Asthma Articles

Valley Fever: What In The Haboob Am I Talking About?

Comments Off on Valley Fever: What In The Haboob Am I Talking About? Written on July 22nd, 2014 by
Categories: Allergies, Allergy Advice, Allergy Articles, Asthma, Asthma Articles, Valley Fever

Who can forget the Great Haboob on July 5, 2011? Beyond all the mess that was left behind to clean up, what else did that big dust cloud give us?  It gave the car wash industry a tremendous boost.   The Haboob has also blown in concerns over an upsurge in cases of Valley Fever.  What exactly is Valley Fever and what does the Haboob have to do with it?

Valley Fever is the common name for Coccidioidomycosis, an infection caused by fungi known as Coccidioides.  This fungus is found in the soil in certain lower deserts of the desert southwest including southern Arizona, south and central California, southwestern New Mexico and west Texas.  It can also be found in parts of Mexico and Central and South America.  The name Valley Fever is actually the shortened older name for Coccidioidomycosis, which was San Joaquin Valley Fever.  The association between the disease and the causative agent was made in the San Joaquin Valley in California.

Now what does a dust storm have to do with Valley Fever?  As I mentioned above, Valley Fever is caused by a fungus, or mold, that lives in the ground or soil here in the Valley of the Sun. Coccidioides grows as a mold a few inches below the surface of the desert soil.  During dry conditions the mold becomes fragile. Even slight air disturbances can fracture the mold into single-cell spores that are 3-5 microns in size and can stay suspended in the air for prolonged periods of time. The spores become suspended in air during times of digging such as landscaping, construction of homes and with big dust storms. Humans, and animals such as dogs, may contract the fungus by breathing when the fungal spores are suspended in the air. Once the spores get into the lungs, they change shape and enlarge sometimes as big as 70 microns or more in diameter.  They continue to grow and eventually lead to the clinical infection known as Valley Fever.  Once the spore fragments are in the lungs and change shape, they cannot be spread from person to person.  Therefore, this is not a contagious disease. This disease can occur after inhaling just one of the single cells.  We are expecting to see a dramatic increase in the number of Valley Fever cases following the Haboob-an intense dust storm that surely suspended millions and millions of Coccidioide spores for a prolonged period of time.

The risk of exposure in the endemic areas varies but is highest during dry periods that follow rainy seasons.  In Arizona these periods tend to be from May thru July and then again from October to early December.  It is estimated that 60 percent of the coccidioidal infections in the US occur in Arizona in the counties of Maricopa, Pima and Pinal.

With all this ominous news, how does one know if they have Valley Fever?  Well, the incubation period is typically between 7 and 21 days, meaning clinical disease is apparent 7 to 21 days after exposure.  Thinking back to our recent Haboob, individuals would start experiencing symptoms around July 12th to July 26th.  But symptoms may remain subclinical for weeks or even months.  Many times individuals never even realize they had Valley Fever due to the mild nature of their illness.

Valley Fever typically presents as community-acquired pneumonia with chest pain, fever, difficulty breathing and cough.  However, one may have only a day or two of mild coughing or cold-like symptoms with muscle aches and joint pains.  Two types of rashes can occur, Erythema nodosum and Erythema multiforme.  A common symptom is fatigue that can last for months.  The arthralgias, or joint pains, have lead to an alternate name for Valley Fever, “desert rheumatism.”  Although most patients have a mild form of the disease the does not require treatment, Valley Fever can be very severe and life-threatening; especially in immunocompromised individuals such as those with AIDS, transplant patients, diabetics, pregnant women, cancer patients on chemotherapy, and patients using high-dose prednisone.

The first step in making the diagnosis of Valley Fever is remembering to consider the possibility that Valley Fever might be present. Physicians and patients need to consider the symptoms that are present and if they follow possible exposure to conditions conducive to contracting the spores. Laboratory findings may be unremarkable but an elevated erythrocyte sedimentation rate, an elevated eosinophil count (part of a complete blood count or CBC) and chest x-ray abnormalities are helpful in making the diagnosis.  Serologic testing is available the measures antibody production against the mold.  This testing can also be used to monitor disease activity and duration.

If you suspect that you may have Valley Fever, and not everyone will have it, please contact your physician or you can call our office for more information.  Stay well and remember, there is a fungus among us.


Have you heard about the New Test for Asthma?

Comments Off on Have you heard about the New Test for Asthma? Written on June 27th, 2011 by
Categories: Allergy Advice, Asthma, Asthma Articles
Tags: , , , ,

Exhaled nitric oxide (eNO) is a new test you may he asked to complete in your clinician’s office if you have symptoms of asthma. This test is receiving wide spread attention from pulmonary and allergy specialists because it offers an easy and noninvasive means to directly monitor airway inflammation. Why is it important to be aware of the level of inflammation in your airways? It is well known that asthma is a disease of chronic inflammation, which causes airway constriction, excessive mucous production, and bronchospasm. Generally speaking, the higher the level of inflammation, the greater are one’s asthma symptoms. One of the causes of this inflammation is the presence of white blood cells called eosinophils in the lungs. The eosinophils are believed to release inflammatory mediators that contribute to inflammation and the resultant symptoms of asthma.

exhaled nitric oxide asthma testNitric oxide is a gas that is produced naturally in the airways and is detectable in the exhaled breath. Research has discovered that eNO levels significantly increase when airway inflammation is present. It is now possible to measure this gas in order to aid in the diagnosis and management of asthma as well as other lung diseases. Levels will be high in untreated or poorly managed asthma and will lower when asthma therapy is initiated and asthma is controlled. Therefore, the results of the test can help to determine how well inhaled anti-inflammatory medications (such as steroid inhalers) are working and can provide further guidance regarding when to increase or decrease medication dosages. This will be helpful in determining patients minimal effective dose of medicine.

Additionally, this valuable tool will be useful in distinguishing asthma from other diseases not associated with nitric oxide elevation such as vocal cord dysfunction, gastroesophageal reflux disease, pulmonary embolism, and acute respiratory illness. This test will assist the clinician in determining the severity of asthma as well as offering insight into patients’ compliance in use of medications. While asthma symptoms may he intermittent, the inflammation of asthma is persistent. Exhaled nitric oxide testing can serve as a marker providing objective evidence of ongoing disease activity even in the absence of symptoms.

Another great benefit of eNO testing is its usefulness with young children who are not always able to understand and follow directions with other methods of pulmonary function testing. The test requires no preparation, is very easy to complete (taking only a few minutes), and is non-threatening for both children and adults. Patients are provided a sterile mouthpiece
that is connected to the eNO device. They will be asked to breathe in slowly followed by a slow, steady exhalation. A computer screen will assist in prompting patients regarding when to take a deep breath and when to exhale. That’s all there is to it!

A patient’s personal history continues to he the most reliable tool in diagnosing and evaluating asthma; however the addition of exhaled nitric oxide testing can augment disease management when used in combination with other conventional diagnostic options (such as pulmonary function testing). Being able to evaluate the level of airway inflammation in asthma
can now more accurately assess treatment responses and ultimately improve quality of life. Allergy, Asthma and Immunology is pleased to have the capability of measuring exhaled nitric oxide in our offices. As health care providers, we are excited when new methods of managing asthma and IMPROVING YOUR HEALTH are available.

Please check our website at or call the office at 480-614-8011 for more information.


Fighting for Air

Comments Off on Fighting for Air Written on February 1st, 2011 by
Categories: Allergy Advice, Asthma, Asthma Articles, COPD
Tags: ,

Struggling to breathe is not a situation that any of us wants to be in but for nearly 800,000 Arizonans that is what they face every day. I would like to take this opportunity to introduce an event and organization that we all can join to help all of us breathe easier.

I, along with one of my partners, Jean Nelson, FNP-C, are the co-chairmans for 2011 Fight For Air Walk put on by the Arizona chapter of the American Lung Association (ALA). This event used to be known as the Asthma Walk but the name has been changed to truly encompass all the respiratory problems that the ALA works to correct, including chronic obstructive lung disease, lung cancer, smoking cessation, air quality issues in addition to asthma. This is one of the largest Lung Association walks in the country. Money raised in the Fight for Air Walk goes to support Camp Not-A-Wheeze, the ALA’s traditional summer camp for children with asthma, research to study asthma, COPD and lung cancer, asthma education, tobacco prevention and cessation along with supporting the fight for clean air.

Money raised in the Fight for Air Walk goes to support Camp Not-A-Wheeze, the ALA's traditional summer camp for children with asthma, research to study asthma, COPD and lung cancer, asthma education, tobacco prevention and cessation along with supporting the fight for clean air.

To help understand the impact of pulmonary disease in Arizona, here are some facts to consider. Arizona has the second highest asthma rate in the country and is the leading cause of school absenteeism for children. COPD is the third leading cause of death in Arizona. The Phoenix-Mesa-Scottsdale area was number 11 on the American Lung Association’s State of the Air report for the most ozone polluted cities. Lung cancer is the second most commonly diagnosed cancer in both men and women.

So why am I taking the time to introduce the ALA’s Fight For Air Walk? I would like to see even more people involved in this very worthwhile event. You may be asking yourself “How can I get involved?” There are three main avenues to becoming involved. First, you or your company could be an event sponsor. There are levels from $1500 and up. This allows your company to be recognized by the community as a leader in the fight for air. Secondly, you can organize a walk team. This can be done with family members, a company team or even a school or athletic team. It is a great way to enjoy a beautiful Saturday morning with friends and colleagues while raising money for a worthy cause. Lastly, you could donate directly to the ALA.

I hope that I have raised some interest in joining Jean and myself in making the 2011 Fight For Air Walk the biggest and best walk yet. The walk will be held at the Scottsdale Civic Center on Saturday, April 2, 2011. For more information go to the American Lung Association’s web site,, or log on to You can also call 602-258-7505. Janelle Tassart or Stacey Mortenson would be more than happy to talk to you about participating or even come to you workplace to help organize a company walk team.

Every day 800,000 individuals in Arizona worry about their next breath. It could be you, a family member or a friend or coworker. There is a good chance that respiratory disease has some impact in your life. Please help us help everyone breathe a little easier. As they have said in the past, “If you can’t breathe, nothing else matters!” See you at the walk.