Question:

Dear Diane: I totally agree with you on preventive measures such as addressing allergies and their control by eliminating the triggering factors. This is very true and sometimes does not get the proper attention. However, I do believe that the reduction of allergen exposure is only a *part* of the treatment plan an in no way it should be the most important part. I believe that treatment with medications has to go along with elimination/reducing exposure to the triggering factors. Regards, — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA

Response:

 Since inflammation is present in the airway even in the patients with mild to moderate asthma, it indicated the need for long-term maintenance treatment in asthma. On top of that, asthmatic inflammation is a response that is usually provoked by allergic reactions or repeated environmental triggers. Thus, continuous anti-inflammatory therapy is usually necessary for the control of the condition. So it seems that the inflammation is often a result of allergic reactions. If the allergic reactions are addressed (avoided or eliminated) then the inflammation caused by them would likely decrease. If the imflammation is reduced then there would be less need for the steriods.

Inflammation is complex immunologic response. Elimination of the triggerging allergens (or at least the ones that trigger the most) is a very necessary effort in control of asthma. Once the inflammation has started, it will take time and pharmacological efforts to decrease it and help it resolve. Elimination of all allergens and triggers is EXTREMELY problematic… For Example, there are 300 kinds of dust.. can u possibly eliminate all of them… no… My point is that even if allergens are removed, inflammation does not self-resolve and additional measures (medications) are needed.. One of the most important things that a patient gets with inhaled corticosteroid is prevention of airway remodeling (which is highly irreversible progressive bronchoconstriction); along with acute reduction of inflammation and symptomatic improvement. If the inflammation is reduced thru addressing allergies, then it seems likely that airway remodeling would reduce also.

******* Control of allergies is only one step in the whole series of the airway remodeling prevention. I would say that if in a moderate asthmatic allergies are addressed properly, then the chances of airway remodeling are less… but on the other hand, the regimen for moderate asthma includes inhaled steroids…Early intervention with steroids have been shown to decrease the airway remodeling. In a patient with severe asthma, *just* addressing allergies is VERY insufficient to prevent or even attenuate airway remodeling.. Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA Disclaimer: "The medical advice and/or health information is provided for purely altruistic reasons. Please consult your physician or other health care provider before applying any of the information towards your personal health condition" – Hide quoted text — Show quoted text -..diane As far as references, there is an excellent article in Respiratory Medicine that has been cited many times — Taylor IK, Shaw RJ. The Mechanism of Action of Corticosteroids in Asthma. Respiratory Medicine, 1993; 87: 261-277.  Another good one is: Barnes J. Molecular Mechanisms of Glucocorticoid Action in Asthma. Pulmonary Pharmacology and Therapeutics, 1997; 10: 3-19. — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA Disclaimer: "The medical advice and/or health information is provided for purely altruistic reasons. Please consult your physician or other health care provider before applying any of the information towards your personal health condition" My concern is, if such medication taken over many years, does not cause some sort of "build up" in lungs and therefore blood stream, that can be as harmful (if not considerably more so) than an occasional oral dose Anyone care to share their thoughts (or better, scientific papers) ? The best reference (and the one that I suspect that your doctor is using) can be downloaded at: http://www.nhlbi.nih.gov/nhlbi/lung/asthma/prof/asthgdln.htm

Response:

– Hide quoted text — Show quoted text – So it seems that the inflammation is often a result of allergic reactions. If the allergic reactions are addressed (avoided or eliminated) then the inflammation caused by them would likely decrease. If the imflammation is reduced then there would be less need for the steriods. Inflammation is complex immunologic response. Elimination of the triggerging allergens (or at least the ones that trigger the most) is a very necessary effort in control of asthma. Once the inflammation has started, it will take time and pharmacological efforts to decrease it and help it resolve. Elimination of all allergens and triggers is EXTREMELY problematic… For Example, there are 300 kinds of dust.. can u possibly eliminate all of them… no… My point is that even if allergens are removed, inflammation does not self-resolve and additional measures (medications) are needed..

I thought it was the dust mite feces and not the dust itself that was considered the allergen in dust. Of course the dust itself might be a problem. If one is only allergic to one or a few types of dust then it would be less of a problem to eliminate. There is also the possiblity that eliminating one allergy can eliminate others. If the suspected allergens are removed and the inflammation does not resolve, then it seems a likely possiblity that other unknown/unsuspected allergens could be continuing to trigger the inflammation. As these additional allergens are detected and addressed, it seems likely that the inflammation could be affected in a positive way. If the inflammation is reduced thru addressing allergies, then it seems likely that airway remodeling would reduce also. ******* Control of allergies is only one step in the whole series of the airway remodeling prevention. I would say that if in a moderate asthmatic allergies are addressed properly, then the chances of airway remodeling are less… but on the other hand, the regimen for moderate asthma includes inhaled steroids…Early intervention with steroids have been shown to decrease the airway remodeling. In a patient with severe asthma, *just* addressing allergies is VERY insufficient to prevent or even attenuate airway remodeling..

It seems a major issue is how the allergies are addressed. Avoidance helps quite a bit, but can be impossible with some allergens. Eliminating the triggering effect of the allergens would seem to be key in reducing/preventing the biochemical processes from occurring which lead/contribute to inflammation, thickening mucosa, and eventual airway remodeling. While the process of addressing/eliminating alleriges is occuring, it seems that some symptom suppression with meds will be needed, depending on the needs of the individual at that point in time. At some point in this process, it is likely that eliminating the triggering action of the allergens would result in less symptoms (inflammation, mucous, etc), requiring less medication…and perhaps at some point, hopefully none. ..diane

Response:

As I have mentioned in one of my earlier posts, long-term administration of inhaled steroids reduces the airway remodeling. Since inflammation is present in the airway even in the patients with mild to moderate asthma, it indicated the need for long-term maintenance treatment in asthma. On top of that, asthmatic inflammation is a response that is usually provoked by allergic reactions or repeated environmental triggers. Thus, continuous anti-inflammatory therapy is usually necessary for the control of the condition.

So it seems that the inflammation is often a result of allergic reactions. If the allergic reactions are addressed (avoided or eliminated) then the inflammation caused by them would likely decrease. If the imflammation is reduced then there would be less need for the steriods. One of the most important things that a patient gets with inhaled corticosteroid is prevention of airway remodeling (which is highly irreversible progressive bronchoconstriction); along with acute reduction of inflammation and symptomatic improvement.

If the inflammation is reduced thru addressing allergies, then it seems likely that airway remodeling would reduce also. ..diane – Hide quoted text — Show quoted text – As far as references, there is an excellent article in Respiratory Medicine that has been cited many times — Taylor IK, Shaw RJ. The Mechanism of Action of Corticosteroids in Asthma. Respiratory Medicine, 1993; 87: 261-277.  Another good one is: Barnes J. Molecular Mechanisms of Glucocorticoid Action in Asthma. Pulmonary Pharmacology and Therapeutics, 1997; 10: 3-19. — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA Disclaimer: "The medical advice and/or health information is provided for purely altruistic reasons. Please consult your physician or other health care provider before applying any of the information towards your personal health condition" My concern is, if such medication taken over many years, does not cause some sort of "build up" in lungs and therefore blood stream, that can be as harmful (if not considerably more so) than an occasional oral dose Anyone care to share their thoughts (or better, scientific papers) ? The best reference (and the one that I suspect that your doctor is using) can be downloaded at: http://www.nhlbi.nih.gov/nhlbi/lung/asthma/prof/asthgdln.htm

Response:

I appreciate that an inhaled steroid medication must be *safer* than an orally administered one But is that comparison fair ? In my case I may take one or two oral courses a year (6 day course) – my doctor suggests that I use Becotide continuously – and I have reservations My concern is, if such medication taken over many years, does not cause some sort of "build up" in lungs and therefore blood stream, that can be as harmful (if not considerably more so) than an occasional oral dose Anyone care to share their thoughts (or better, scientific papers) ? Cheers

Response:

My concern is, if such medication taken over many years, does not cause some sort of "build up" in lungs and therefore blood stream, that can be as harmful (if not considerably more so) than an occasional oral dose Anyone care to share their thoughts (or better, scientific papers) ?

The best reference (and the one that I suspect that your doctor is using) can be downloaded at: http://www.nhlbi.nih.gov/nhlbi/lung/asthma/prof/asthgdln.htm

Response:

As I have mentioned in one of my earlier posts, long-term administration of inhaled steroids reduces the airway remodeling. Since inflammation is present in the airway even in the patients with mild to moderate asthma, it indicated the need for long-term maintenance treatment in asthma. On top of that, asthmatic inflammation is a response that is usually provoked by allergic reactions or repeated environmental triggers. Thus, continuous anti-inflammatory therapy is usually necessary for the control of the condition. One of the most important things that a patient gets with inhaled corticosteroid is prevention of airway remodeling (which is highly irreversible progressive bronchoconstriction); along with acute reduction of inflammation and symptomatic improvement. As far as references, there is an excellent article in Respiratory Medicine that has been cited many times — Taylor IK, Shaw RJ. The Mechanism of Action of Corticosteroids in Asthma. Respiratory Medicine, 1993; 87: 261-277.  Another good one is: Barnes J. Molecular Mechanisms of Glucocorticoid Action in Asthma. Pulmonary Pharmacology and Therapeutics, 1997; 10: 3-19. — Andrey Zenovich University of Minnesota Minneapolis, MN 55455 USA Disclaimer: "The medical advice and/or health information is provided for purely altruistic reasons. Please consult your physician or other health care provider before applying any of the information towards your personal health condition" – Hide quoted text — Show quoted text – My concern is, if such medication taken over many years, does not cause some sort of "build up" in lungs and therefore blood stream, that can be as harmful (if not considerably more so) than an occasional oral dose Anyone care to share their thoughts (or better, scientific papers) ? The best reference (and the one that I suspect that your doctor is using) can be downloaded at: http://www.nhlbi.nih.gov/nhlbi/lung/asthma/prof/asthgdln.htm

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Question:

I am interested by this user group opinion on the value of a simple air ventilation filtering and recycling system that can be installed and operated easily in all beds where breathing clean air is an issue ( asthma, pulmonary deficiency etc…) I am ignorant of medical technology  but I have a proposed licence and would appreciate if you think it’s a known problem without an affordable solution today. Thank you  

Response:

I am interested by this user group opinion on the value of a simple air ventilation filtering and recycling system that can be installed and operated easily in all beds where breathing clean air is an issue ( asthma, pulmonary deficiency etc…) I am ignorant of medical technology  but I have a proposed licence and would appreciate if you think it’s a known problem without an affordable solution today. Thank you

try an air purifier austin  air machine of choice.

Response:

I am interested by this user group opinion on the value of a simple air ventilation filtering and recycling system that can be installed and operated easily in all beds where breathing clean air is an issue ( asthma, pulmonary deficiency etc…) I am ignorant of medical technology  but I have a proposed licence and would appreciate if you think it’s a known problem without an affordable solution today.

When it comes to air purification, there are many affordable approaches available today. You have your choice of HEPA filters, ozonation/ionization machines such as those made popular by Alpine Industries, and combination machines that do HEPA filtration, electrostatic, and ionization such as the Oreck systems. Any of these systems can be had for somewhere in the range of $240-$600. I am an Alpine dealer. My experience with asthmatics so far is that they do very well with the Alpine ozone/ionization machines. Allergy sufferers are more hit and miss. My experience has been that for every two allergy sufferers that try an Alpine machine, one is helped (sometimes seemingly miraculously, sometimes far less dramatic) and the other it doesn’t do a thing for. I think this must be because allergies are not all related to airborne contaminants. Other things such as food allergies enter in to the picture and of course an air machine isn’t going to help there. I’ll spare you the Alpine pitch, but, in answer to your question, there are plenty of things you can try that are within the economic reach of most. Alpine’s policy is for you to try one of their machines in your environment for 3 days and decide for yourself if it is helpful in any way. At least you don’t have to shell out the money before you know if the unit is helping. Regards, Tom Cianflone Independent Alpine Dealer Have a Clean Air Day!

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Question:

- Hide quoted text — Show quoted text – Hope I am around to visit you in the ER when you come in with acute RDS. Don’t matter to me if your lung problem is neoplastic (cancer) or emphysema, allergic rhinitis, pulmonitis, asthma, pulmonary cystitis, embolism,fibosis, bronchitis and ad nauseam. Point being, sick is sick and dead is dead. Bet you don’t buckle up either cause it might not happen to you. My Ist question would be, did you wear a mask? Not to beat a dead horse, I refer concerned and interested readers to the following text book which is available at medical libraries. My edition is probably not the latest so page numbers may change.              PATHOLOGIC PHYSIOLOGY              Mechanisms of Disease              Sodeman and Sodeman, editors              W. B. Saunders Co., Publishers              6th edition   page 458 section on hypersensitivity pneumonitis   ** page 460 section on pneumoconiosis. This is an outstanding description of what exactly happens to inhaled dust particles in the lungs. If I could figure how to scan this section to the posting, I would try and do such. If you like to play Russian roulette, continue to breathe dust freely, I don’t. The ER’s and pulmonary sepecialists will certainly appreciate the added visits. Point of interest, could an insurance company refuse to cover medical costs of a dust related problem if it is documented that proper protection was not utilized?

p.s. e-mail adress was wrong, correct is above

Response:

Hope I am around to visit you in the ER when you come in with acute RDS. Don’t matter to me if your lung problem is neoplastic (cancer) or emphysema, allergic rhinitis, pulmonitis, asthma, pulmonary cystitis, embolism,fibosis, bronchitis and ad nauseam. Point being, sick is sick and dead is dead. Bet you don’t buckle up either cause it might not happen to you. My Ist question would be, did you wear a mask? Not to beat a dead horse, I refer concerned and interested readers to the following text book which is available at medical libraries. My edition is probably not the latest so page numbers may change.               PATHOLOGIC PHYSIOLOGY               Mechanisms of Disease               Sodeman and Sodeman, editors               W. B. Saunders Co., Publishers               6th edition    page 458 section on hypersensitivity pneumonitis    ** page 460 section on pneumoconiosis. This is an outstanding description of what exactly happens to inhaled dust particles in the lungs. If I could figure how to scan this section to the posting, I would try and do such. If you like to play Russian roulette, continue to breathe dust freely, I don’t. The ER’s and pulmonary sepecialists will certainly appreciate the added visits. Point of interest, could an insurance company refuse to cover medical costs of a dust related problem if it is documented that proper protection was not utilized?

Response:

- Hide quoted text — Show quoted text – Hope I am around to visit you in the ER when you come in with acute RDS. Don’t matter to me if your lung problem is neoplastic (cancer) or emphysema, allergic rhinitis, pulmonitis, asthma, pulmonary cystitis, embolism,fibosis, bronchitis and ad nauseam. Point being, sick is sick and dead is dead. Bet you don’t buckle up either cause it might not happen to you. My Ist question would be, did you wear a mask? Not to beat a dead horse, I refer concerned and interested readers to the following text book which is available at medical libraries. My edition is probably not the latest so page numbers may change.              PATHOLOGIC PHYSIOLOGY              Mechanisms of Disease              Sodeman and Sodeman, editors              W. B. Saunders Co., Publishers              6th edition   page 458 section on hypersensitivity pneumonitis   ** page 460 section on pneumoconiosis. This is an outstanding description of what exactly happens to inhaled dust particles in the lungs. If I could figure how to scan this section to the posting, I would try and do such. If you like to play Russian roulette, continue to breathe dust freely, I don’t. The ER’s and pulmonary sepecialists will certainly appreciate the added visits. Point of interest, could an insurance company refuse to cover medical costs of a dust related problem if it is documented that proper protection was not utilized? p.s. e-mail adress was wrong, correct is above

Usually i ignore a post when it is sent by someone that does not know what the original thread was all about, especially someone that has to answer in a wise alecky  debate type manner. there is a wide differance to an open honest intellectual discussion  and the type of response you have diplayed here. If you are in dire need of attention then go play in traffic. I have been very bust and this issue is not done yet. I do thank you for the information about the book you mentioned, however you did not say if it had any *medical proof of wood dust causing cancer* That is what the discussion was about. If i can get a copy of the book i’ll post the pertitant information if there is any. BYTW my lungs are perfectly healthy other than the damage of 30 years of smoking has done to them. On year 7 of being a nonsmoker. Unless you have some information that is valid and useful to this topic by all means post it, other than that i will delete any other messages from you. You have a great day.  *  A man who works with his hands    *  is called a Laborer                *  A man who works with his hands    * Happy Woodworking                *  and his mind                      * George M. Kazaka                *  is called a Craftsman             * Specialty Woodworking & Design  *  A man who works with his hands                                    /  *  is called an Artist               /  *                                   /

Response:

the added visits. Point of interest, could an insurance company refuse to cover medical costs of a dust related problem if it is documented that proper protection was not utilized?

Doubtful. If they could, there would be a lot of uninsured smokers.

Response:

I do thank you for the information about the book you mentioned, however you did not say if it had any *medical proof of wood dust causing cancer*

Hi, George. I THINK this has been said before in this thread, but just in case, I’ll point out: you’ll never find any PROOF that wood dust causes cancer, any more than you will find proof that smoking causes cancer. They don’t. But they are contributing factors, as demonstrated by the increased statistical occurence, which was reported in the studies that you found not to be very good studies. The point that I am missing in all of this discussion is exactly how big that risk is. I don’t mind doing something that increases a risk many-fold if it was large enough to begin with. E.g., if one in 10 million in the general population gets nasal cancer, and the risk is 5 times as great for those exposed to wood dust, I’m not going to sweat it. I’d much more worry about a mear 20% chance that I will go from heart disease — bigger baseline, so smaller RELATIVE increase is still a much larger risk.

Response:

I do thank you for the information about the book you mentioned, however you did not say if it had any *medical proof of wood dust causing cancer* BYTW my lungs are perfectly healthy other than the damage of 30 years of smoking has done to them. On year 7 of being a nonsmoker.

The term "proof" is a very funny term in the field of medicine.   Being shot in the heart is a very bad thing, but there is no "proof" that it will kill you.  In fact, it won’t always kill you!  There are numerous examples of a large caliber slug lodging in the heart without causing death.  Part of the reason is that there are so many different entry pathways, so many different calibers, places along the tajectory (thus different momentums), so many different heart morphologies, so many different times of entry (contraction, expansion, etc…). I cannot PROVE that shooting you in the heart with a Ruger .44 WILL kill you.  At best, I can say that the odds ratio of mortality following such an insult will be greater than 1000:1, with a CI of 95%.   Now, 1000:1 is pretty convincing. But the cause and effect are dramatically linked.  The tissue damage is obvious, and the time delay is short.   What about things without such obvious linkages, and long gestation periods? For example, tobacco companies can get away with their vacuous claim that "there is no proof that smoking causes cancer" because the insult caused by smoking is not as dramatic or as immediate as that caused by the entry of a .44 bullet into the heart.  That time delay allows numerous complicating factors to cloud the issue.  This "clouding" allows people who wish to deny the linkage to do so…  yet, if one were to approach this issue with a clear unbiased viewpoint, then it seems obvious to state that smoking is clearly damaging to one’s health. The same with woodworking…  it is clearly damaging to one’s health to breath lots of wood dust.  Will it kill you as quickly as being shot with a .44?  Normally not.  But to deny the increased risks is to deny something that is probably "real". — If I was smart, I’d have a clever .sig

Response:

Point of interest, could an insurance company refuse to cover medical costs of a dust related problem if it is documented that proper protection was not utilized?

Highly doubtful.  They don’t refuse to cover costs of smokers because they smoke and there’s an obvious and well established link there (despite what tobacco growers would lead you to believe).   –Al Amaral– — "G’day, and welcome to All Things Delta.  If it’s not Delta, IT’S CRAP!"

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