Thoracic and Sleep Group Queensland People caring for how you breathe and sleep

July 13, 2017

What is Exercise-induced Bronchoconstriction (EIB)?

Filed under: Blog — Mark Russell-Pavier @ 11:15 pm

For most people, maintaining a fitness regime is complicated enough as it is. After all, life does tend to get in the way. But for patients who suffer from exercise-induced bronchoconstriction (EIB), there are added difficulties.

EIB: What is it?

EIB occurs when the airways that bring air into and out of your lungs narrow during exercise, and it typically affects patients with asthma. People who don’t have asthma may suffer from it too.

EIB is also known as exercise-induced asthma (EIA). The preferred term is EIB, though, as EIA wrongly suggests that exercise causes asthma. Instead, exercise is often an asthma trigger. In the case of teens and young adults, EIB might be the most common cause of asthma symptoms.


EIB causes symptoms of asthma, which may include:

  • Coughing
  • Wheezing
  • Chest tightness
  • Shortness of breath

More often than not, symptoms won’t occur immediately at the beginning of an exercise session. Rather, they may start during the session and can become progressively worse five to 10 minutes after stopping.

Symptoms typically resolve within 30 minutes. Some sufferers may even feel a second wave, or “late-phase” of symptoms 4 to 12 hours after exercising. These are typically less severe, though, and can take up to 24 hours to settle.


Ever noticed that you normally inhale through your mouth when you exercise? Well, you do because your body needs to work harder, meaning it needs more oxygen to keep it going. Inhaling through your mouth allows you to breathe faster and deeper.

The trouble with mouth breathing is that it causes the air to be dryer and cooler than when you breathe through your nose. Dry and cold air trigger your airway to narrow, so exposure to it during exercise is more likely to cause asthma symptoms than exercising in warm, humid conditions.

These triggers can also make EIB symptoms worse:

  • Pollution levels
  • High pollen counts
  • Exposure to irritants such as smoke and strong fumes


Controlling EIB

When looking to treat a medical condition, it’s always wise to consult a medical practitioner. But for EIB sufferers, here are a few standard remedies.


You can manage EIB by using various types of medication. Talk to a medical practitioner about the benefits linked with them.


It may be wise to exercise less when you have a viral infection, pollen or air pollution levels are high, or when temperatures are low. It’s also a good idea to do warm-ups and cool-downs as they may help lessen EIB symptoms.

Low endurance exercise like swimming in a warm, humid environment or walking, as well as activities that require short bursts of exercise (like volleyball or gymnastics) are good options for EIB sufferers. Sports that require constant activity (like soccer) may not be.

Children with EIB

With children back at school, cricket, swimming and future summer sporting activities will be back on the agenda. In addition to seeking advice from a medical practitioner, tell teachers and coaches if your child suffers from EIB. And remember, with the proper care, your child can thoroughly enjoy summer, sports and life in general.

July 3, 2017

Sinus infection (sinusitis) related to asthma

Filed under: Blog — Mark Russell-Pavier @ 6:36 am

Sinus infection (sinusitis) is related to asthma. The sinuses are located in the cheekbones, around the eyes and behind the nose in hollow cavities. The sinuses help keep the air that is inhaled warm, moist and filtered by being lined with mucus. If something blocks the mucus from draining normally, an infection can occur.

The asthma and sinusitis relationship – also known as rhinosinusitis – exists because the conditions are quite similar and both affect airways. In fact, there are high rates of allergic rhinosinusitis in those with asthma. Sinusitis symptoms include sneezing, congestion and inflammation of the nasal passages. In asthmatics, the same things that trigger asthma can also trigger the nasal passages to become inflamed, thus contributing to sinusitis.

Presence of sinusitis in asthma patients

Numerous studies show a relationship between asthma and sinusitis. One study in particular compared the two respiratory conditions and found asthma symptoms worsen for asthmatics with sinusitis, asthma flares become more severe and their sleep is more disturbed.

Other research found that developing sinusitis in asthma patients is more common in women than men. Acid reflux and smoking can also increase the risk of developing sinusitis in asthma patients. Furthermore, the more debilitating a person’s asthma is, the more severe sinusitis will be.

In an alternative study of 78 asthma patients, 50.7 percent of them also showed evidence of sinusitis. Those asthmatics had lower forced expiratory volume within one second compared to asthmatics without sinusitis. The study revealed that although sinusitis can reduce lung function at baseline, it does not contribute to long-term lung impairment after a three-year follow-up.

Asthma related chronic sinusitis vs. allergic rhinitis

Asthma related chronic sinusitis vs. allergic rhinitisAllergic rhinitis is when you inhale something you are allergic to that causes the nose to become inflamed and swollen.

Both chronic sinusitis and allergic rhinitis share many symptoms, so the two are often confused with one another. However, there are some distinct differences between the two. For example, symptoms of allergic rhinitis are a blocked nose, runny nose, watery and itchy eyes, sneezing and itchy mouth, nose and ears.

Symptoms of chronic sinusitis include throbbing pain in the cheek area, forehead and eyes, yellowish or greenish nasal discharge, loss of smell, aches and pain in the face or jaw and even fever or nausea.

A fever is a sign of infection and is related to sinusitis; therefore, a fever will not be experienced in allergic rhinitis.

Additionally, there are differences in treatment. Treatment for allergic rhinitis consists of preventing an allergic attack and avoiding allergens, and sinusitis treatment involves antibiotics and nasal decongestions.

Tips to prevent sinusitis from triggering asthma

Sinusitis is an infection, so in order to prevent it you must take the necessary steps to protect yourself from getting infected. Tips to prevent sinusitis include:

  • Practice good hygiene – wash your hands, use hand sanitizers, avoid people who are sick.
  • Get the flu shot.
  • If you have asthma, speak to your doctor as symptoms of asthma can worsen if you contract sinusitis.
  • Keep breathing equipment clean, i.e., asthma inhalers or mouthpieces.
  • Keep your nose moist.
  • Avoid dry indoor air – use a humidifier.
  • Avoid products that give off fumes.
  • Get yourself tested for allergies.
  • Avoid swimming for long hours in chlorinated pools.

Treatments for asthma and sinusitis

Treatments for asthma and sinusitisIf you’re asthmatic, sinusitis can worsen your asthma. Treating both conditions can offer optimal relief. Treatment for asthma and sinusitis include:

  • Avoid upper respiratory infection – the prevention tips above can help you with that.
  • Treat all respiratory infections promptly.
  • Manage your allergies.
  • Avoid cigarette smoking, smoke in general and air pollution – pay attention to news reports or air pollutants.
  • Use an air filter or humidifier within your home and bedroom.
  • Use an air purifying system within your home.

Working closely with your doctor can provide you with more effective treatment tips in order to successfully treat both conditions.

7 myths about cough

Filed under: Blog — Tags: — Mark Russell-Pavier @ 5:51 am

A cough is the rapid expulsion of air from the lungs to clear the throat airways of mucus, foreign particles, fluids, microbes and various irritants.

People tend to get worried if a cough lasts more than a week to ten days, but a 2013 review found that the average cough actually lasts around 18 days. After more than eight weeks a cough can be regarded as chronic and it is advisable to seek medical advice.

Here are seven misconceptions about this common respiratory reflex:

1. All coughs are caused by infections

The occasional cough to clear one’s throat doesn’t indicate a health problem or condition. Frequent bouts of coughing, however, is a sign that there is something more serious irritating the throat. This may or may not be caused by infection.

Infectious causes of cough include the common cold, flu, laryngitis, sinus infections, bronchitis, pneumonia and whooping cough.

Non-infectious causes of cough include post-nasal drip, emphysema, asthma, GERD (gastroesophageal reflux disease) and allergies.

2. Antibiotics will cure a cough

Antibiotics kill bacteria, but do not have any effect on viruses. A cough is most commonly caused by a cold or flu, which are both viral infections, so the answer in most cases is no. Pneumonia may however be caused by bacteria, in which case antibiotics will be effective.

A good reason to avoid using antibiotics for colds and flu is the emergence of “superbugs” that are resistant to antibiotics. In South Africa antibiotic resistance is being driven by the incorrect use of antibiotics by people suffering from a cold.

3. Hot soup can cure a cough

People suffering from colds or flu tend to produce excess mucus (wet cough), which can get into the lungs and result in coughing. Warm liquids like soups are soothing to the throat and decrease irritation and may therefore ease coughing, but cannot cure the respiratory tract infection that – in most cases – caused the cough.

4. All coughs are contagious

A cough may or may not be contagious. A cough that is caused by a viral or bacterial infection will tend to be contagious, whereas coughs that are the result of allergies, asthma or airway irritation are in most cases not contagious at all.

5. Cough syrups are an effective remedy

Commercial cough syrups typically include cough suppressants like dextromethorphan, which block your cough reflex, and expectorants like guaifenesin, which are supposed to loosen up mucus in the airways. However, studies have found no good evidence that cough meds are any better than a placebo.

6, There are lots of different types of cough

The truth is that there are in fact only two types of cough, wet (productive) and dry (non-productive).

A dry cough will tickle your throat and is mostly caused by viral infections, smoke, dust or inflammation. A wet or “slimy” cough is caused by phlegm or mucus in the lungs.

7. Vaccination will prevent a cough

CDC cautions that pertussis (whooping cough) vaccines are effective, but not perfect. They typically offer good levels of protection within the first two years of getting vaccinated, but protection decreases over time.

The annual flu vaccine is the best way to avoid the seasonal flu, which will most likely involve coughing. Trivalent (three-component) and quadrivalent (four-component) flu vaccines are available, which means that your flu shot will offer protection against three or four of the most common flu strains. There are however many other flu strains around against which you will not be protected.

Vaccination will have no effect on non-infectious causes of cough (e.g. post-nasal drip, emphysema, asthma, GERD, allergies).

June 21, 2017

Here’s why swimming is good for asthmatic kids

Filed under: Blog — Tags: , , , — Mark Russell-Pavier @ 11:16 pm

For some, an asthma attack feels as though an elephant is sitting on their chest, while for others breathing becomes so laboured that it’s like trying to suck peanut butter through a straw.

Dilemma for many families

Asthma is the most common chronic childhood disease, and entails struggling to breathe due to constricted airways.

Because of these adverse effects, children are often discouraged from taking part in sport, but new research now suggests that when it comes to cardio activities that are well-tolerated, swimming, specifically, is highly recommended, particularly in indoor swimming pools.

Staying active can be a challenge for the more than six million children with asthma in the United States, noted Dr Tod Olin, a paediatric pulmonologist at National Jewish Health.

“It can be a dilemma for many families. All it takes is one asthma attack, and suddenly patients can become very tentative about overdoing it,” he said in a hospital news release.

Symptoms of asthma in kids

Common symptoms of asthma among kids include:

  • Coughing usually at night or with activity. Coughing usually starts late at night or in the early hours of the morning. It can be dry or wet and is persistent.
  • Complaints of chest pain
  • Avoidance and a refusal to participate in active sports and games
  • Asthma wheeze (whistle)

How is asthma treated?

Because asthma is two conditions rolled into one, inflammation and bronchoconstriction of the airways, the most effective treatment consists of a two-pronged approach, treating both factors simultaneously. In most cases this involves treatment with puffers or inhalers which contain a bronchodilator to relieve bronchoconstriction and an inhaled corticosteroid to reduce airway inflammation.

Asthmatic kids should exercise

Children with asthma have often been told to limit exercise, Dr Olin noted. “More recently, we’ve changed our approach,” he said. “We now encourage kids to exercise, especially as the obesity epidemic has become more and more problematic.”

Starting with swimming and letting kids with asthma choose the sports they enjoy make it more likely they will stay active, he said.

“I generally recommend that they use their albuterol inhaler about 15 minutes before exercise, but if their asthma is well-controlled, there is no reason to limit any activity,” Dr Olin said. “If their heart is taking them toward a certain sport, they should be encouraged to pursue that.”

Just keep swimming

The high humidity in indoor swimming pools protects against asthma attacks by keeping airways open, Dr Olin said.

“We think that the way asthma attacks happen is that the airways dry out, and that sets off a cascade of reactions that ultimately squeezes down the airway,” Dr Olin explained. “If we can prevent that initial airway-drying step by staying in a humid environment, we prevent the asthma attack all together.”


Article source:

June 9, 2017

Suicide and Sleep in Veterans

Filed under: Blog — Tags: , , — Mark Russell-Pavier @ 5:13 am

Past research has shown when people lose hope that they will ever get another good night’s sleep they become at high risk for suicide. Furthermore, insomnia and nightmares, which are often confused and may go hand-in-hand, are known risk factors for suicide. Returned serviceman often report sleep disturbances and when combined with other risk factors, such as PTSD and mood disorders, the risk of suicide is significantly increased.

Much of the previous research into the correlation between sleep and suicide has been centred on insomnia, however, recent research is investigating the link between Obstructive Sleep Apnoea (OSA) and suicide among veterans. The research, presented at the 31st Annual meeting of  the Associated Professional Sleep Societies LLC (APSS):SLEEP 2017, adjusted findings for comorbidities such as depression, anxiety and PTSD and showed that OSA remains an independent variable in the ideation, planning and committal of suicide in veterans.

To hear Dr Kathleen Sarmiento, MD, Pulmonary Sleep Physician and VA San Diego Healthcare System, discus the research and more about sleep and veteran health click on the link below:

June 1, 2017

May 31, 2017

Respiratory Infections Linked to Increased Risk of Heart Attack

Filed under: Blog — Mark Russell-Pavier @ 6:33 am

New research conducted at the University of Sydney in Australia found that the risk of having an acute myocardial infarction, commonly referred to as a heart attack, is 17 times higher in the seven days following a respiratory tract infection.

The study, “Triggering of acute myocardial infarction by respiratory infection,” was published in the Internal Medicine Journal.

According to the research team, this is the first study of its kind to find an association between respiratory infections such as pneumonia, influenza and bronchitis, and the risk of heart attack.

The study enrolled 578 patients with angiography-confirmed heart attacks due to coronary artery blockage. Participants were questioned regarding recent symptoms of respiratory infection including sore throat, cough, fever, sinus pain, flu-like symptoms, or if they had a confirmed diagnosis of pneumonia or bronchitis.

Exposure to respiratory infection prior to the onset of heart attack was then compared against the usual frequency of exposure in the past year.

Interestingly, the researchers found that 17% of patients reported symptoms consistent with a respiratory infection within seven days before the heart attack, and 21%  of patients reported respiratory symptoms within 31 days of the heart attack.

“Our findings confirm what has been suggested in prior studies that a respiratory infection can act as a trigger for a heart attack,” Geoffrey Tofler, MD, the study’s senior author said in a press release. Tofler is a professor and cardiologist at University of Sydney, Royal North Shore Hospital and Heart Research Australia.

“The data showed that the increased risk of a heart attack isn’t necessarily just at the beginning of respiratory symptoms, it peaks in the first [seven] days and gradually reduces but remains elevated for one month.” Tofler added.

A secondary analysis limited to patients who reported only milder upper respiratory tract infection symptoms also was conducted and revealed an increased risk of heart attack by 13%.

“Although upper respiratory infections are less severe, they are far more common than lower respiratory tract symptoms. Therefore it is important to understand their relationship to the risk of heart attacks, particularly as we are coming into winter in Australia,” Tofler said.

Tofler believes that ”possible reasons for why respiratory infection may trigger a heart attack include an increased tendency toward blood clotting, inflammation and toxins damaging blood vessels, and changes in blood flow.”

The team concluded that future research is needed to develop improved treatment strategies, particularly for patients who are at an increased risk of heart attack.

“Our message to people is while the absolute risk that any one episode will trigger a heart attack is low, they need to be aware that a respiratory infection could lead to a coronary event. So consider preventative strategies where possible, and don’t ignore symptoms that could indicate a heart attack.” Tofler concluded.

This article appeared on


May 3, 2017

Thunderstorm-asthma and pollen allergy

Filed under: Blog — Mark Russell-Pavier @ 10:39 pm

Thunderstorm-asthma has made headlines in Victoria recently after claiming the lives of two people and hospitalising dozens more, however, this phenomenon is far from new.  Thunderstorms have been linked to asthma epidemics, especially during the pollen seasons, and there are descriptions of asthma outbreaks associated with thunderstorms, which occurred in several cities, prevalently in Europe (Birmingham and London in the UK and Napoli in Italy) and Australia (Melbourne and Wagga Wagga).

It has been demonstrated that changes in the weather, such as rain or humidity, may induce hydration of pollen grains and sometimes also their fragmentation, which generates atmospheric biological aerosols carrying allergens.

During the first phase of a thunderstorm, pollinosis subjects may inhale a high concentration of allergenic material dispersed in atmosphere, which can induce asthmatic reactions and sometimes even severe ones. In other words, there is evidence that under wet conditions or during thunderstorms, pollen grains may, after rupture by osmotic shock, release into the atmosphere part of their content, including respirable, allergen-carrying cytoplasmic starch granules (0.5–2.5 μm) or other paucimicronic components that can reach lower airways inducing asthma reactions in pollinosis patients.

Fortunately, although it can induce severe asthma, outbreaks associated with thunderstorms are neither frequent nor responsible for high entity of disease exacerbations. However, the mechanisms involved in the release of allergens from pollens during thunderstorm should be known so that pollinosis patients can receive information about the risk of an asthma attack also in subjects affected only by seasonal allergic rhinitis.

Although thunderstorm-associated asthma outbreaks are not frequent, it is possible to observe in clinical practice single cases of patients with deterioration of the allergic respiratory symptoms during a thunderstorm and this possibility should be considered, because the frequency of thunderstorms is recently increased in some geographical areas, particularly in temperate and subtropical climate.

The characteristics of described epidemics of thunderstorm-associated asthma can be summarized as follows:

  • There is a link between asthma epidemics and thunderstorm.
  • The epidemics related to thunderstorm are limited to seasons when there are high atmospheric concentrations of airborne allergenic pollens.
  • There is a close temporal association between the start of the thunderstorm and the onset of epidemics.
  • There are not high levels of gaseous and particulate components of air pollution.
  • Subjects with pollen allergy, who stay indoors with window closed during thunderstorm, are not involved.
  • There is a major risk for the subjects who are not under antiasthma correct treatment, but subjects with allergic rhinitis and without previous asthma can experience severe bronchoconstriction.

In the light of the above, subjects affected by pollen allergy should be alert to the danger of being outdoors during a thunderstorm in the pollen season, as such events may be an important cause of severe exacerbations of asthma

In other words, when asthmatic patients realize that a thunderstorm is approaching the best thing for them to do is to stay indoors, with windows closed.


D’Amato, G., Liccardi, G. and Frenguelli, G. (2007), Thunderstorm-asthma and pollen allergy. Allergy, 62: 11–16. doi:10.1111/j.1398-9995.2006.01271.x

April 28, 2017

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