Wheezy? It might be time to change your duvet

In case you thought that out-of-breath feeling was just a sign of ageing ...

For months Christine Scott battled with breathlessness. ‘I struggled to keep up with my family on walks and was wheezy when I climbed stairs, yet I wasn’t a smoker and didn’t have asthma,’ says Christine, now 64.

She assumed it couldn’t be an animal allergy either, as the family had kept a pet cockatoo, Tweety, for more than 20 years.

But as Christine later disovered, she did have a condition caused by her pet — the quaintly-termed ‘bird fancier’s lung’ (BFL). A similar condition can be triggered by duck or goose down duvets.

But oblivious to this back then, Christine, who lives in Brackley, Northamptonshire, couldn’t think what could be causing the breathlessness. ‘It was deeply worrying, but eventually I put it down to being overweight.’ Christine, who is 5ft 6in, weighed 15st, although that weight gain pre-dated the wheeziness by years.

But after months of problematic breathing, Christine — who’d been reasonably fit and enjoyed walking — finally went to her GP.

He told her it was nothing to worry about. Christine wasn’t convinced, so saw a lung specialist privately. Tests including an MRI, X-ray and bronchoscopy (where a camera was inserted via her nose down her throat) revealed her lungs were scarred and inflamed.

‘When the doctor said it was so bad I had to stay in hospital, I couldn’t believe it,’ she says. After quizzing Christine the consultant diagnosed a bird allergy — specifically to a protein in their droppings and feathers.

‘He prescribed steroids but said Tweety had to go, which was sad because he’d been a big part of our family for so long,’ she says. ‘But I knew it was the best thing for my health and we found him a new home at a sanctuary.’

Christine thought that if she avoided birds, she would recover. But after a couple of years of improvement, in 2014 her condition suddenly worsened. ‘I was breathless on the treadmill at the gym before I even got started, and trailing behind my family on days out,’ she says. ‘I always had to take the lift rather than stairs and was wheezy at night, too.’

A chest X-ray showed significant deterioration in her lungs. A biopsy revealed fibrosis (stiffening of the tissue) and scarring.

Christine’s specialist explained that, although most people with bird allergies get better when they avoid them, her immune system was still reacting as if it was being exposed to Tweety — even though the cockatoo hadn’t lived with them for six years.

Her allergy had led to a condition called hypersensitivity pneumonitis — she had the most common form, bird fancier’s lung. An allergen causes the alveoli (small sacs in the lungs) to become inflamed, changing their structure and reducing their ability to move air in and out of the body.

Symptoms of hypersensitivity pneumonitis often go unnoticed for years, explains Stephen Spiro, a professor of respiratory medicine at royal Brompton and Harefield NHS Foundation Trust, and medical adviser to the British Lung Foundation. The condition nibbles away at the lungs and causes them to stiffen over a long period.

‘The amount of allergen needed to cause damage to the lungs is tiny and it happens so slowly, over so many years, that typically people aren’t diagnosed until the disease is quite advanced,’ he says.

‘It usually stops or slows if the bird is removed from the patient’s home, but the lungs may be so damaged from past exposure that the full extent of damage is not noticed until it disrupts breathing.’

In most people inflammation is short-lived and can be controlled by steroids and avoiding the allergen — however, sometimes the only treatment for extensive damage is a lung transplant.

Up to 20 per cent of pigeon breeders were found to have BFL in a recent study in Salt Lake City in the U.S., and a similar condition — feather duvet lung — has been diagnosed in people who have duvets filled with duck or goose down.

Tests showed that Christine’s lung function was down to just 33 per cent. ‘My specialist told me he was referring me for assessment for a lung transplant,’ says Christine, who cried when she realised she had a life-threatening condition.

‘Doctors could treat the inflammation but couldn’t do anything about the scarring, which was getting worse and meant I was vulnerable every time I had a chest infection.’

Christine is on a waiting list for a lung transplant and in the meantime is hooked up to a constant supply of oxygen and on strong medication to try to stop any more damage (but which makes her more susceptible to infections for life).

‘All of this is because we kept a cockatoo. I wish now I hadn’t ignored my wheeziness for so long and explained it away by saying I was overweight and getting older.’

Her story is extreme but there are many common causes of wheezing that shouldn’t be ignored. ‘Wheeziness is a continuous, coarse whistling sound caused by turbulence in your air flow,’ explains Dr James Hull, a consultant respiratory physician at royal Brompton and Harefield NHS Foundation Trust.

‘If you’re wheezing, some part of the respiratory tract must be obstructed,’ he says, adding that chronic wheeziness needs investigating. Here we look at some of the most common causes . . .

WHEEZING WITH BREATHLESSNESS

Could be: Asthma RECURRENT attacks of wheezing, shortness of breath, coughing and chest tightness occur when the lining of the airways swells and the muscles around the airways constrict, reducing the flow of air in and out of the lungs.

‘As asthma is so common (affecting 5.4 million in the UK) it is often assumed it must be the cause (of any wheezing),’ says Dr Hull. But, ‘a significant proportion of the patients I see at the royal Brompton, who have been initially diagnosed with asthma, will end up with a different diagnosis,’ he adds.

As asthma symptoms can be very similar to those of other conditions, patients must ensure they get the right tests to avoid misdiagnosis. These include spirometry, to measure the amount of air you can hold in your lungs, or a ‘peak flow monitor’ can measure how fast you can blow out air from your lungs.

Treatments include daily steroid ‘preventer’ inhalers to reduce lung inflammation, and ‘reliever’ inhalers to widen the airways.

WHEEZING PLUS A COUGH

Could be: Cardiac asthma ‘THIS isn’t asthma at all but a symptom of heart failure,’ explains Professor Spiro. Heart failure is when the heart can’t pump blood efficiently — it often occurs following a heart attack and causes fluid to build up around the lungs. As well as breathlessness with or without wheezing, patients suffer a chronic cough and rapid shallow breathing. A common sign is if these symptoms wake you up at night, adds Professor Spiro.

‘Blood that normally pools in the legs re-enters the bloodstream [when lying down] and those with heart failure can’t cope with the increased volume — resulting in a fluid build-up in the lungs which affects your ability to breathe.

‘It’s more common in older people, and usually diagnosed after a patient is admitted to hospital with breathing difficulties at night.’

Treatments include medication to improve heart function.

WHEEZING DURING EXERCISE

Could be: Exercise-induced laryngeal obstruction (EILO) ‘THIS is where the voice box closes during exercise,’ says Dr Hull. ‘It’s a common cause of breathing difficulty in people under 20, although we don’t understand why.’

The problem only develops during exercise — the larynx looks normal at rest. Treatment usually involves speech therapy and muscle training exercises. For some (those who have narrowing above the vocal cords) laser and surgical treatment may be appropriate.

one study showed 84per cent of patients treated with laser surgery had normal laryngeal function five years later, compared to 21 per cent treated with speech therapy and muscle training exercises.

WHEEZING WHEN BREATHING OUT

Could be: Chronic obstructive pulmonary disease (COPD) THIS is the name for a group of lung diseases including chronic bronchitis and emphysema. The main symptoms are breathlessness when active, persistent wheezing (especially breathing out), a chesty cough with phlegm and frequent chest infections.

‘COPD is the fourth most common medical condition in the UK, affecting an estimated three million people,’ says Professor Spiro. ‘It most commonly affects smokers and ex-smokers, but can also result from severe long-term asthma or occupational exposure to dust or fumes. The lungs are permanently damaged, inflamed and narrowed.

Bronchodilators, which relax muscles in the lungs to widen airways, and steroid inhalers can help. Patients may also be offered oxygen therapy to help them sleep.

WHEEZING AT NIGHT

Could be: Dust mite allergy DUST mites — found in bedding, carpets and soft furnishings — are about a quarter of a millimetre long and people are allergic to the protein in their droppings.

They affect adults as well as children. ‘If you’re wondering why your child gets wheezy when they go to bed — check out their soft toys,’ says Holly Shaw, a nurse and adviser to Allergy UK. ‘Cuddly toys can harbour dust mites and their faeces, and these can trigger allergic rhinitis in susceptible children — including those with eczema,’ she says.

Wash stuffed toys at 60c, as you would bedding, says Ms Shaw.

WHEEZING AND A HOARSE VOICE

Could be: Glottic stenosis WHEEZING, noisy breathing and hoarseness ‘may be caused by the vocal cords closing due to structural problems such as narrowing (stenosis),’ says Dr Hull. ‘Causes can be congenital (from birth) or as a result of damage from breathing tubes inserted to help ventilate patients in intensive care.’

It is diagnosed with lung function tests and most importantly by looking at the voice box area with a camera. But it can be misdiagnosed as asthma because symptoms are similar, says Dr Hull. ‘Glottic Stenosis is rare but it is really important to detect because surgical treatment can cure the condition.’