Very concerned - 15 week respiratory irritation

[AnthonEE]

Four months ago my wife and I worked on a home improvement project that involved removing old horsehair plaster. Used P100 respirators and worked several hours in extremely dusty environment. During work had no indication anything was wrong with respirator. No cough or irritations.

A few hours after finishing the work, had burning tightness in lungs. Then I was fine for 3-4 days.

At day 4 I had a sudden histamine reaction that produced wheezing and nasal stuffiness.

Next 2-3 weeks had marginally productive cough which produced distinctive metallic taste. Taste went away but cough continued another 4-6 weeks, especially after shower. Always sleep fine, worse during day.

Cough has abated, but have chronic irritation in airway running deep within chest up into voice chords. When I speak I feel a strong cough reflex. I've become convinced that my airway is producing secretions causing me to constantly AHEM... AHEM... clear my throat and airway. I have nonlocalized nonexertional chest ache that responds to NSAID. It feels like airway is extremely irritated, like it has been burned or something.

My wife never had any symptoms. Zero. I had several contractors working in same work area with MUCH higher dust concentration, and they wore only N95 paper face masks. All are fine.

Only thing different about my respirator was that cartridges had been used 9months previously, by me, while painting. They were probably damp, wrapped in plastic and stored in a <55% humidity basement. My wife's cartridges were new.

I've seen PCP and pulmonologist. At week 4 had zero WBC. Never fever or flu like symptom. Lungs are clear except occasional wheeze during forced exhale. XRay shows mild evidence of hyperinflation, but PFT is 120%  normal, so bronchodilators not used. Several weeks flovent not helpful. 20mg prilosec for mild reflux.

I'm 45, ideal weight, excellent health, no smoke, no drink, no asthma.

Please help! Fungus, mold? Bacteria? Silica? Permanent? Very scared. THANKS!!

[David Tinkelman, M.D.]

Greetings,

You ask, Fungus, mold? Bacteria? Silica? I would deem it could be any of these, along with insulation and allergenic insect debris.  Your description of events strongly suggests that your suspicion of a faulty filter is correct so that, in effect, you inhaled a full measure of whatever allergens or irritants were on the plaster or within the wall.

Your description suggests a respiratory condition called the Reactive Airways Dysfunction Syndrome.  See the description of this disease, below, from Goldman’s Textbook of Medicine.

"Irritant Exposure and Reactive Airways Dysfunction Syndrome (RADS) A high level of usually accidental exposure to an irritant agent can cause asthma. Although the clinical manifestations can be dramatic, irritant-induced occupational asthma represents a relatively small proportion of all occupational asthma. The most definitive criteria for this condition are those applied to the term reactive airways dysfunction syndrome: the onset of asthma symptoms within 24 hours of the exposure, generally severe enough to lead to an unscheduled physician visit; exposure to a single high-level irritant; asthma symptoms that persist for at least 3 months; pulmonary function testing that confirms asthma with a significant beneficial response to bronchodilators or a bronchoconstrictor response to a methacholine challenge; and the lack of preexisting lung disease or other conditions to explain the symptoms. When these criteria are not completely met (e.g., symptoms start later than 24 hours after exposure or resolve within weeks after exposure), the term irritant-induced asthma is commonly applied, recognizing that this diagnosis is less certain than reactive airways dysfunction syndrome.
Irritant-induced asthma and reactive airways dysfunction syndrome may clear after weeks or months. Management is the same as for other causes of asthma (Chapter 87), although these patients are often less responsive to the usual pharmacologic treatment."

The reference that follows my coments addresses this condition under the heading of Occupational Asthma.  That is because most such exposures occur in the workplace.  However this article contains much information about RADS that could apply to your exposure, albeit in the home.  I have provided this reference as it might be of interest to your doctor.  The bottom line is that you probably have experienced irritant induced asthma and the treatment for asthma should continue under the pulmonary specialists supervision.

Good luck


AuthorsDykewicz MS.
Authors Full NameDykewicz, Mark S.
InstitutionAllergy and Immunology Service, Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. ***@****
TitleOccupational asthma: current concepts in pathogenesis, diagnosis, and management. [Review] [73 refs]
SourceJournal of Allergy & Clinical Immunology. 123(3):519-28; quiz 529-30, 2009 Mar.
However, patients with RADS may have persistent bronchial hyperresponsiveness that makes them subject to exacerbations
after exposure to many unrelated workplace irritants and unable to tolerate irritant-prone workplaces.

Irritant-induced OA
Not previously considered a form of occupational asthma,
de novo asthma caused by exposure to inhaled irritants at work
now is commonly termed irritant-induced OA.2
The existence of the reactive airways dysfunction syndrome
(RADS) resulting from a single episode of a high level exposure to
an irritant agent (usually from an occupational accident) has long
been recognized.2,8 Examples of agents reported to cause RADS
include chlorine gas, hydrochloric acid, anhydrous ammonia,
hydrogen sulfide, fumigating fog, heated acids, and smoke by
inhalation. In 1984, a toxic cloud of methyl isocyanate gas released
from a chemical plant in Bhopal, India, killed thousands
of people, and caused thousands more to develop persistent
respiratory disease, some with reversible airway obstruction. After
the collapse of the World Trade Center towers in New York
City during the 2001 terrorist attacks, a complex mixture of airborne
dusts and pollutants was elaborated that has been associated
with RADS (and other respiratory disorders) in exposed rescue
and recovery workers and residents of the surrounding area.9
The 2008 ACCP consensus guidelines retain use of the RADS
term, but consider it to be a form of irritant-induced asthma.2 By
definition, the diagnosis of RADS can be made only when defined
criteria are satisfied and should not be made in patients with
pre-existing asthma (Table II). This leaves open another debate
about how to define worsening of pre-existing asthma caused
by inhalation of high levels of irritants or worsening of pre-existing
smoking-related chronic obstructive pulmonary disease.
There is still controversy about whether chronic lower-level
exposure to irritants can cause OA.2,5 Repeated peak exposure to
irritant gases in the pulp industry has been shown to increase the
risk for both adult-onset asthma and wheezing.10 There is also a
report that asthma symptoms developed in 3 patients after repetitive
exposure to irritants that occurred over several days to
months.11 According to the 2008 ACCP guidelines, cases that
do not meet the stringent criteria for RADS (eg, when there is several-
day lag before the onset of symptoms, or when there is no single
massive exposure but rather repeated exposures over days or
weeks, less massive exposures, or a shorter duration of symptoms)
are all classified under the general category of irritantinduced
asthma. Specific examples include meat wrapper’s
asthma, pot room asthma, asthma from professional cleaning materials,
and asthma from exposure to ozone, endotoxin, formaldehyde,
and quaternary ammonium compounds.

[AnthonEE]

Thank you Doctor Tinkelman for your detailed reply to my question. I know I speak on behalf of many people when I say that the time you spend here is very much appreciated.

I will discuss this article with my healthcare provider. It does sound like a very plausible diagnosis, and one that I very much hope will resolve, eventually.

The only other thing that seemed plausible to me is the idea that the paper filter cartridges had become moldy during storage, and I may have perhaps been overwhelmed by a large exposure to some type of spore. Could I be fighting a low grade chronic fungal infection of some sort, in the absence of fever or sputum? Is it even possible? Or can this be safely ruled out? I have an otherwise competent immune system.

Thanks again for your helpful comments.

[AnthonEE]

I've had a few occasions of night sweats, but not really any malaise other than what you might reasonably expect when some health issue like this happens.

Was there some event that started your cough? How long has it been going on? My pulmonologist advised that as long as there was no fever then it would probably not be something I should be overly concerned about. But I've never felt like this before, and for four months now (!)

[tx1980]

I have been having the same Problem 42 never smoked.i have had night sweats,cough,maliase.I have been to Pulmonologist also but still don have any answers either.