to obtain a sample, a long stick with a cotton swab on the end is touched to the back of the throat. The results are then sent to the laboratory for testing. The results of the test will determine the appropriate course of treatment. In the meantime, the doctor may recommend something like ibuprofen to reduce inflammation and pain.

A particularly useful, non-medicinal treatment option is to irrigate the sinus cavity with warm salt water. Over the counter saline nose sprays can be used for this purpose. Another method is to use a method called pulsatile irrigation. This is an effective means for flushing out the bacteria and sticky mucus.

Patients suffering from the complications of chronic sinusitis sometimes require surgery. A great deal of relief is experienced when the mucus is cleaned out. Once the sinus passages are no longer a breeding ground for bacterial infections, the frequency of antibiotic therapy can be reduced. Additionally, the threat of lower respiratory infections is greatly reduced.

For more information and related articles, please visit the following sites:

Endoscopic Sinus Surgery for CF

Cystic Fibrosis and Sinusitis

US Dept. of Health Sinusitis Fact Sheet

Dr. Hening, Stanford University CF Center: Sinusitis and CF

Sinusitis Info from eHealth-info

Sinusitis and Allergies (WebMD)

Pulsatile Irrigation Device (product ordering info)

Understanding and Preventing Mold Growth

Indoor air quality is a topic of great importance to everyone, but particularly to persons with cystic fibrosis.

Understanding Mold Reproduction and Growth

In order to reproduce, mold generates what are called "spores." Spores are small enough to drift through the air in a home with ease. Mold thrives when it has a chance to settle in a damp, dark area. Some types of mold are particularly fond of warm environments. Mold is exceptionally resilient and is opportunistic, meaning it will lie in wait for just the right conditions to reproduce, even if that means waiting for a long time.

The warm, moist environments like the human body provide an ideal setting for mold spores to reproduce and colonize. Effective way to control mold is to control moisture.

At some point, the colony generates additional spores, which may become airborne. Some are small enough to be respired into the human body where they irritate the small airways, thus triggering allergic reactions in some individuals.

Controlling the Mold

Despite the fact that there is no way to remove all mold and mold spores from the home, there is good news. Certain things can be done to effectively control mold and avoid serious health effects such as allergic reactions. Furthermore, dealing with potential moisture issues is beneficial to the soundness of your home.

I make a point to combat mildew and mold in my home to the greatest extent practicable. We have laminate floors in the bedroom and our entire downstairs, since those are the areas where we spend the most time. By having less carpet, there is less likelihood that spores being tracked in from outside will lie unnoticed in the carpet threads.

The bathroom can be a breeding ground for mold and mildew since there is a lot of moisture there. When showering, it is a good practice to run the exhaust fan. Once a week I use Tilex in our sinks and in the shower to kill off anything that may be growing in there.

In the kitchen we make good use of our refrigerator's built-in humidity control function. This keeps mold from taking hold of the soft cheeses and other foods that may be potential breeding grounds.

People with allergies and CF should look into HEPA (High Efficiency Particulate Air) filter systems. When an air filter unit is categorized as a true HEPA, its ability to remove certain contaminants from the air is 99.97% effective at removing particles that are .3 microns and larger in diameter. A micron is one millionth of a meter; a grain of salt is approximately 60 microns in size. Mold spores can range from 1-60 microns in diameter. The smaller the diameter, the easier it is for the pathogen to get into the body's small airways and cause irritation.

Conclusion

Mold spores can lie dormant for long periods of time and can reproduce again when just the right conditions are in place. Although mold cannot be completely avoided, and eradicating the offending spores if difficult but not impossible. With minimal effort and effective control measures, a home's overall indoor air quality can be a more healthful environment.

This article has been adapted from the article "Limiting Exposure to Mold in the Home" by Lauren G. Beyenhof. Please read the full article on Associated Content.

Understanding Allergic Bronchopulmonary Aspergilliosis (ABPA)

Nearly 5% of asthmatics may develop ABPA at some point. A study of Cystic Fibrosis patients in Australia between 1998 and 2002 reports that nearly 19% had been colonized (i.e. infected) with Aspergillus. However, determining the prevalence of apergiullus colonization in patients with CF is difficult.

ABPA stands for "allergic broncho pulmonary aspergilliosis." It means that in addition to culturing aspergillus (a type of fungus), the body reacts to it with an allergic response. Some people can culture aspergillus but don't have ABPA. The body responds to the allergen by increasing the amount of IgE (immunoglobulin E) in the blood. To bring the IgE back down and control the fungal infection, doctors prescribe antifungal medications like Vfend or Sporanox in combination with corticosteroids (such as prednisone) to reduce inflammation in the lungs and/or sinuses.

Other medications used to treat ABPA include:

Amphotericin
AmBisome
Cancidas
Itraconazole
Voriconozole

A IgE number of 100 or greater is considered "high" for adults. During periods of acute exacerbation, it can climb into the thousands. When this happens,the first thing the doctors would try is prednisone. For some however, prednisone is worse than the infection itself since it brings about so many horrible side effects.

High IgE levels are presumed to be associated with a decrease in lung function. The significance and danger of a high IgE number is that if IgE numbers stay high for a prolonged period of time, the degree of severity of lung damage can potentially increase. However, this is largely just a hypothesis on my part based on things I've read. IgE and its connection with lung function is something that isn't fully understood at this point in time but several studies are ongoing.

A doctor will determine the best course of treatment based on the prevailing symptoms (cough, hemoptysis, fatigue, weight loss) as well as lab culture results. An aspergillus specific IgE blood test can be performed. Which medications are used depends on whether the infection is invasive or non-invasive, and where the infection lies. In patients with cystic fibrosis, an aspergillus infection may start in the upper respiratory tract (e.g. sinuses) and spread to the lower respiratory tract. More aggressive treatments and higher dosages of drugs or combinations of drugs are required to treat invasive aspergilliosis.

Avoiding an aspergillus infection in the first place involves making sure that the home environment is free from the conditions that would encourage mold growth (i.e. moisture, dampness, live plants, etc.) Once aspergillus takes hold in the body, completely eradicating it is difficult. Antifungal therapies may be required for long periods of time, especially in people who are already prone to upper respiratory infection.

Understanding Allergic Rhinitis

Allergic rhinitis ranks high on the list of common illnesses. Simply defined, rhinitis is the body's way of responding to inflammation of the nasal passages or sinuses. Inflammation can occur as a result of exposure to allergens as is the case with allergic rhinitis or may be the result of a bacterial or viral infection. Whatever the cause, symptoms like repetitive sneezing, post nasal drip, sinus congestion or itching are those that plague those who suffer from rhinitis.

Rhinitis affects people of all ages, though most people develop the condition in the first few decades of life. People who have a family history of asthma or allergies are far more likely to have rhinitis than those without.

People with allergic rhinitis may notice that their symptoms worsen during certain times of the year. This is commonly referred to as hay fever. There are many allergens that can trigger an episode of allergic rhinitis. Where a person lives and the local weather and climate may also be a contributing factor.

In order to determine the best method for coping with seasonal allergies and allergic rhinitis, a person should know what exactly his or her triggers are. This can be done by a simple test called a scratch test, which is administered in the doctor's office. To do this, a grid is drawn on the patient's back. Different allergen serums are then applied to the grid in an orderly manner, and the skin is lightly pricked so that the serum gets just under the surface of the skin. The doctor watched carefully for any reaction such as redness, bumps, hives or swelling. This test can check for allergies to a variety of plant types, molds, animal dander, and even some foods.

Coping with allergic rhinitis may be as simple as the doctor providing a prescription. Certain over-the-counter medications have also been approved for the treatment of allergic rhinitis. Sinus flushes and rinses, particularly those containing saline, are effective in stimulating the sinus passages to produce additional mucus that will flow out of the nose taking the allergen with it. Prescription nasal sprays are usually formulated with an anti-inflammatory component which helps shrink the inflamed tissue, unblocking the sinuses.

Avoiding the allergens by modifying the lifestyle is another way to cope. For example, if an allergy test reveals that a person is allergic to dyes and perfumes, that person should try to rid their home of any product containing such things.

Infection rhinitis, the type that is caused by a bacteria or virus, can also be remedied with prescription medications or over-the-counter remedies. Antibiotics in nasal sprays are only effective against bacteria. If a sinus infection resulting in rhinitis is caused by a virus, antibiotics will not help. However, inhaling steam or rinsing using nasal decongestants may provide some relief. A warm compress or washcloth held in place over the eyes and nose will stimulate the blood vessels to open up and may relieve the headache associated with the pain and pressure of sinus congestion.

Coping with non-allergic rhinitis is usually more difficult, as there are a myriad of environmental triggers that are not easily avoided. Automobile exhaust, ground level ozone, smoke and air pollution are common causes of sinus inflammation. Indoor air pollution can be easily remedied by purchasing a HEPA filter system. Some medications do treat environmental triggers, but not many. In severe cases a person may need to move to a different region where there are fewer environmental triggers.