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Q. My son’s asthma specialist recommended I put a valved holding chamber on his bronchodilator inhaler. How do they work and why are they important?

A. A valved holding chamber is a handheld device that attaches to a metered-dose inhaler (MDI) and captures the asthma medication as it sprays out. The medication is trapped inside the holding chamber long enough for you to inhale it at your own speed.

Valved holding chambers are very important because they can increase how much medication is delivered into your lungs. The average inhaler – even when used correctly – only delivers about 60 percent of medication into the lungs. The valved holding chamber allows you to better streamline delivery of the medication so more of it can get into your lungs, making it more effective at controlling your asthma. It can also pull out larger particles of medication unable to make it into your narrow airways, keeping them from settling in your mouth or throat.

It's a good idea to keep your valved holding chamber right next to your asthma inhaler so you don’t forget to use it! Some inhalers even come with the holding chambers already attached, which may be more helpful for patients who find it difficult to remember to use it all the time.

It’s often helpful – especially for children – to use a mask that attaches to the valved holding chamber. The mask should fit over the mouth and nose and allow the user to take several breaths to inhale the medication fully.

It’s very important to clean your valved holding chamber. If you don’t, it can collect dust mites and mold – allergens that can often make your asthma worse. Valved holding chambers should be washed at least once a week if used every day. Read and follow the package instructions for proper cleaning – some can even go in the dishwasher!

Some insurance plans will cover valved holding chambers, and some won’t. The good news is the cost of valved holding chambers is not very high – around $10-15 apiece. If you do have to pay out of pocket, they are affordable and fairly long-lasting.

Q. I recently lost 10 pounds and noticed my asthma improved. What is the connection between weight and the respiratory system? What are some ways to lose weight so that it helps your asthma?

A. This is really a question of body mechanics. When you are overweight or obese, most excess weight is usually in the central area of the body, or the midsection. This can reduce your lung volume, making you not able to breathe as well.

Also, the foods you put in your body are an important factor. With obesity, there’s often a pro-inflammatory diet that includes sugary, starchy foods. This can cause your body to release inflammatory hormones, such as leptin, that increase inflammation in the lungs and can lead to asthma symptoms.

Diseases that often occur with obesity, such as gastroesophageal reflux disease (GERD), diabetes and hypertension, have also been found to worsen asthma. So losing weight can also help you reduce the risk of developing these conditions.

Losing 10 pounds can make a huge difference in a person’s asthma symptoms. And as an added benefit, weight loss allows patients to be better able to exercise – obviously the less weight you have, the easier it is to move around. Regular exercise has been shown to improve not only asthma symptoms but also asthma outcomes.

A good way to start is to eat a healthy, balanced diet that includes more fruit and vegetables and less sugary, starchy foods. Regular exercise is also important, but make sure you warm up properly, stay hydrated and keep your quick-relief inhaler with you if exercise causes asthma symptoms. Ask your doctor or allergist for a referral to a nutritionist or dietitian.

Q. Do certain foods cause asthma symptoms to flare up? Are there any foods to avoid?

A. Research studies do not directly link specific foods to asthma flares – however, there are some important dietary considerations to keep in mind if you have asthma.

1) Eat a healthy diet that includes the following: 

  • Vitamin D – people with asthma and allergies have been found to have low vitamin D levels. Check your vitamin D level and then maintain normal levels, through both a dietary supplement and getting extra sunshine. This may help keep asthma symptoms at bay.
  • Fruits and vegetables –good sources of antioxidants like vitamins C, E and flavonoids. Fruits and vegetable have an anti-inflammatory effect that may improve asthma and prevent symptoms.
  • Fish and other sources of Omega 3 – they also have an anti-inflammatory effect that may prevent asthma flares.

2) Avoid foods with sulfites. Some studies link sulfites – an additive that serves as a food preservative – to triggering asthma in those with moderate to severe symptoms. Sulfites are found in wine, dried fruit, pickles, shrimp and condiments. Sulfites also naturally occur in vegetables such as asparagus and onions and can be found in corn starch and soy.

Sulfites are found in ingredients with these names: sulfur dioxide, sodium sulfite, sodium metabisulfite, potassium bisulfite and potassium metabisulfite. However not everyone with asthma will experience symptoms. If you feel you’re sensitive to foods with sulfites, keep a food diary and avoid those foods that contain sulfites to see if there is improvement.

3) If you have food allergies, avoid the foods containing your allergen. Accidental exposure to foods to which you have a true IgE-mediated food allergy can trigger an allergic reaction which can have mild to severe symptoms, including asthma symptoms such as coughing, wheezing and shortness of breath.

4) Maintain a healthy weight in general. Obesity and weight gain can worsen asthma symptoms because they put more of a demand on your lungs.

Q. At present we are having work done in our house. The dust is causing my partner to have breathing troubles, but he insists he is fine and will not seek advice or support from our general practitioner. He wheezes badly, but says that Vicks and lozenges will help him. It has been going on for months and I am concerned for his health. What is your advice to him?

A. Depending upon the age of the house, renovation could stir up many allergens and toxins that have been settled for many years. These may include mold, dust mites, and asbestos, among others.

If your partner does not have a history of asthma and/or environmental allergies, reactive airway disease could be responsible for the symptoms he is experiencing. Common symptoms of asthma include breathlessness, wheezing, cough, and chest tightness.

If your partner has not experienced similar symptoms in the past, and the timing of his symptoms relates with the work being done on his home, a first step would be to minimize his exposures within the home. This can be accomplished by either not being in the home while work is being done or wearing a respirator or N95 face mask while in the building.

It is also possible that your partner has asthma and his symptoms coincidentally appeared at the time of the renovation, without a direct cause and effect relationship. His allergist may want to conduct a pulmonary function test. If your partner has asthma, his treatment will be based on the severity and frequency of his symptoms.

Treatment for severe, irregular episodes typically involves use of a short-acting inhaled beta agonist. If symptoms persist and/or worsen, his allergist will likely recommend ongoing tailoring of his medications.

Your partner should discuss his symptoms and potential strategies for diagnosing and managing his symptoms with his allergist.

Q. I have been having several breathing problems for about five years now. I get shortness of breath during running. When I am relaxing and experience a sudden change in the environmental temperature, I start coughing, wheezing, and getting chest congestion. Sometimes I get a recurring faint pain in the lower right side of my ribcage. My biggest concern is that at night, around 3-4 am, I usually wake up struggling to breathe. I do not have anybody in my family with asthmatic issues, and I never used to have these problems when I was young. I have visited many doctors and taken many medications, and I have been successfully managing the breathing difficulties with salbutamol inhaler. However, I’m looking for a permanent solution to this, so that I can stop depending on the inhaler.

A. Based on the information you have provided, your symptoms seem to be compatible with asthma that is not completely controlled.  Asthma can present at any age.

While salbutamol is of benefit as a “rescue inhaler,” it should not be used on a daily or very frequent basis.  Patients with frequent asthma symptoms generally need a “controller inhaler,” which includes an inhaled steroid.  Asthma is a very controllable disease, but so far there is no “cure” for asthma.

Allergies can create airway inflammation in allergic patients and make patients more sensitive to other triggers such as cold air and running.  However, not everyone with asthma has allergies.

Your allergist can assist to determine if you are allergic to inhalant allergens such as pollen or dust mites. 

If a patient has inhaled allergen sensitivities, treatment with allergen immunotherapy (allergy shots) may help to relieve asthma symptoms.  Allergen immunotherapy is the closest thing that we have to a cure for asthma.   

Q. One of my neighbors is always outside each fall, blowing leaves off his large backyard patio, which is upwind from our yard where my seven-year-old son plays. My son has recently been diagnosed as having asthma, and I think he may have allergies as well. I do try to bring him inside when this neighbor uses his leaf blower. Is there any evidence that leaf blowers can cause worsening allergy and asthma symptoms?

A. When people are mowing lawns, they stir up a fair amount of mold spores. One would imagine this applies to leaf blowers as well. Also, leaf blowers probably put into the air little fragments of leaves, and other dust which could be irritating, and could aggravate asthma with exposure. Additionally, there are the exhaust fumes from gas-powered blowers. All in all, it's probably a good idea to avoid being in the path of the leaf spray. Such momentary exposures would not likely lead to increased allergies by themselves.