Posts Tagged ‘cigarette smoking’

Generic Name
Clotrimazole (kloe-TRIM-uh-zole) 0
Brand Name Mycelex
The information in this profile also applies to the following drug:
Generic Ingredient: Sertaconazole Ertaczo
Type of Drug Antifungal.
Prescribed For
Fungal infections of the mouth, skin, and vaginal tract.
General Information
clotrimazole is useful against a variety of fungal organisms that other drugs do not affect. The exact way in which clotrimazole works is unknown. Sertaconazole is used for athlete’s foot in people age 12 and older with compromised immune systems.
Cautions and Warnings
Do not use this product if you are allergic or sensitive to any of its ingredients.
If clotrimazole causes local itching or irritation, stop using it. Do not use clotrimazole in your eyes.
Proper diagnosis is essential for effective treatment. Do not use this product without first consulting your doctor.
Possible Side Effects
Side effects are infrequent and usually mild.
Cream and Solution
V Most common: redness, stinging, blistering, peeling, itching, and swelling of local areas.
Vaginal Tablets
♦ Most common: mild burning, rash, mild cramps, and frequent urination. Your sexual partner may also experience some burning or itching.
Lozenges
V Most common: stomach cramps or pain, diarrhea, nausea, and vomiting.
Drug Interactions
None known.
Food %%ractions
The oral form of clotrimazole is best taken on an empty stomach, at least 1 hour before or 2 hours after meals. However, you may take it with food as long as you allow the lozenge to dissolve fully in your mouth.
Usual Dose
Topical Cream and Solution
Adult and Child (over age 2): Apply to clean, dry, affected areas morning and night for 7 consecutive days or as needed. For athlete’s foot and ringworm, use daily for 4 weeks. For jock itch, use daily for 2 weeks.
Vaginal Cream
Adult: 1 applicator’s worth at bedtime for 3-7 consecutive days.
Vaginal Tablet
Adult: 1 tablet inserted into the vagina at bedtime for 3 days, or 2 tablets a day for 3-7 consecutive days.
Lozenge
Adult and Child (over age 3): 1 lozenge 5 times a day for 2 weeks or more.
Overdosage
Little is known about the effects of clotrimazole overdose or accidental ingestion. Call your local poison control center for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
If treating a vaginal infection, you should refrain from sexual activity. Call your doctor if burning or itching develops or if the condition does not improve within 7 days.
If you are using the vaginal cream, you may want to wear a sanitary napkin to avoid staining your clothing. Do not use a tampon during treatment.
Dissolve the lozenge slowly in the mouth. This may take up to 30 minutes.
This medicine must be taken on consecutive days. If you forget a dose of oral clotrimazole, take it as soon as you remember. Do not double your dose.
When using clotrimazole for skin infections, do not cover the area with any kind of bandage unless directed to do so by your doctor. For athlete’s foot, wear well-fitting, ventilated shoes, and change your socks at least once a day.
clotrimazole is not effective on scalp or nails.
Special Populations
Pregnancy/Breast-feeding: Women who are or might be pregnant should talk to their doctor about the medication’s risks and benefits. Women who are in the first 3 months of pregnancy should use this drug only if directed to do so by their doctor. If you are pregnant, your doctor may want you to insert vaginal tablets by hand rather than use a vaginal applicator.
It is unknown whether the drug passes into breast milk. Use with caution or use infant formula.
Seniors: Seniors may use this medication without special precaution.

Generic Name
Clozapine (KLOE-zuh-pene) 03
Brand Names
Clozaril    FazaClo Orally Disintegrating Tablets
Type of Drug  Antipsychotic.
Prescribed For  Severe schizophrenia.
General Information
Clozapine is a unique antipsychotic that has the capacity to treat people who do not respond to or cannot tolerate other drugs. It works by a mechanism that differs from those of other antipsychotic drugs.
A very small number of people who take clozapine develop a rapid drop in their white-blood-cell count, known as agranulocytosis. This effect usually reverses itself when the drug is stopped, but the drug must be stopped as soon as it is discovered. An unusually large number of people who have developed clozapine algllaTwlocytosis in the United States are of Eastern European Jewish descent, but the association is not very strong. Most cases of agranulocytosis occur between week 4 and week 10 of treatment. It is essential that blood samples be taken approximately every week and for 4 weeks after the drug is stopped to watch for this effect. Because of the risk of agranulocytosis, clozapine should not be tried until at least 2 other antipsychotic medicines have failed.
Some people taking antipsychotic drugs develop tardive dyskinesia, a potentially irreversible condition marked by uncontrollable movements. Tardive dyskinesia has not been seen in patients taking clozapine, a major advantage of this drug over other antipsychotic medicines. However, there is still a risk that this set of symptoms could occur with clozapine.
Cautions and Warnings
Do not take clozapine if you are allergic or sensitive to any of its ingredients.
Women, seniors, people with serious illnesses, those who are emaciated. those with a history of diseases affecting the white blood cells, or those who are taking other medication that could affect white blood cells may be more susceptible to clozapine agranulocytosis.
Clozapine has been associated with increased mortality in seniors with dementia or Alzheimer’s disease. The specific causes of death related to clozapine and other atypical antipsychotic drugs were either due to a heart-related event or infection, mostly pneumonia. Clozapine should not be taken by those with dementia-related psychosis.
About 5% of people taking the drug experience a seizure in the first year of treatment. Seizure is most likely to occur at higher drug doses.
People with heart disease should be carefully monitored while on clozapine because of possible cardiac risks.
Clozapine may cause low blood pressure, especially at the beginning of therapy.
Clozapine has been associated with obesity, high cholesterol, high blood sugar, and diabetes. Diabetics and pre-diabetics (people with elevated blood sugar and a family history of diabetes) should be carefully monitored.
A serious set of side effects, known as neuroleptic malignant syndrome (NMS), includes a high lever and has been associated With clozapine when it is used together with lithium or other drugs. The symptoms that constitute NMS include muscle rigidity, mental changes, irregular pulse or blood pressure, increased sweating, and abnormal heart rhythm. NMS is potentially fatal and requires immediate medical attention.
Use this drug with caution if you have glaucoma, prostate
problems, or liver or kidney disease.
clozapine may interfere with mental or physical abilities because of the sedation it usually causes during the first few weeks
of treatment.
Possible Side Effects
✓    Most common: rapid heartbeat, low blood pressure, dizziness, fainting, drowsiness or sedation, salivation, and constipation.
✓    Less common: headache, tremor, sleep disturbance, restlessness, slow muscle motions, absence of movement, agitation, convulsions, rigidity, restlessness, confusion, sweating, dry mouth, visual disturbances, high blood pressure, nausea, vomiting, heartburn or abdominal discomfort, fever, and weight gain.
♦    Rare: agranulocytosis (symptoms include fever with or without chills, sore throat, and sores or white spots on the lips or mouth), tardive dyskinesia (symptoms include lip smacking or puckering, puffing of the cheeks, rapid or wormlike tongue movement, uncontrolled chewing motions, and uncontrolled arm and leg movements), and NMS (see “Cautions and Warnings”). Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Clozapine’s anticholinergic effects—blurred vision, dry mouth, and confusion—may be enhanced by interaction with other anticholinergics, such as tricyclic antidepressants like amitriptyline.
•    Drugs that reduce blood pressure may enhance the bloodpressure-lowering effects of clozapine.
•    Alcohol and other nervous system depressants, including benzQUIQOmrn and other antianxiety drugs, may enhance clozapine’s sedative action. At least 1 person has died as a result of combining diazepam and clozapine.
•    Combination contraceptive drugs may increase blood levels of clozapine leading to toxic side effects. Women starting on a combination contraceptive may need to have their clozapine dose adjusted.
•    Clozapine should not be used with ritonavir.
•    Cimetidine, caffeine, citalopram, ciprofloxacin, erythromycin, and ketoconazole may increase blood levels of clozapine resulting in increased side effects. Caution should be used with combining clozapine with paroxetine, fluvoxamine, or sertraline as similar reactions may occur, although these interactions are less well-defined.
•    Clozapine may increase blood levels of digoxin, warfarin, heparin, and phenytoin.
•    Use of clozapine with phenytoin, carbamazapine, and rifampin may cause decreases in blood levels of clozapine, reducing its effectiveness.
•    The combination of lithium and clozapine may cause seizures, confusion, and NMS (see “Cautions and Warnings”).
•    Cigarette smoking may alter clozapine dosage requirements.
•    Combining selective serotonin receptor inhibitors (SSRls) with clozapine may require a lower clozapine dosage.
Food Interactions None known.
Usual Dose
Tablets
Starting dose: 25 mg in divided doses twice a day; maintenance dose    generally, 300-450 mg a day in divided doses. Dosage may be increased gradually to a daily maximum of 900 mg in divided doses if required.
Orally Disintegrating Tablets
Starting dose: 12.5 mg once or twice a day increasing to 300450 mg a day in divided doses by the end of 2 weeks. Dosage may then be increased up to 900 mg a day in divided doses if required.
Overdosage
Symptoms of overdose are delirium, drowsiness, changes in heart rhythm, unusual excitement, nervousness, restlessness, hallucinations, excessive salivation, dizziness or fainting, slow or irregular breathing, and coma, Overdose victims must be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Clozapine may cause a fever during the first few weeks of treatment. Generally, the fever is not important, but it may occasionally be necessary to stop treatment due to a persistent fever.
Regular blood tests are necessary to monitor blood composition for any changes that might be caused by clozapine.
Call your doctor at once if you develop lethargy or weakness, a flu-like infection, sore throat, feelings of ill health, fever, sweating, muscle rigidity, mental changes, irregular pulse or blood pressure, mouth ulcers, or dry mouth that lasts for more than 2 weeks.
Dry mouth, a common side effect of clozapine, may be countered by using gum, candy, ice, or a saliva substitute such as Orex or Moi-Stir.
Do not stop taking clozapine without your doctor’s knowledge and approval, because a gradual dosage reduction may be necessary to prevent side effects.
Avoid alcohol or any other nervous system depressants while taking clozapine.
Some of the side effects of clozapine    drowsiness, blurred vision, and seizures—may interfere with the performance of complex tasks like driving or operating hazardous equipment.
While taking clozapine, rapidly rising from a sitting or lying position may cause you to become dizzy or faint.
If you take clozapine twice a day and forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose as soon as you remember and another in 5 or 6 hours, then go back to your regular schedule. If you take clozapine 3 times a day and forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose as soon as you remember and another in 3 or 4 hours, then go back to your regular schedule. Never take a double dose.
Orally disintegrating tablets should be left in the unopened blister until time of use. They should not be pushed through the foil. Just prior to use, peel the foil from the blister and gently remove the orally disintegrating tablet. Immediately place the tablet in the mouth, allow it to disintegrate and then swallow with saliva. No water is needed.
Special Populations
Pregnancy/Breast-feeding: This drug Should be used during PM Only if your doctor determines that it is absolutely necessary.
clozapine may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to the side effects of clozapine, such as dizziness on rapidly rising from a sitting or lying po-sition, confusion, and excitability. Older men are also more likely to have prostate problems, a reason to be cautious with clozapine. Seniors with psychosis due to dementia who take clozapine are more likely to die from heart disorders and infections than those not taking it.

Generic Name
Codeine (KOE-deep) 0
Brand Name
Only available in generic form.
The information in this profile also applies to the following drugs: Generic Ingredient: Fentanyl
Actiq Lozenge on a Stick    Fentora Buccal Tablet
Duragesic (Patch)    lonsys (Patch)
Generic Ingredient: Morphine Sulfate 10
Avinza    Oramorph SR
Kadian    RMS Suppositories
MS Contin    Roxanol MSIR
Generic Ingredient: Oxycodone Hydrochloride RE
Combunox    OxyFAST
Endocodone    OxylR
M-Oxy    Percolone
OxyContin    Roxicodone Oxydose
Generic Ingredient: Oxymorphone Opana
Type Q( UTUg  Narcotic.
Prescribed For
Mild to severe pain, breakthrough cancer pain, and cough. Long-acting narcotics are meant only for people with chronic pain. Also prescribed for pain and anxiety in pediatric burn patients.
General Information
Codeine relieves pain and suppresses cough. The pain-relieving effect of 30-60 mg of codeine is equal to approximately 650 mg, or 2 tablets, of aspirin. Codeine may be less effective than aspirin for pain associated with inflammation because aspirin reduces inflammation and codeine does not. Codeine suppresses the cough reflex but does not cure the underlying cause of the cough. Other narcotic cough suppressants are stronger pain relievers, but codeine remains the best cough medication available.
Morphine sulfate is a pure narcotic that has been in use for many years. In addition to pain relief, morphine’s effects include drowsiness, mood changes, breathing difficulty, slowed movement of the gastrointestinal tract, nausea, vomiting, and changes in the endocrine and autonomic nervous systems. Morphine sulfate liquid, immediate-release tablets, and suppositories must be taken several times a day. The medication they contain is released immediately for absorption into the bloodstream. Extended- and controlled-release morphine products are designed to release some of the narcotic right away and the rest over a 24-hour period, allowing for less-frequent dosage.
Fentanyl is a potent pain reliever that can be substituted for other narcotic drugs. The patch form, which must be replaced about every 3 days, delivers fentanyl to the bloodstream at a steady rate. The lozenge has a shorter length of action than any other narcotic pain reliever, which makes it useful when given to children before surgery because it provides doctors with the flexibility to obtain maximum benefit with minimal side effects. The lozenge on a stick is used for breakthrough cancer pain as a booster for people already taking narcotic pain relievers. These forms should only be used under controlled circumstances because of the risk of side effects or overdose. Low dosages of fentanyl relieve pain—larger amounts cause loss of consciousness and breathing difficulties.
Oxycodone is a narcotic used to control moderate to severe pain. Most people take it together with aspirin (Percodan) or acetaminophen (Percocet), but it can be used by itself. This is a potent pain reliever that carries a risk (31 addiction with continued use.
Cautions and Warnings
Do not take narcotics if you are allergic or sensitive to any of their ingredients.
Long-term use of narcotics may cause drug dependence or addiction.
Use narcotics with extreme caution if you suffer from asthma or other breathing problems.
Narcotics may make it difficult to monitor the progress of people who have suffered head injuries and acute abdominal conditions.
Actiq contains fentanyl in an amount that can be fatal to children. Keep used and unused lozenges and lozenges on a stick out of reach of children.
Possible Side Effects
♦    Most common: lightheadedness, dizziness, sleepiness, nausea, vomiting, appetite loss, and sweating. If these occur, ask your doctor about lowering your dosage. Most of these side effects disappear if you lie down.
♦    Less common: euphoria (feeling “high”), headache, agitation, uncoordinated muscle movement, minor hallucinations, disorientation and visual disturbances, dry mouth. constipation, flushing of the face, rapid heartbeat, palpitations, faintness, urinary difficulties or hesitancy, reduced sex drive or impotence, itching, rash, anemia, lowered or raised blood sugar, and yellowing of the skin or whites of the eyes. Narcotic analgesics may aggravate convulsions in those who have had them.
More serious side effects of codeine are shallow breathing or breathing difficulties.
Drug Interactions
•    Avoid combining narcotics with alcohol, sleeping medications, sedatives, other depressant drugs, or non-prescription drugs that have alcohol as an ingredient. Alcohol speeds the release of morphine from Avinza. The mixture can result in a deadly narcotic overdose.
•    Narcotic analgesics should not be used at the same time as monoamine oxidase inhibitor antidepressants. Separate usage by at least 14 days.
•    Combining a narcotic pain reliever with an anticholinergic medication may result in severe constipation.
•    Combining a narcotic pain reliever with any other medication that lowers blood pressure can lead to excessive blood-pressure lowering. Avoid this combination.
•    Combining cimetidine with a narcotic pain reliever may cause confusion, disorientation, breathing difficulties, and seizure.
•    Reserpine, rifampin, and remifentanil may decrease the pain-relieving effects of morphine.
•    Fentanyl should be used with caution with azole antifungals (e.g. ketoconazole).
Food Interactions
Codeine may be taken with food to reduce upset stomach. Morphine capsules and the fentanyl patch may be used without regard to food.
Usual Dose
Dosing of narcotic pain medications is highly individualized based on patient tolerance and response to medication.
Codeine
Adult: 15-60 mg every 4-6 hours for relief of pain; 10-20 mg every few hours as needed to suppress cough.
Child: 1 mg per lb. of body weight every 4-6 hours for relief of pain; 2.5-10 mg every 4-6 hours to suppress cough.
Fentanyl Lozenge and Lozenge on a Stick
Adult: 200-1600 mcg. Dosage may be repeated up to 4 times daily. Allow the lozenge to dissolve in your mouth. DO NOT CHEW. Child: not recommended.
Fentanyl Patch: Apply to a clean and non-irritated patch of skin as directed, usually once every 3 days.
Morphine Extended-release and Controlled-release
Tablets and Capsules
Adult: 1-3 capsules a day, depending on the specific product and individual need.
Morphine Oral Liquid and Immediate-release Tablets Adult: 5-30 mg every 4 hours.
Morphine Suppositories
Adult: 5-30 mg several times a day.
Oxycodone
Adult: 10-30 mg every 4 hours as needed. OxyContin should be swallowed whole and not broken.
Child: not recommended.
Overdosage
Symptoms include breathing difficulties or slowing of respiration, extreme tiredness progressing to stupor and then coma, pinpointed pupils, no response to pain stimulation, cold and clammy skin, slowing of heartbeat, lowering of blood pressure, convulsions, and cardiac arrest. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Codeine is a respiratory depressant and affects the central nervous system (CNS), producing sleepiness, tiredness, or inability to concentrate. Be careful when driving or doing any task that requires concentration. Avoid alcohol.
Call your doctor if you develop breathing difficulties, constipation, dry mouth, or any bothersome or persistent side effect.
Apply the fentanyl patch only to non-irritated skin on a flat surface of the upper body. Hair at the application site should be clipped or cut, not shaved, before applying the patch. Do not use oils, soaps, lotions, alcohol, or anything else that might irritate the skin before applying the patch.
If you are taking a controlled-release narcotic product, do not crush, chew, or break the tablet or lozenge. Rapid release may result in a potentially fatal dose of the drug.
If you forget a dose of codeine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Narcotics pass into the fetal circulation. Excessive use of them during pregnancy may cause drug dependence in newborns. Narcotics may also cause breathing difficulties in infants during delivery. Animal studies show that codeine may cause fetal harm. If given to a pregnant woman before cesarean section, fentanyl may cause drowsiness in newborns. When either of these drugs is considered crucial by your doctor, its potemt(a1 bel)elft must be carefully weighed against its risks.
Narcotics pass into breast milk. Nursing mothers who must take codeine should use infant formula.
Seniors: Seniors are more likely to be sensitive to side effects and should be treated with the smallest effective dosage.

Air Pollution and Allergy

Air pollution plays a variety of roles in allergic reactions. Some pollutants irritate the nose and airways (and sometimes the skin) making them more sensitive to allergens. These pollutants can worsen existing allergic symptoms and may promote the development of allergies in children, by making the airway membranes more permeable. Other chemical pollutants may affect the immune system directly, increasing any existing tendency to allergic reactions.
Indoor pollution
For many of us, the air in our houses is much more polluted than any outdoor air. Several of the indoor pollutants irritate the nose and airways, and some can trigger asthma attacks. A few of the pollutants found indoors can also make allergies and asthma more likely to develop in young children.
Background pollution
One of the worst irritants in indoor air is tobacco smoke. Other people’s cigarette or pipe smoke can trigger asthma attacks in the short term, and makes asthmatics generally worse in the long run. Passive smoking might also affect the immune system making allergies more likely to develop, though this is not proven. Do whatever you can to eliminate tobacco smoke from your home.
Everyone is different
This article considers air pollution from the point of view of someone with classical allergies (e.g. hayfever or asthma). Those with chemical intolerance (see p. 84) may well be more severely affected by air pollution.
If you smoke yourself, there are many good reasons for giving up:
• If individuals from atopic families (see p. smoke, they have a far greater chance of developing allergies and/or asthma when exposed to an allergen in the air.
• For those who had asthma as children and have since grown out of it, cigarette smoking doubles the chance of it coming back.
• Parents of asthmatic children who smoke indoors make their children’s asthma worse. Teenagers can be just as badly affected by passive smoking as young children.
• Smoking during pregnancy significantly increases the risk of a woman’s baby developing allergies and asthma. (Smoking also leads to more prematurity, still-births and cot deaths.)
If possible, have an electric cooking stove rather than a gas one –or fit a powerful extractor fan. Cooking with a gas stove generates a lot of nitrogen dioxide, a gas that you can’t smell or see but which affects the airways. This same gas also comes from motor traffic, but peak levels of nitrogen dioxide in kitchens with gas cookers are often ten times the average level on city streets, and frequently exceed standards for outdoor air set by the world Health Organisation. Other sources of nitrogen dioxide include cigarettes, gas fires and kerosene-burning stoves.
For some people with allergies, nitrogen dioxide enhances their response to the allergen. So if you inhale dust-mite allergen together with nitrogen dioxide, it may have more effect than the Smoke screen
Smoke particles from coal or wood do not seem to make allergies more likely to develop - in fact, quite the reverse. In rural areas of Germany, researchers have found that children with coal or wood stoves in their homes were less likely to have allergies or asthma. An Australian study made a similar finding. Bronchitis and pneumonia are more common in those children with wood and coal stoves and these infections may stimulate the immune system in such a way that allergies are less likely to develop later. However, wood smoke may be a cause when asthma begins in an adult.
allergen alone. Breathing sulphur dioxide (see below) and nitrogen dioxide together boosts the reaction to allergen more powerfully than either gas alone.
Nitrogen dioxide might also make asthma attacks more likely, but the evidence on this is conflicting.
For young children, a high level of nitrogen dioxide at home may make the development of allergic reactions more likely. A recent Canadian study showed that children exposed to high levels of nitrogen dioxide in the home - usually from gas cookers - were ten times as likely to develop asthma as those breathing low levels of nitrogen dioxide. If a dog, cat or other furry pet was kept, and there were high nitrogen dioxide levels, the risk of developing asthma shot up even higher, to 25 times that of children with low nitrogen dioxide and no pets. (Other studies have not produced the same spectacular results, but their methods of measuring nitrogen dioxide exposure were less precise.)
Try to eliminate materials that produce formaldehyde fumes, or seal the items with a good coat of paint. Formaldehyde is given off by chipboard and to a lesser extent by MDF (medium-density fibreboard). Injected cavity wall insulation can also produce persistent formaldehyde fumes, and is very difficult to get rid of -moving out is often the only option. A recent study from Australia showed that children exposed to formaldehyde, especially in the bedroom, were more likely to develop allergic reactions: the higher the level of formaldehyde exposure, the more severe the child’s allergic sensitisation.
Those with asthma have more frequent symptoms if exposed to high formaldehyde levels. A recent study from Finland shows that easy-to-clean plastic wall-covering and flooring increases the risk of asthma in children.
A Canadian study found that children whose first home was less than 20-30 years old were 50% more likely to develop asthma than children living in older houses. One possible explanation for this lies with the materials used in the construction and fitting of new houses, especially the plastics, wood preservatives and insulation materials. Solvents, and chemicals such as formaldehyde, are still being given off by these materials some years later.
Air fresheners provoke asthma attacks in some people. For a few individuals they can cause general symptoms of ill-health that are similar to those described for mild chemical intolerance (see p. 84). Those affected generally don’t realise that the air freshener is the source of the trouble. This malign effect is not entirely surprising, since air fresheners work by giving off a chemical that targets part of the brain - the part involved in processing sensory input from your nose. The chemical ‘freshens the air’ by partially disabling your sense of smell. Better to open a window.
Cleaning products, furniture polish and deodorant were never intended to go into the nose and airways, but that’s what happens when they are sprayed from an aerosol, and they can trigger asthma attacks. Steer clear of aerosols as much as possible - there are usually alternatives.
Pollution peaks
Read the instructions and ingredients lists on all products carefully. It is not just a question of what’s in them, but also what gases they might give off when used. One asthmatic died within minutes when the de-rusting agent she was using on her dishwasher produced a large amount of sulphur dioxide gas: her airways tightened up so much that she couldn’t even use an inhaler to save herself. ‘Sulphuric’, ’sulphate’ or ’sulphite’ in the list of ingredients should ring warning bells if you have asthma: sulphur dioxide gas could be given off by this product.
Bleach, and other chlorine-based cleaning products, such as toilet cleaner and scouring powder, should be used sparingly, and with plenty of ventilation. These products release chlorine gas which, in large amounts, can irritate the airways of asthmatics. Never allow bleach or toilet cleaner to become mixed with any other product. Take care with any product containing hypechlorte, chloramine, ammonia, acids or morpholine and with the chemicals used for swimming pool water. All these can trigger asthma attacks.
If doing repairs or DIY work about the house, take special care. Always ventilate the work area well, and wear a dust mask if sawing or drilling.
The smell of paint is due to solvents, and these can act as irritants to the nose and airways. When decorating, ventilate well, and use low-odour water-based paint. Some of the best low-odour paints, tested and shown to be safe for paint-sensitive asthmatics, are only available by mall order: see p. 255.
‘Instant foam’ kits sold for DIY insulation can provoke asthma in those who were not asthmatic previously. Two different substances are mixed to create the polyurethane foam, and during the mixing process, isocyanate is released – this is one of the most powerful asthmagens known (see box on p. 132). The level of isocyanate can breach the safety limit set for factories.
Avoid using fly spray or other insecticides: look for other methods of pest control. A study from Ethiopia showed that people using an insecticide in their houses were twice as likely to develop allergies. A study of Canadian farmers suggested that asthma might be linked to the use of carbamate insecticides (e.g. carbofuran). The sprays used for cockroaches can act as irritants for those with allergic rhinitis or chronic sinusitis.
If advised that your house needs spraying with insecticide, for woodworm or other wood-boring pests, ask for more information before you go ahead. Is the spraying really necessary? What will happen if the house isn’t sprayed? How quickly will it happen? Is there any other method of eradicating the pest? Spraying is often done when it is not really essential – houses remain standing even with woodworm holes all over them. Unless you have a heavy infestation that is threatening the structure of the house, you are probably better off not having the house sprayed. The heavy and ongoing exposure to insecticide that spraying of a house involves is something you and your family should avoid if at all possible. All the sprays used are toxic to some extent – don’t believe those who tell you otherwise. A heavy exposure to pesticides can sometimes make allergic symptoms worse or precipitate chemical intolerance (see p. 85).
The garage, workshop or garden shed can also be very polluted. Petrol, kerosene and paraffin can affect some people with rhinitis or asthma, and can bring on their symptoms. These fuels should always be kept in airtight containers. Paints sold for cars often contain isocyanates, among the most common causes
of work-related asthma (see box on p. 132). If using such paint, wear a mask with an activated carbon filter and make sure the area is well ventilated. Avoid prolonged or repeated exposure.
Outdoor pollution
Some of the pollutants in outdoor air can make allergic reactions worse and can trigger asthma attacks in people who are already asthmatic. A study of hospital admissions in London, Paris. Barcelona and Helsinki found that high levels of pollution increased hospital admissions for asthma by about 3%.
The pollutants that matter to those with allergies are:
• ozone, which soars to high levels on sunny days, mainly in country areas that are near large cities. The reason for this is a chemical reaction which occurs when car exhaust fumes are exposed to sunlight, producing ozone, a highly reactive form of oxygen. Further chemical reactions, involving another ingredient of exhaust fumes, then break the ozone down again. Thanks to this second reaction, there is usually little ozone in city air. But in a relatively rural area 20 miles or so upwind of the city, the pollutants are too dispersed for the second reaction to occur, and the ozone from the urban traffic can accumulate.
Ozone levels in the air tend to peak in the late afternoon and early evening – but it takes 4-24 hours for ozone to produce its effects on the airways. Indoors, ozone breaks down very quickly because of contact with other gases inside the house.
Ozone can increase the effects of allergens, such as pollen, on the nose and airways.
In addition, ozone makes the airway muscles contract, even for people without asthma. Healthy people tend not to notice these effects, whereas some asthmatics may have more symptoms, and may need more drugs, on days when ozone levels are unusually high.
• diesel particulates, which can become a problem in town centres, and close to main roads used by vans and lorries. Unlike ordinary petrol, diesel fuel contains oil, so when it burns it produces tiny black particles. These consist of flakes of carbon (soot), coated with complex chemicals that are produced by the
But what about the ozone layer…?
Is ozone good for us or bad for us? People often get confused about this, because of all the discussion about
‘the destruction of the ozone layer’. But that ozone layer (which screens us from harmful ultraviolet light) is a natural phenomenon and it is thousands of feet up, well away from our lungs. At ground level, in the air we breathe, ozone is unnatural and potentially damaging .
The size of the particles
Diesel particles are 1-10 microns in size, with most smaller than 2.5 microns. Tobacco smoke, coal smoke, fumes from oil-burning boilers, and the smoke from frying food all contain very much smaller particles, down to a hundredth of a micron (.01 microns) in size. (A micron is a thousandth of a millimetre.)
In pollution reports, counts for particles in the air (mostly diesel particles these days, except in heavily industrialised areas) will often appear as ‘PM1 0′, meaning ‘Particulate Matter less than 10 microns in diameter’. This particle size is chosen because larger particles tend to settle in the nose and throat, and not reach the airways of the lungs. The term ‘Small Particles’ is sometimes used to mean PM10.
To deal with air pollution, you need a really good mask with two filters: a dust filter that can take out very small particles and an activated carbon filter that absorbs irritant fumes and gases. Note that while activated carbon filters remove most pollutants, they do not take out nitrogen dioxide unless they have been specially treated.
partial combustion of the oil. It is probably these surface chemicals, rather than the soot particles themselves, that have such bad effects on the nose and airways.
Some research suggests that diesel particulates might increase the risk of allergies developing – to pollen for example. Additionally, when levels of diesel particulates are high, asthmatics tend to have more symptoms. If levels rise above 50 micrograms per cubic metre there is a sharp increase in asthma attacks – and a recent study in Birmingham showed that such levels are regularly reached at roadsides.
• sulphur dioxide, which often reaches high levels in areas of heavy industry, particularly near coal-fired power stations and coking plants. It acts as an irritant to the airways and can trigger attacks in asthmatics, who are far more sensitive to sulphur dioxide than healthy people (see box on p. 207). However, at the sort of concentrations normally encountered, even in quite polluted air, sulphur dioxide does not have any effect on most asthmatics.
• nitrogen dioxide, which is produced by all types of vehicles, and by power stations and some factories. In towns and cities with heavy traffic, nitrogen dioxide can build up to high levels. This gas is also found indoors (see p, 128) – often at far higher levels.
Oil refineries and cement works
In addition to these widespread pollutants, there are localised areas of air pollution, around industrial sites, that are frequently accused of causing health problems, including high rates of asthma. The kinds of industrial sites regularly mentioned include:
• oil refineries and oil-burning power stations
• cement works that use waste solvents for fuel
• dock areas where oil is loaded into tankers.
None of these accusations has been investigated in any detail, so it is impossible to say if there is a real link with asthma.
Avoiding outdoor air pollution
If you live in the kind of area that experiences high levels of ozone (see p. 130), plan your outdoor activities, especially jogging or playing sport, to avoid summer afternoons and early evenings.
Those who live very close to a main road, with a lot of lorries going past, would probably improve their own health, and reduce the chance of their children developing allergies and asthma, by fitting air conditioning or high-quality HEPA air filters – or by moving house. However, the benefits, in terms of decreased risk, are not enormous, and it is important to take other preventive measures as well (see Chapter 8).
When driving, if you stop behind a lorry or bus, keep your distance, close the window and turn off the fan. Diesel vehicles often emit a thick cloud of particles as they set off, and this can come straight into your car, setting off severe attacks for some asthmatics.
A car with air conditioning will reduce your exposure to diesel particulates while driving. When buying a new car, you can make a contribution to air quality by choosing a non-diesel vehicle, preferably one with a catalytic converter fitted. Alternatively, buy a diesel vehicle with a particle filter on the exhaust (now fitted as standard in Germany).
In Britain, the Vehicles Inspectorate of the Department of Transport encourages the public to report lorries and buses seen pumping out black smoke (look in the phone book for the number).
If you are asthmatic, breathing through your nose may help as this can filter out some damaging pollutants before they reach the airways in your lungs. (If your nose is usually blocked, try the exercises on pp. 230-31).
When levels of ozone or sulphur dioxide are high, taking a supplement of Vitamin C and eating plenty of foods that contain Vitamin E and beta-carotene (see p. 207) can protect your airways.