Steam bath and CF

Question

Should a CF patient who also has ABPA take a steam bath?

Answer

Dear,
We thank you for this question which does bring up an aspect of daily life.
In a nutshell: it is unlikely that taking a steam bath has any benefit for people with CF. There may even be some risk: patients with cystic fibrosis lose a lot of salt in their sweat; this can occur during strenuous exercise or during exposure to high temperatures such as with the use of a steam bath. This salt loss needs to be replaced by extra salt intake.
Patients with cystic fibrosis suffer from chronic lung infection by bacteria such as Pseudomonas aeruginosa. Since Pseudomonas are known to cause faster decline in lung function we try to prevent exposure to it. Patients can contract Pseudomonas Infection by exposure to other patients with this infection: thus close contact between carriers and non-carriers should be avoided. But Pseudomonas is also an environmental bacteria present in still standing water, on dirty aerosol machines, in moist hot places cause bacteria grow better in a warm and moist environment. Good hygiene and disinfection of physiotherapy and aerosol material is therefore important. Whether more strict regulations to prevent the infection with Pseudomonas are of benefit is not well known: subjects are exposed to environmental Pseudomonas on a daily basis but the risk of acquring infection is actually rather small. Classically we advise patients to clean their aerosol machine and to avoid warm and humid places like tropical swimming pools, saunas and steam baths but the scientific evidence supporting this statement is limited.
Aspergillus is a mould present in the environment that also survives very well in the thick mucus in the airways of CF patients where it can cause allergical reactions with symptoms like coughing, shortness of breath, wheezing and deterioration of the lung function called allergic bronchopulmonary aspergillosis (ABPA). This fungus grows in moist environment such as the walls in a humid room and Aspergillus is also typically found in horse stables especially on the straw. A steam bath also seems the ideal environment for Aspergillus. If you have ABPA you must avoid further contact with Aspergillus, and thereforeyou better avoid steam baths.
In conclusion the use of a stema bath is not advised in patients with cystic fibrosis, because of the potential side effects.
K. De Boeck, M. Proesmans, F. Vermeulen, L. Dupont

23.04.2009