with the Chronic Cough
and Text © 2008 Jeffrey C. May
is a light photomicrograph (about 400x) of dust from Sally's living-room
easy chair. The long pink rectangular shapes are dog dander, and
the brown spherical shapes are dust mite fecal pellets.
I first met them, Sally and Burt had been married for 50 years. Though
they taunted and teased each other mercilessly while I was in their home,
it was clear to me that they cared for each other deeply and were almost
the same person - they even finished each other's sentences.
and Burt had lived in the same house since their wedding day.
When their oldest daughter got married, they changed the home into a two-family
moved to the first floor, converting a porch built over a crawl
space at the back of the house into their new bedroom. Their daughter and
lived in the larger apartment above, and over the years, two
grandchildren joined the extended family.
grandson has asthma. His parents had just stopped smoking because they
felt that this would help their child, but the wall to wall carpet in the
upstairs apartment still reeked of smoke. Because she had a chronic cough
condition, Sally hadn't slept through the night in three years. She would
awaken and have to sit up, because she coughed so violently. Then she would
pace for hours to calm down enough to go back to sleep. Sally and Burt
had a small dog that I suspected might be a problem, and when I visited
the house, they put the pooch in a cage for the duration of my stay.
I arrived, we sat in the kitchen while Burt described his wife's health
problems. Sally was sitting in the background, adding comments and muffled
coughs. As per my instructions, they had shut all the doors to the various
rooms before my visit, to keep air flows to a minimum. The master bedroom
was located off the kitchen, and when I opened the door and peeked in,
I immediately started to cough (I'm allergic to mold and dust mites).
explained to the couple that I would have to wear a fine particle mask
in order to enter their bedroom to take dust and air samples. As I was
putting on my mask, it occurred to me to offer one to Sally. I went out
to my car to get a new mask for her, and showed her how to wear it properly
(taking care to be certain the fit around her nose was airtight). She looked
uncomfortable sitting there with a mask on her face, but I noticed immediately
that she was a lot quieter; she had stopped coughing. For the entire three
hours of my visit, I don't think that Sally twitched, for fear that she
would start to cough again. When I was packing up my equipment to leave,
I suggested that she and I both remove our masks together. We both started
coughing at the same time.
analysis of the air and dust samples revealed significant contamination
of the bedroom carpet with dust mites and mold. The presence of carpeting
in their bedroom was particularly problematic, for the room wasn't adequately
heated; the floor, three of the walls, and the ceiling (directly under
a low roof) were always cold. This led to high relative humidity in the
cooler seasons of the year. Mildew grows on surfaces when the relative
humidity is high; in fact, during my visit, I had seen mildew on the wood
panel at the back of their bedroom dresser.
suggested that Sally spend that night in the guest room, where there was
a hardwood floor and a pullout couch that was rarely used. She slept through
the night for the first time in years. I recommended that they remove the
carpeting in their bedroom and install hardwood floors, disinfect the bedroom
walls with a mild bleach solution, and keep the room warmer. I also strongly
encouraged them to pick another room for their bedroom.
later followed my recommendations, and most of Sally's coughing problems
is a remarkable person - a real fighter. She had had at least two different
surgeries for medical problems, and a third procedure to correct a hernia
that resulted from a severe coughing fit. Her spunk was admirable, but
some of her suffering, at least from the coughing and hernia, could have