Dangerous when wet/ Respiratory illness tied to indoor hot tubs

0 Comments | Gazette, The (Colorado Springs), Apr 28, 2003 | by BILL RADFORD

Trouble may be bubbling in the soothing waters of your hot tub.

A new respiratory condition, commonly called hot-tub lung, has surfaced in the past few years. It's not clear how prevalent it is, but it's enough of a concern that Mayo Clinic researchers last fall urged doctors to routinely ask about hot-tub use when diagnosing respiratory ailments.

The culprit is non-tuberculosis mycobacteria, one of several bugs that can thrive in hot-tub water. The steam and bubbles aerosolize the organism, making it easy to breath in.

All reported cases of hot-tub lung have been attributed to indoor hot tubs, where the bacteria-laden mist is less likely to disperse. Most have involved tubs in homes.

There are about 5 million hot tubs in the United States, according to the National Spa and Pool Institute. It's not known how many are indoors, though it's clearly a minority. Mark and Margie Maloney had never heard of hot-tub lung when they decided to add a room onto their Monument home for their hot tub. They brought the tub with them from New Jersey when they moved to Colorado a little more than a year ago. Back East, the tub had been outside.

The Maloneys installed the hot tub in August and soaked in the tub just about every day. There are several windows in the hot-tub room, but they kept them closed to keep out the cold - "a bad, bad mistake," Mark Maloney says.

Within a month, his wife had fallen ill.

"It was like a flu-like thing where I was totally exhausted," says Margie Maloney, 65, who also was bothered by a persistent cough.

She saw a series of doctors - her regular physician, an ear, nose and throat specialist, a cardiologist and finally, in January, a pulmonologist - in her quest to get better. The pulmonologist suspected hypersensitivity pneumonitis, which involves an inflammation of the lungs, but couldn't say what caused it.

"No one thought to ask me if I had a hot tub," Margie Maloney says.

But once the Maloneys came across an article on hot tub lung and showed it to the doctor, he advised her to avoid the tub.

The most effective treatment is to eliminate exposure to the hot tub, says Dr. Cecile Rose of National Jewish Medical and Research Center in Denver, which has been at the forefront in investigating hot tub lung, studying about 30 cases. Many undiagnosed patients unwittingly worsen their condition by continuing to use their hot tub, hoping a good soak will make them feel better, Rose says.

Some patients go on steroid therapy. Although some have been treated with antibiotics, the condition appears to be an immune reaction rather than an infection, Rose says.

Many patients return to normal, but patients may be left with some lung impairment, Rose says.

Margie Maloney is taking prednisone, which acts as an immunosuppressant and an anti-inflammatory. She's also on oxygen and doesn't know when that will end. For a time, doctors feared her lungs had been scarred, but that wasn't the case.

Mark Maloney doesn't know why he didn't get sick too. As a runner, perhaps his lungs are stronger than his wife's, he says.

It's not clear whether proper maintenance and tub cleaning are enough to keep it safe. The Mayo researchers noted chlorine loses much of its disinfectant properties at temperatures higher than 84 degrees.

In some cases Rose has investigated, people were "very fastidious" about cleaning the tub.

The Maloneys plan to get rid of their hot tub, which now sits empty and silent.

"We made some major decisions in our lives sitting in the hot tub and kicking things around," Mark Maloney says. "I'm going to miss it."

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SYMPTOMS

Hot-tub lung can resemble a lot of other diseases, such as asthma or a cold, says Dr. Cecile Rose of the National Jewish Medical and Research Center in Denver. Symptoms can include shortness of breath, cough or tightness in the chest.

"Fatigue is very commonly reported, and sometimes people have really pronounced or acute symptoms like fevers or chills," Rose says, "but often they don't. It can be much more subtle."