Fungal spore and air quality forecasts

Good air quality is important for everyone’s health. However, those with lung conditions, such as aspergillosis and asthma, may be more vulnerable to the effects of poor air than others. Airborne pollutants and allergens are found both indoors and outdoors, and can irritate our lungs and exacerbate existing conditions. It can be useful, therefore, to know when and where these irritants are at their most harmful concentrations ⁠— this can allow us to understand, avoid and prevent any harmful air conditions that may be affecting our health. Here we have compiled a selection of air quality forecasts and information:

Fungal Spores

Fungal spores are microscopic particles responsible for the reproduction of fungi. We inhale huge numbers of these particles in each breath ⁠— for most people, this doesn’t affect their health. However, some individuals, including aspergillosis patients, are more susceptible to allergic reactions and infections from mould spores. It can therefore be useful to know when mould spores are at their highest concentrations, in order to reduce exposure to them. We are currently entering peak spore season for most moulds (June – August). Peak spore season coincides with hayfever season, and allergies to pollen and spores carry similar symptoms (runny nose, sore eyes, rashes). Therefore, it is often difficult to distinguish between these conditions, and medical tests may be necessary.

The National Pollen and Aerobiology Research Unit at the University of Worcester has produced a number of helpful calendars, showing the monthly spore count averages over a period of 5 years. They have also compiled useful information on the allergenicity of each spore type and where each mould prefers to grow. This allows those at risk to avoid areas where the spore concentration is potentially very high. The information for Aspergillus/Penicillium spp. is copied below:

 

The year starts with a high risk for these types with a total monthly average of 1,333 (per m3) spores in January and 1,215 in February. Spores continue to be airborne during Spring and early Summer but possibly below the levels needed to trigger symptoms. From mid-August the risk starts to rise again and people often report symptoms during warm, humid conditions in late August, September and October, with the peak reaching an average of 1,950 spores in October. Although the spore levels continue to be high during November and December, few people report symptoms, so it is likely that the types occurring during these months are less allergenic.

Habitat / Substrates:


microscopic view of fungal spores in small round particles

There are many species of Aspergillus and Penicillium, which live on a wide range of substrates. The spores can be very prevalent during the peak periods, triggering a range of respiratory problems. The spores are particularly prevalent in wooded areas, compost heaps, rotting wood chips and bark mulch. Some species rot down pine needles, so conifer plantations should be avoided during Autumn. Penicillium chrysogenum is found widely in nature, occurs on indoor substrates and is the type used to produce the antibiotic penicillin. N.B. Houseplants can be sources of spores, particularly Aspergillus/Penicillium types.  If you’re keen to have houseplants, only have cacti, which require dry conditions, and ensure the soil surface is covered in grit.

Season: 

Aspergillus and Penicillium spores are present in the air throughout the year but the main peak periods are late August to October and January to February.

Allergenicity: 

High for some types, particularly A. fumigatus and P. chrysogenum. A. fumigatus is a major cause of aspergillosis (farmer’s lung).

For spore forecasts and information about other species:

For regular updates on pollen and spore counts:

Indoor air

 

Those self-isolating due to COVID-19 are spending almost all of their time at home. Therefore, indoor air quality is more of a concern than ever. Over the past ~50 years, our homes have become far more insulated. While this stops drafts and keeps our homes warmer, it also means than our living spaces are generally damper and less ventilated. This can provide ideal conditions for mould to grow and thrive. There are a number of small things that we can do to prevent mould and damp: these include drying laundry outside (if possible), fixing leaks and using lids when cooking. It is also important to identify and remove any mould in your living space, in order to prevent it from spreading. A selection of articles on indoor air quality and instructions for how to safely remove mould are listed below.

For more information:

Pollution

pollution causes poor air quality

Air pollution is a significant health concern, especially for those living with existing lung conditions. This is a particular issue in urban areas, where the sources of pollutants are concentrated. Weather also influences levels of pollution, with stiller conditions often worsening the issue. It can therefore be useful to access pollution forecasts, so that high levels can be avoided, where possible.

Regularly-updated pollution forecasts for the UK and worldwide:

 

For further information on air quality:

Living with a lung condition during the COVID-19 pandemic: patient stories

The current pandemic is a frightening time for us all, but it can be especially nerve-wracking for those already living with lung conditions. The European Lung Foundation has compiled 4 stories from individuals living with pre-existing lung diseases, and their experiences living through this period. One contribution is from an aspergillosis patient and co-founder of the Aspergillosis Trust, Sandra Hicks, and has been copied below. To read all of the contributions, or share your own experience, click here.

The Aspergillosis Trust has also continued to collect and share the experiences of those living with aspergillosis during this time. To read and share stories, or find out more about the Trust’s work, click here to visit their website.

Sandra Hicks:

During the last weekend of February 2020, I had a bit more of a productive cough than usual. I stayed in bed, as I felt even more fatigued than usual and that’s already a lot! I have aspergillosis, Nontuberculous Mycobacteria (NTM), asthma and bronchiectasis colonised with Pseudomonas. The reason for these unusual infections is a rare primary immunodeficiency (PID) syndrome, which means that my immune system doesn’t make antibodies very well.

On 1 March, I had a severe pain in my right side, it felt to me like I had pulled a muscle between my ribs and another in my neck. The pain was so bad that I could hardly cough and I certainly couldn’t breathe in deeply. I also had worsening shortness of breath. I realised it was better to get on top of the pain, to be able to clear my lungs. I had a productive cough, not a persistent, dry cough as listed in the COVID-19 symptoms. I felt it didn’t really match with the description of the ‘red flags’ for COVID-19. I didn’t have a sore throat at any point. I did have a high temperature, which went up to 39.5°C during the first week of March. I also had headaches and dizziness, but didn’t lose my sense of taste or smell. The final symptom was coughing-up dark red, thick mucous (haemoptysis) a few times a day, for several weeks. I have never had haemoptysis to that extent ever before, or that dark a red (although the mucous can sometimes be ‘pinky’ in colour).

My routine CT scan which I have for the aspergillosis showed improvements and did not reflect the development of haemoptysis. So it seemed to me like something else was going on in addition to the usual lung problems.

I had phone consultations instead of outpatient clinic appointments with two consultants. The first one was with my mycology consultant on 25 March. He felt that it was possible that I could have had COVID-19. We discussed options for my regular treatment. Should I go into hospital daily for my 14 days of IV caspofungin, or should I delay treatment? Even if I hadn’t had COVID-19, I am in the shielding category and had been advised to stay at home for 12 weeks. The balance of risks were in favour of starting treatment sooner. This was due to the lower numbers of cases of COVID-19 in the UK at that time, compared to the rest of Europe. I was concerned that if we followed the same pattern as Italy, Spain and France, then in the next 2-3 weeks, the number of cases and deaths would rise hugely. When that cycle of treatment started on 30 March, there were 1,408 deaths from COVID-19 reported in the UK. On Easter Sunday, 12April the last day of treatment, there were 10,612 deaths reported in the UK. It was a very scary time, having to go into hospital daily during those two weeks. If I had delayed treatment, the hospital might not have had capacity to treat me. My lung condition could also have deteriorated. I may have been at greater risk of catching COVID-19 too. Looking back, it turned out to be the right decision for me.

My immunology consultant also said on 27 March in another phone appointment, that it was possible I’d had COVID-19. However, there is no way of knowing for sure if I have. COVID-19 blood tests look for the presence of antibodies produced by the immune system. If these antibodies are present, then that means a person has had the infection in the past. However, these tests might not be accurate in people with primary immunodeficiency syndromes, because we don’t always make antibodies properly. The consultant said that they do not yet know for sure whether having COVID-19 means that you will develop immunity. He also said that if patients need to come in for procedures then they take measures to prevent infection: they pull the curtains in between beds, everyone wears masks, staff also wear aprons and gloves.

So, I still don’t know if I have had COVID-19, but it is possible! I will probably never know either. If this was mild or moderate COVID-19, it was still bad enough on top of the usual lung conditions.

It is an incredibly sad situation that so many people have lost their lives prematurely. The current total number of deaths in the UK is 34, 636 (18 may). It’s so important to stay at home for those of us with lung disease, who are most at risk. I personally don’t see a ‘quick fix’ for this pandemic and it is possible there will be a second and third wave. I am looking forward to the vaccine being available, so it protects more people.

COVID isolation: Mental well-being while staying at home

The UK NHS has released a list of helpful resources to assist in safeguarding your mental health during this current COVID isolation period. We have reproduced some of it here for the purpose of allowing indexing of the many sections, hopefully making access a bit quicker and easier.

Taking care of your mind as well as your body is really important while staying at home because of coronavirus (COVID-19).

You may feel bored, frustrated or lonely. You may also be low, worried or anxious, or concerned about your finances, your health or those close to you.

It’s important to remember that it is OK to feel this way and that everyone reacts differently. Remember, this situation is temporary and, for most of us, these feelings will pass. Staying at home may be difficult, but you are helping to protect yourself and others by doing it.

The tips and advice here are things you can do now to help you keep on top of your mental wellbeing and cope with how you may feel while staying at home. Make sure you get further support if you feel you need it.

The government also has wider guidance on staying at home as a result of coronavirus.

To read the complete NHS page ‘Worried about coronavirus’ click here

 

 

For a more complete resource on mental health see the NHS page ‘Every Mind Matters’.

EMM - Coronavirus - Stay at home - Find out about your rights

1. Find out about your employment and benefits rights

You may be worried about work and money while you have to stay home – these issues can have a big effect on your mental health.

If you have not already, talk with your employer about working from home, and learn about your sick pay and benefits rights. Knowing the details about what the coronavirus outbreak means for you (England and Wales only) can reduce worry and help you feel more in control.

GOV.UK: Coronavirus support

2. Plan practical things

Work out how you can get any household supplies you need. You could try asking neighbours or family friends, or find a delivery service.

Continue accessing treatment and support for any existing physical or mental health problems where possible. Let services know you are staying at home, and discuss how to continue receiving support.

If you need regular medicine, you might be able to order repeat prescriptions by phone, or online via a website or app. Contact your GP and ask if they offer this. You can also ask your pharmacy about getting your medicine delivered, or ask someone else to collect it for you.

If you support or care for others, either in your home or by visiting them regularly, think about who can help out while you are staying at home. Let your local authority (England, Scotland and Wales only) know if you provide care or support someone you do not live with. Carers UK has further advice on creating a contingency plan.

Carers UK: Coronavirus

3. Stay connected with others

Maintaining healthy relationships with people you trust is important for your mental wellbeing. Think about how you can stay in touch with friends and family while you are all staying at home – by phone, messaging, video calls or social media – whether it’s people you usually see often, or connecting with old friends.

Lots of people are finding the current situation difficult, so staying in touch could help them too.

4. Talk about your worries

It’s normal to feel a bit worried, scared or helpless about the current situation. Remember: it is OK to share your concerns with others you trust – and doing so may help them too.

If you cannot speak to someone you know or if doing so has not helped, there are plenty of helplines you can try instead.

NHS – recommended helplines

5. Look after your body

Our physical health has a big impact on how we feel. At times like these, it can be easy to fall into unhealthy patterns of behaviour that end up making you feel worse.

Try to eat healthy, well-balanced meals, drink enough water and exercise regularly. Avoid smoking or drugs, and try not to drink too much alcohol.

You can leave your house, alone or with members of your household, for 1 form of exercise a day – like a walk, run or bike ride. But make you keep a safe 2-metre distance from others. Or you could try one of our easy 10-minute home workouts.

Try a 10-minute home workout

6. Stay on top of difficult feelings

Concern about the coronavirus outbreak is perfectly normal. However, some people may experience intense anxiety that can affect their day-to-day life.

Try to focus on the things you can control, such as how you act, who you speak to and where you get information from.

It’s fine to acknowledge that some things are outside of your control, but if constant thoughts about the situation are making you feel anxious or overwhelmed, try some ideas to help manage your anxiety.

7. Do not stay glued to the news

Try to limit the time you spend watching, reading or listening to coverage of the outbreak, including on social media, and think about turning off breaking-news alerts on your phone.

You could set yourself a specific time to read updates or limit yourself to checking a couple of times a day.

Use trustworthy sources – such as GOV.UK or the NHS website – and fact-check information from the news, social media or other people.

GOV.UK: Coronavirus response

8. Carry on doing things you enjoy

If we are feeling worried, anxious, lonely or low, we may stop doing things we usually enjoy.

Make an effort to focus on your favourite hobby if it is something you can still do at home. If not, picking something new to learn at home might help.

There are lots of free tutorials and courses online, and people are coming up with inventive ways to do things, like hosting online pub quizzes and music concerts.

9. Take time to relax

This can help with difficult emotions and worries, and improve our wellbeing. Relaxation techniques can also help deal with feelings of anxiety.

10. Think about your new daily routine

Life is changing for a while and you are likely to see some disruption to your normal routine. Think about how you can adapt and create positive new routines and set yourself goals.

You might find it helpful to write a plan for your day or your week. If you are working from home, try to get up and get ready in the same way as normal, keep to the same hours you would normally work and stick to the same sleeping schedule.

You could set a new time for a daily home workout, and pick a regular time to clean, read, watch a TV programme or film, or cook.

11. Look after your sleep

Good-quality sleep makes a big difference to how we feel, so it’s important to get enough.

Try to maintain your regular sleeping pattern and stick to good sleep practices.

12. Keep your mind active

Read, write, play games, do crosswords, complete sudoku puzzles, finish jigsaws, or try drawing and painting.

Whatever it is, find something that works for you.

Coronavirus Outbreak 2020 ANNOUNCEMENT: A notice for all patients that attend the National Aspergillosis Centre, Manchester, UK, 10th April.

NAC CARES

A plea to all NAC patients

As you will be aware the NHS faces unprecedented times due to the Coronavirus pandemic. The National Aspergillosis Centre (NAC) team are extremely busy working on the frontline.

We are currently still trying to offer telephone consultations in place of face to face appointments. However, we are currently overwhelmed with the numbers of calls still required. May we politely request again that you call us to postpone all non-urgent telephone appointments.

Chronic Pulmonary Aspergillosis (CPA) Patients

Many patients have also been in contact with us regarding NHS social shielding letters and support. The National Aspergillosis Centre (NAC) has now sent letters to all NAC registered patients (and their GPs) who have a diagnosis of chronic pulmonary aspergillosis (CPA) advising that they are extremely vulnerable and should follow social shielding advice.

For further details on shielding and protecting highly vulnerable people click here.

All patients living in England will be added to the government’s list of extremely vulnerable people and can register for support at https://www.gov.uk/coronavirus-extremely-vulnerable

NOTE: There is separate advice for patients living in Scotland, Northern Ireland and Wales. For country-specific information regarding social shielding please follow these web links or contact you GP:

Allergic Bronchopulmonary Aspergillosis (ABPA) Patients

Patients with Allergic Bronchopulmonary Aspergillosis (ABPA) and Severe Asthma with Fungal Sensitisation (SAFS) requiring to shield should have been identified by the NHS database searches across the UK. These searches were based on the medication you take to control your asthma. If you have not received a letter and you believe you have severe asthma you should first contact your local respiratory consultant or GP for advice. Please note that the National Institute for Health and Care Excellence (NICE) have defined severe asthma for the purposes of COVID-19 as follows:

“asthma that requires treatment with high-dose inhaled corticosteroids (see inhaled corticosteroid doses for NICE’s asthma guideline) plus a second controller and/or systemic corticosteroids to prevent it from becoming ‘uncontrolled’, or which remains ‘uncontrolled’ despite this therapy.”

Aspergillus bronchitis and Aspergillus sinusitis Patients

Aspergillus bronchitis and Aspergillus sinusitis have not been identified as risk factors for serious complications from COVID-19. If you have one of these conditions alone, you should not follow shielding advice. Instead, you should follow social distancing guidelines.

For further guidance on social distancing click here