How a 60-Year-Old Man's Recurring Asthma Was Linked to Home Renovation: A Case Study in Environmental Triggers and Long-Term Management

Disclaimer: This article is intended for educational and informational purposes only. To protect patient privacy, all personal details have been modified or anonymized.

Understanding the Connection Between Indoor Environments and Asthma Exacerbations

Asthma is a chronic respiratory condition often triggered by environmental factors such as allergens, cold air, chemical irritants, viral infections, and physical exertion. In this case, a 60-year-old male patient experienced recurrent episodes of wheezing, shortness of breath, chest tightness, and persistent coughing—symptoms that first emerged three years prior during home renovation work. These symptoms appeared episodically at first but gradually increased in frequency and severity over time. Despite multiple hospitalizations across different medical centers, it wasn't until a comprehensive evaluation at Harbin Medical University's Second Affiliated Hospital in November 2019 that he received a definitive diagnosis: bronchial asthma with an environmental trigger component linked to indoor pollutants from construction materials.

Patient Profile:

Gender & Age: Male, 60 years old
Diagnosis: Bronchial Asthma (Allergy-Induced)
Hospital: Harbin Medical University Second Affiliated Hospital
Treatment Period: November 2019
Therapy Plan: Pharmacological intervention including Budesonide Inhalation Suspension, Methylprednisolone, and Amoxicillin Capsules
Treatment Duration: 7-day inpatient care followed by ongoing outpatient monitoring
Outcome: Symptom control achieved; stable post-treatment condition

Initial Clinical Assessment: Recognizing Severe Airway Obstruction

Upon entering the clinic, the patient exhibited audible wheezing even before any diagnostic tools were used—a hallmark sign of significant airway constriction. He reported a three-year history of intermittent asthma-like symptoms that began shortly after initiating home renovations involving paints, adhesives, and new flooring materials. His symptoms included paroxysmal dyspnea, cough with sputum production, palpitations, and fatigue. Although previous treatments with long-acting bronchodilators like Salmeterol Fluticasone Powder Inhaler and Fluticasone Propionate Nasal Spray provided temporary relief, inconsistent medication adherence led to repeated flare-ups.

Three days before admission, a common cold exacerbated his baseline condition, prompting him to seek comprehensive care. At presentation, he showed mild cyanosis around the lips, pharyngeal congestion, and widespread bilateral wheezes on lung auscultation. Vital signs revealed a respiratory rate of 22 breaths per minute, heart rate of 110 bpm, blood pressure of 130/70 mmHg, and normal body temperature (36.8°C). No signs of jugular venous distention, leg edema, or abdominal abnormalities were noted. The patient also had a documented history of allergies to dust and seafood, further supporting an atopic predisposition.

Diagnostic Workup and Treatment Strategy

Given the severity of acute bronchoconstriction, immediate intravenous corticosteroid therapy was initiated using Methylprednisolone to reduce airway inflammation and prevent disease progression. A full diagnostic panel was conducted to assess lung function and confirm the asthma classification:

Key Diagnostic Findings:

Pulmonary Function Test: FEV1/FVC ratio reduced to 63.2%, positive bronchodilator response indicating reversible airflow obstruction
Lung Physiology: Obstructive ventilatory defect with impaired small airway function
Blood Work: WBC 6.8×10⁹/L, neutrophil percentage elevated at 78% suggesting low-grade bacterial involvement
Arterial Blood Gas: pH 7.40, PaO₂ 87 mmHg, PaCO₂ 32 mmHg – indicative of compensated respiratory status
Chest X-ray: Increased bronchovascular markings without consolidation
ECG: Normal sinus rhythm, no ischemic changes

Comprehensive Treatment Approach:

Trigger Elimination: With yellow sputum present and neutrophilia observed, oral Amoxicillin was prescribed to address suspected bacterial superinfection despite normal imaging results.
Acute Symptom Control: Transitioned from IV steroids to inhaled corticosteroids once stabilization occurred, ensuring rapid anti-inflammatory action while minimizing systemic side effects.
Secretion Management: Introduced mucolytic agents to facilitate easier expectoration and reduce mucus plugging in narrowed airways.

Positive Response to Therapy and Discharge Planning

Within three days of starting intravenous Methylprednisolone, the patient experienced noticeable improvement in breathing difficulty. Wheezing diminished significantly upon repeat auscultation, though occasional dry crackles remained. After completing a 3-day course of Amoxicillin, sputum volume and viscosity decreased markedly. The treatment plan then shifted to maintenance therapy with inhaled Budesonide Suspension via nebulizer, combined with oral expectorants.

By day seven, nebulized medications were discontinued, and the patient transitioned to a combination inhaler containing both a corticosteroid and dual bronchodilators. A personalized long-term management strategy was established, emphasizing regular follow-ups, proper inhaler technique training, and emergency rescue medication availability. Both the patient and family expressed high satisfaction with the outcome, noting improved sleep quality, energy levels, and overall well-being.

Essential Post-Treatment Guidelines for Asthma Patients

While successful symptom control is encouraging, sustained remission requires consistent self-management and environmental awareness. Key recommendations include:

Monitor for Complications: Acute asthma attacks can lead to serious complications such as pneumothorax, mediastinal emphysema, or atelectasis. Any sudden increase in chest tightness or breathlessness warrants urgent medical evaluation.
Optimize Indoor Air Quality: Maintain good ventilation by opening windows regularly. Use air purifiers and humidifiers to stabilize humidity and temperature, reducing airborne irritant concentration—especially important after home remodeling projects.
Nutritional Guidance: Adopt a light, balanced diet rich in fresh fruits and vegetables. Avoid spicy foods, strong condiments, and stimulants like coffee or black tea that may aggravate airway sensitivity.
Physical Activity: Engage in moderate exercise such as walking or swimming to enhance lung capacity and immune resilience, provided activity is paced and performed in clean-air environments.

Clinical Insights: Rethinking Asthma Management in the Modern Era

This case underscores the importance of patient education in chronic respiratory diseases. While asthma remains incurable, most individuals can achieve full control through consistent, tailored therapy. It's critical to help patients identify personal triggers—not just to avoid them, but to recognize when their current regimen is insufficient. For instance, if exposure to a known allergen or irritant (like paint fumes) causes an attack, it indicates poor disease control rather than mere environmental misfortune. In such cases, intensifying maintenance medication—not just avoidance—is key.

Modern asthma care emphasizes individualized treatment plans based on phenotype, severity, and lifestyle. Emerging biologic therapies targeting specific inflammatory pathways (such as IL-4, IL-5, and IgE) are revolutionizing options for difficult-to-control cases. As research advances, clinicians now view asthma not as a single disease but as a spectrum of conditions requiring precision medicine approaches. Ultimately, empowering patients with knowledge, tools, and confidence transforms asthma from a disruptive illness into a manageable part of daily life.