Q. One of my neighbors is always outside each Fall blowing 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.

Q. My son recently was selected for his junior high school basketball team. During his last game, I noticed that, after playing for about 6-7 minutes, he appeared tired and more winded than usual, especially after he got back to the bench. He continued to play, but moved slowly up and down the court. Later he told me that had been experiencing breathing difficulty and coughing during practice sessions. His coach recently told him that he was "not in good enough shape" and needs to run more to catch up to the other players. For many years, he has suffered with nasal allergies during the spring and fall but never before has he had difficulty breathing. I am very worried - what should I do?

A. Your son could have exercise-induced asthma - also called exercise-induced bronchospasm - in addition to his nasal allergies. This is a very common condition in which exercise can trigger constriction of the bronchial airways resulting in symptoms of shortness of breath, chest tightness, and cough during or after intense aerobic exercise (such as running). Asthma symptoms begin within minutes after starting an exercise activity that causes a rapid increase in heart rate. Individuals (like your son) who have nasal allergies may be at higher risk for exercise-induced asthma.

He should be evaluated as soon as possible by a board certified allergist. The allergist will assess your son’s breathing condition and determine the best treatment. A measurement of his lung capacity, with breathing tests before and after exercise, may be done. To prevent exercise-induced asthma symptoms, the allergist may advise your son to take a relief inhaler/bronchodilator (such as albuterol) 20-30 minutes before every practice and game. In nearly every case, symptoms can be managed so that your son should be able to enjoy playing basketball and other sports. With proper treatment prior to events, many elite athletes affected by this condition have been able to compete successfully!

Q. Can you tell me if fog machines sometimes contribute to asthma attacks?

A. Fog machines use various components to create their effects. Water, dry ice, liquid nitrogen and liquid air have all been used to create a fog effect, and additional chemicals can be added - such as glycol in water-based fog. The first issue with these machines is assuring adequate ventilation to allow proper oxygen levels. In people with asthma and airways hyper-reactivity, the irritant effect of short term exposure to water-based fog machines - particularly when the chemical glycol is used - could trigger acute asthma symptoms including cough, wheeze, chest tightness and shortness of breath. Even in a person without asthma, short term exposure to glycol-containing fog machines can be associated with headaches, dizziness, drowsiness, and eye irritation. Prolonged exposure to this substance in a person with asthma could trigger even more severe respiratory difficulty and could cause bronchitic symptoms even in those without asthma. Long term exposure to smoke and fog can result in upper airway and voice symptoms as well, while extended (multi-year) exposure to smoke and fog has been associated with both short-term and long-term respiratory health problems. So be careful around fog machines if you have asthma - and check how they generate their "fog"! Fog machines using liquid air are the safest, as those do not reduce oxygen levels and do not contain glycol.

Q. I am a pregnant mom-to-be with asthma and I have several questions. Are asthma medications safe to take during pregnancy? Is it safe to continue my allergy shots while pregnant? And should I take my asthma medications with me to the hospital, for use during labor and delivery?

A. The risks from letting asthma get out of control during pregnancy are much greater than any associated with asthma medications, so these are safe in pregnancy. When the airways get obstructed (even before you feel symptoms), you don’t get as much oxygen as you or the baby needs to grow properly. Secondly, if you have reached your maintenance dose of allergy injections with no problems, then these are safe to continue during pregnancy. We won’t begin immunotherapy or increase the dose during pregnancy but it’s safe to maintain the dose. Regarding your final question, hospitals often don’t want patients to use medications brought from home, but it’s important for hospital staff to see what you have been using. Fortunately, very few women have worsening asthma during delivery. Follow your daily asthma action plan as normal; it’s unlikely you’ll need a bronchodilator medication – but if you feel like you do, then speak up.

Q. Can asthma be caused by emotions, or stress?

A. Asthma is not an emotional or psychological disease, although strong emotions such as laughter or crying, and psychological stressors can definitely trigger asthma or make symptoms worse. People with asthma have very sensitive lungs that may react to numerous triggers, causing the airways to tighten, swell and fill with mucus. These factors can then lead to symptoms of difficulty breathing - shortness of breath, a sensation of chest tightness, coughing and wheezing. Regarding stress, a previous study showed that college students with asthma had reductions in lung function the week prior to final exams!

Q. How can asthma be controlled when one is also suffering from GERD?

A. GERD, or Gastro-Esophageal Reflux Disease, triggers or worsens respiratory symptoms in a number of people with asthma. Once the GERD is controlled, asthma often improves - leading to a reduction in medication required and allowing easier breathing.

GERD is a common condition in which the acid from the stomach flows up the esophagus causing irritation and inflammation. This is often felt as a burning sensation in the upper abdomen and can lead to a bad taste in the mouth and a sense of burning in the chest if the fluid rises high enough. Since the nerves in the lower esophagus are connected to the nerves in the lungs, it is common for acid reflux to trigger asthma symptoms so it is important to control the reflux as much as possible.

The most important way to control reflux is to first see a doctor to make sure that reflux is the correct diagnosis, as other conditions can mimic it. The treatment for GERD itself is the same as if one did not have asthma. In many cases a simple trial of an acid reducer such as ranitidine, which is available over the counter, might control the symptoms. Stronger medications called proton pump inhibitors also can reduce acid secretion. From a dietary standpoint, it helps to avoid eating meals for several hours before bedtime (avoiding large evening meals) and to reduce fat intake. Alcohol consumption in excess and caffeine can also predispose to acid reflux. Sleeping on several pillows with the upper body propped up to let gravity keep the fluid down may help. Weight loss for those who are overweight is recommended, as weight gain can worsen reflux.

It is also important to assess whether certain asthma medications may be worsening GERD. Asthma medications that could increase reflux include theophyllines and oral steroids, and should be used only if there are no other alternatives. For most who suffer from both conditions, asthma can be controlled with the usual asthma therapies along with treatment of GERD.

If these simple measures don't work, then more extensive evaluation and treatment may be needed. Sometimes, medical therapy is not adequate and GERD will require a surgical repair. Further evaluation should be done under the supervision of a qualified physician.

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