Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease that causes scarring (fibrosis) of the lungs. The most common symptoms are shortness of breath and cough, and the progression of the disease varies considerably from person to person. However, many people with IPF experience flare-ups or exacerbations, which is when symptoms suddenly become much more serious. You could experience a worsening in cough, shortness of breath, fatigue, or fever.
Flare-ups are often triggered by an identifiable cause, such as an infection or poor air quality. There may be “hidden triggers” in your home that you may not be aware of. Avoiding triggers is important as it can help prevent flare-ups, and there are practical ways to remove them or at least minimize them.
1. Strong Scents and Cleaning Products
Products with strong scents or odors, whether it’s a perfume or laundry detergent, can act as an irritant. These are substances that can inflame your airways and trigger symptoms like coughing or shortness of breath.
“Cough is a common symptom for patients with IPF, and there is data that these individuals develop hypersensitive cough reflexes,” says Nirav G. Shah, MD, clinical chief of pulmonary, critical care, and sleep medicine at the University of Maryland Medical Center in Baltimore. “This results in exacerbations of cough with exposure to fumes and scents that may not bother other people.”
The problem with scented items is generally not so much the smell in and of itself, but rather the substances used to create it. Typically made from a mix of natural and man-made chemicals, fragrances contain many ingredients. A typical scent may have been developed using anywhere from 100 to 350 different substances. Some scented products may contain a mix of toxic chemicals that turn into vapor in the air, and these particles may attach themselves to your hair, clothing, and household items.
“Not everyone is affected by fumes or scents, but some people are,” says Amy Hajari Case, MD, chief medical officer for the Pulmonary Fibrosis Foundation and director of the interstitial lung disease program and pulmonary and critical care research department at Piedmont Healthcare in Atlanta. “For those who are sensitive, this can lead to symptoms such as coughing, wheezing, or even chest tightness as a result,” she says.
Unfortunately, scents are found in a huge range of products, including:
- Soap
- Shampoo and conditioner
- Hand and body lotions
- Deodorants
- Cologne or perfumes
- Air fresheners
- Scented laundry detergents
- Fabric softeners
- Cleaning products.
Studies have shown that long-term exposure to cleaning agents can lead to respiratory problems, as well as other health problems, such as cancer.
Some cleaning products release unsafe chemicals, including volatile organic compounds (VOCs), which are chemicals that vaporize at room temperature. A higher risk of developing asthma and other respiratory problems has been linked to VOC exposure in cleaning products. This risk is particularly high for vulnerable populations, such as those who already have a preexisting heart or lung condition. VOCs are also a major contributor to indoor air pollution, as their indoor concentrations are much higher than in outside settings. The fumes can linger indoors for extended periods of time, even for weeks or months.
“In general, we advise patients with lung diseases to avoid perfumes, strong scents, fumes, and other environmental exposures, as they may worsen cough symptoms and even result in increased breathlessness,” says Dr. Shah. “We also advise against using scented candles, air fresheners, and strong cleaners, such as bleach, as it may exacerbate symptoms.”
While it may be impossible to avoid all scented items and products with potentially toxic components, there are steps that can be taken to minimize your contact with them:
- Identify Your Triggers You may not be sensitive to all scents and odors, so try to identify and avoid those that act as triggers.
- Go Fragrance-Free Opt for scent-free personal and household products, as this will reduce your exposure to harmful chemicals.
- Avoid Aerosols Avoid or at least cut back on your use of aerosol sprays, including air fresheners, hairspray, and spray deodorants, as inhaling fine particles and chemical fumes can worsen symptoms.
- Seek Safer Products Use safer products for household cleaning, preferably those without VOCs. Read product labels, and look for products certified by Safer Choice, Green Seal, or EcoLogo programs.
- Never Mix Products Avoid using bleach or ammonia for cleaning and never combine cleaning products; some of them, like bleach and ammonia, can create toxic and even fatal gases when mixed together.
- Simplify Try using simple nontoxic items like vinegar and baking soda, or mild soap, for cleaning.
- Wear Protective Gear If you must use cleaning products that contain VOCs, limit exposure by wearing protective gear, including gloves and an N-95 mask, and make sure the room is well ventilated to reduce the amount of fumes you inhale.
2. Smoke and Allergens
Cigarette smoking is not only a risk factor for developing IPF but can also trigger exacerbations. Smoking can inflame your lungs and increase mucus production, which will subsequently impact breathing. Additionally, smoke from other sources, such as secondhand smoke, wood stoves, and wood burning fireplaces, can also act as triggers.
If you have known allergies, causative allergens could also be a trigger. Common allergens found within your home include animal dander, dust mites, and mold. Pollen, a powdery substance produced by trees, grasses, and weeds, is a common allergen typically found outdoors, but it can also get inside your home. If you think you may have allergies, or you are allergic to several substances, you might want to consider going for allergy testing.
“An air purifier with a HEPA filter can help reduce smoke, dust, pollen, and airborne pathogens such as bacteria and viruses,” says Dr. Hajari Case. She recommends avoiding air purifiers that produce ozone, a potential respiratory irritant.
Steps to minimize exposure include the following:
- Stop Smoking If you currently smoke, it is important to consider quitting. Refrain from using e-cigarettes or vaping products.
- Avoid Secondhand Smoke Do not allow others to smoke in your home or car. Keep a distance from smokers.
- Avoid Burning Wood Avoid wood burning fireplaces and wood stoves. If you have one in your house, make sure that it is well ventilated.
- Keep Pollen Outside If you have pollen allergies, learn which type affects you and during which seasons. Keep windows closed and use air-conditioning when pollen counts are high, and use an air filter. Consider removing your shoes when you enter your home, to avoid tracking pollen around the house.
- Remove Animal Dander Dander can stick to carpets, clothing, and furniture, so make sure to keep those things clean if you have a pet. Wash your hands after touching animals, including your own pets. If dander is a problem, you might consider getting a pet that doesn’t shed or sheds minimally.
- Control Dust Mites Dust mites live in mattresses, bedding, carpets, curtains, and on dusty furniture, so it is important to keep those items clean. Wash bedding in hot water every week, cover mattresses and pillows with special mite-proof cases, and keep household dust at a minimum.
- Prevent Mold Keeping your house dry (relative humidity in the 30 to 50 percent range) is important for preventing mold. Use an exhaust fan in the bathroom when the shower is running, or keep a window open. Use a dehumidifier, if needed. When cleaning mold, use a mask and gloves, especially if you are using a strong cleaning agent. Keep windows or doors open when using any cleaning products, and if mold is extensive, consider getting it professionally cleaned.
3. Gastroesophageal Reflux Disease (GERD)
“GERD is a major factor of concern in patients with lung diseases, especially interstitial lung diseases like idiopathic pulmonary fibrosis,” says Shah, noting that GERD can also trigger flare-ups in IPF. When stomach contents back up, there is the possibility of microaspiration. This is when stomach contents such as acid, bile, and pepsin travel up the airway and are then inhaled in the lungs. Repeated aspirations can damage the lungs.
“GERD is a common trigger for coughing,” says Hajari Case. “Air quality and other environmental factors may impact GERD, and keeping the indoor climate comfortable can help with symptoms.”
She recommends having a fan running during the summer to keep the air moving and maintain a comfortably cool indoor temperature. “In the winter, humidity is often lower, and having a heater running can dry indoor air even more,” she says. “If you choose to use a humidifier, be sure to keep it clean by changing the water daily, cleaning it regularly, and replacing filters per the manufacturer’s instructions to avoid mold growth in the unit.”
Lifestyle modifications can also help control GERD symptoms. “We highly recommend interventions such as elevating the head of the bed with bed risers or cinder blocks — not pillows, because we often roll off of them in the middle of the night,” Shah says, “and not eating or drinking anything except for water for two to three hours prior to bedtime so that everything in your stomach can move to the small intestine and result in less reflux.”
With regard to temperature and humidity, a relative humidity level of 40 to 50 percent is recommended because dry air can irritate airways and cause coughing, while overly humid environments can make it harder to breathe, he points out. “In cold, dry environments, such as the wintertime, a mask or face covering can help humidify the air and make breathing a little easier,” he says.
Sometimes medications are needed to treat GERD to control acid reflux. However, the first step is determining that GERD is causing your symptoms. “If you think you might have GERD, be sure to talk with your doctor about your symptoms to be sure the diagnosis is correct,” says Hajari Case.
4. Respiratory Infections
Respiratory Infections are a common trigger for IPF flare-ups and can have serious consequences for people with chronic lung diseases. While infections can’t always be prevented, there are many ways to protect yourself and minimize the risk.
Some measures you can take include the following:
- Get Vaccinated The American Lung Association emphasizes that staying up to date on recommended vaccines is a crucial step in preventing respiratory infections. This includes vaccines for influenza, COVID-19, respiratory syncytial virus, and pneumonia. Encourage your family and friends to keep their own vaccinations up to date to lower the risk of transmitting a virus to you.
- Practice Good Hand Hygiene Wash your hands frequently with soap and water for at least 20 seconds. If soap and water isn’t available, use a hand sanitizer that is at least 60 percent alcohol. Sanitize your hands after touching anything that other people have touched, such as doorknobs or keypads.
- Don’t Touch Your Face Avoid touching your face, particularly your nose and mouth, especially if you haven’t washed your hands.
- Don’t Share Personal Equipment Do not share masks or any sort of inhaler with others.
- Mask Up Wear a mask if you are in a large group of people, especially in an indoor setting and during the winter, when respiratory viruses are circulating at their peak.
- Clean Surfaces Frequently clean and disinfect heavily used surfaces in your home, such as countertops and doorknobs.
- Limit Contact With Sick People Avoid as best you can, or at least limit, contact with people, especially children, who are sick with a respiratory virus. Wear a mask when with them.
- Avoid Potential Exposure Stay away from or limit your time in crowded places, such as shopping malls, especially during cold and flu season.
The Takeaway
- Hidden triggers within the home can cause IPF symptom flare-ups, but steps can be taken to minimize their danger.
- Scented products, including perfumes, air fresheners, and personal care products can be irritants for people with IPF, causing their symptoms to worsen. Some cleaning supplies and household products may release chemicals that are linked to respiratory illnesses.
- It is important to be tested if you suspect you have allergies, in order to identify the trigger and minimize contact with it.
- GERD is a suspected cause of IPF, and if left untreated, it may trigger symptom flare-ups.
- Getting vaccinated for respiratory illnesses such as influenza, COVID-19, and pneumonia is a crucial preventive measure for people with IPF.
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