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N Engl J Med 2019 Mar;380(13):1268-1277

From the Departments of Medicine (K.E.B., S.B.M.), Radiology (J.F.F.), and Pathology (E.J.M.), Massachusetts General Hospital, and the Departments of Medicine (K.E.B., S.B.M.), Radiology (J.F.F.), and Pathology (E.J.M.), Harvard Medical School - both in Boston.

Multidiscip Respir Med 2019 12;14:13. Epub 2019 Mar 12.

1Department of Respiratory Medicine, Thomayer Hospital, Videnska 800, 140 00 Prague 4, Czech Republic.

Background: Extrinsic allergic alveolitis (EAA) patients form heterogenous group with different clinical manifestation and different prognosis. We aimed to determine how to phenotype distinct EAA subgroups. Predictive role of the bronchoalveolar lavage fluid (BALF) IL-4Rα concentration at the time of diagnosis with regard to the clinical behavior in EAA patients was studied. Read More

Internist (Berl) 2019 Apr;60(4):345-361

Abteilung für Innere Medizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland.

Fibrosing lung diseases describe a heterogeneous group of interstitial lung diseases (ILD) of highly variable etiology, but with a unifying terminal process of irreversible, fibroproliterative destruction of the alveolar surface, loss of compliance and progressive impairment of gas exchange. In view of the heterogeneity, the disastrous prognoses in some cases and the treatment consequences, a thorough differential diagnosis is essential in all patients. Antifibrotic therapies are currently only indicated in idiopathic pulmonary fibrosis (IPF). Read More

Cas Lek Cesk 2018 Dec;157(8):396-399

The causes of occupational diseases are changing, thats why a regular update of Czech List of Occupational Diseases is needed. New compensable occupational diseases, such as cancer of the larynx and ovarian cancer due to asbestos, and chronic obstructive pulmonary diseases due to black coal dust were included in the last two updates of the Czech List. The need of an early examination at the Centers of Occupational Diseases is stressed in this article, especially before a surgery or other treatment of epicondylitis and carpal tunnel syndrome. Read More

Rev Mal Respir 2019 Mar 22;36(3):298-306. Epub 2018 Nov 22.

Service des maladies infectieuses et de réanimation médicale, CHU de Rennes, 35043 Rennes, France; Inserm-CIC-1414, faculté de médecine, IFR 140, université de Rennes I, 35033 Rennes, France.

Introduction: The aim of our study was to compare the features at diagnosis in patients with ornithosis to patients with avian acute hypersensitivity pneumonitis (HP). Clinical, biological and radiological differences could potentially help clinicians to distinguish these diseases.

Methods: We conducted a retrospective study on patients admitted from 2000 to 2016 in three hospitals. Read More

J Cutan Pathol 2019 Feb 18;46(2):159-161. Epub 2018 Dec 18.

Department of Dermatology, Columbia University Medical Center, New York, New York.

We report a case of disseminated Trichosporon asahii in a patient on systemic antifungal therapy who presented with multiple cutaneous nodules suggestive of fungal infection. Histologic features resembled neutrophilic eccrine hidradenitis but staining with periodic acid-Schiff and Gomori methenamine silver confirmed the clinical diagnosis. This case highlights the importance of maintaining suspicion for trichosporonosis and contextualizing histologic findings within the underlying clinical picture. Read More

Respir Res 2018 Nov 8;19(1):215. Epub 2018 Nov 8.

Pneumology Research Group, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.

Background: The soluble receptor for advanced glycation end-products (sRAGE) has been suggested that it acts as a decoy for capturing advanced glycation end-products (AGEs) and inhibits the activation of the oxidative stress and apoptotic pathways. Lung AGEs/sRAGE is increased in idiopathic pulmonary fibrosis (IPF). The objective of the study was to evaluate the AGEs and sRAGE levels in serum as a potential biomarker in IPF. Read More

BMC Infect Dis 2018 Sep 18;18(1):470. Epub 2018 Sep 18.

Centro de Ciências da Saúde, Laboratório de Micologia Médica e Molecular, Departamento de Análises Clínicas e Toxicológicas, Universidade Federal do Rio Grande do Norte, Rua Gal. Gustavo Cordeiro de Faria S/N, Petrópolis, Natal, Rio Grande do Norte, Brazil.

Background: Trichosporon species may colonize the skin, respiratory tract and gastrointestinal tract of human beings. The yeast is recognized as etiological agent of white piedra, a superficial mycosis. Nevertheless, immunocompromised hosts may develop invasive Trichosporonosis. Read More

PLoS One 2018 12;13(9):e0203779. Epub 2018 Sep 12.

Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, México.

Background And Objective: Idiopathic Pulmonary Fibrosis (IPF) is a progressive disease of unknown etiology. The diagnosis is based on the identification of a pattern of usual interstitial pneumonia either by high resolution computed tomography and/or histology. However, a similar pattern can be observed in other fibrotic lung disorders, and precise diagnosis remains challenging. Read More

Eur Respir J 2018 08 16;52(2). Epub 2018 Aug 16.

Departments of Medicine and Pathology/Molecular Medicine, McMaster University, Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, ON, Canada.

Intern Med 2018 Dec 10;57(24):3507-3514. Epub 2018 Aug 10.

Division of Pulmonary Medicine, National Hospital Organization Kochi Hospital, Japan.

Objective Human intelectin-1 (hITLN-1) binds to galactofuranosyl residues, which are present in the microbial cell wall, but which are absent in mammalian tissues, and has been suggested to play an immunological role against microorganisms. However, the involvement of hITLN-1 in the pathogenesis of diffuse pulmonary diseases remains unknown. The aim of this study was to compare the hITLN-1 concentrations in the bronchoalveolar lavage (BAL) fluid of patients with diffuse pulmonary diseases. Read More

J Mycol Med 2018 Sep 6;28(3):452-456. Epub 2018 Jul 6.

Public Health Agency of Turkey, National Molecular Microbiology Reference Centers Laboratory, Türkiye Halk Sağlığı Kurumu, Moleküler Mikrobiyoloji Referans Laboratuvarları, Adnan Saygun Cad. No: 55 Sıhhiye, Ankara, Turkey.

Introduction: Trichosporon asahii is the most common species that causes trichosporonosis.

Materials And Methods: In the present study, a collection of 68T. asahii strains recovered from hospitalized patients urine samples between 2011 and 2016 was examined. Read More

Clin Imaging 2018 Sep - Oct;51:332-336. Epub 2018 Jun 27.

Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, United States of America.

There are three major pathologic patterns of pulmonary fibrosis; usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP) and airway-centered fibrosis (ACF). These pathologic patterns correspond with radiographic patterns of UIP, NSIP, and chronic hypersensitivity pneumonitis (CHP). Previous studies have demonstrated that the radiologic diagnosis is correct approximately 50% of the time for these fibrotic lung diseases. Read More

Respirology 2018 Dec 13;23(12):1160-1165. Epub 2018 Jun 13.

Laboratory of Pneumology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.

Background And Objective: Although idiopathic pulmonary fibrosis (IPF) patients experience a worse survival compared with chronic hypersensitivity pneumonitis (CHP), organic dust exposure is a known risk factor for both IPF and CHP.

Methods: We divided patients diagnosed with IPF, based on their exposure to moulds/birds (absent: group A; present: group B). We retrospectively compared pulmonary function and survival between groups A and B, and a separate CHP cohort (group C). Read More

Pediatrics 2018 06 17;141(6). Epub 2018 May 17.

Department of Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Electronic cigarette (e-cigarette) use, or "vaping," is gaining widespread popularity as an alternative to conventional cigarettes among adolescents. Little is known of the health risks of e-cigarette use, especially in children and adolescents. We present a Case Report of a previously healthy 18-year-old woman who presented with dyspnea, cough, and pleuritic chest pain after e-cigarette use. Read More

Expert Rev Respir Med 2018 06 11;12(6):493-507. Epub 2018 May 11.

a Service de Pneumologie , CHU de Besançon , Besançon , France.

Introduction: Hypersensitivity pneumonitis (HP) is the result of an immunologically induced inflammation of the lung parenchyma in response to inhalation exposure to a large variety of antigens in genetically susceptible individuals. HP shares clinical and radiological features with other acute and chronic interstitial lung diseases and is sometimes difficult to diagnose if exposure to an antigenic agent is not detected. Several classifications and diagnostic criteria have been proposed but are not currently recommended by guidelines from any scientific society. Read More

Respir Med 2018 05 30;138:95-101. Epub 2018 Mar 30.

Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.

Background: Pleuroparenchymal fibroelastosis (PPFE) has been described in hypersensitivity pneumonitis (HP) yet its functional implications are unclear. Combined pulmonary fibrosis and emphysema (CPFE) has occasionally been described in never-smokers with HP, but epidemiological data regarding its prevalence is sparse. CTs in a large HP cohort were therefore examined to identify the prevalence and effects of PPFE and emphysema. Read More

Ghana Med J 2017 Sep;51(3):143-147

Lousiana State University Health Science Center. Shreveport. LA, USA.

In pulmonary medicine, identical pathogenesis due to varied etiological agents can present with indistinguishable clinical presentation, and produce similar laboratory and radiological changes. The importance of eliciting detailed occupational and social history from patients cannot be stressed enough when dealing with patients suffering from diffuse parenchymal lung diseases. Hot Tub Lung(HTL) is a perplexing pulmonary disease attributed to the Mycobacterium Avium-intracellulare Complex (MAC). Read More

Pol Merkur Lekarski 2018 Mar;44(261):152-156

Medical University of Lublin, Poland: Chair and Department of Pneumonology, Oncology and Allergology.

Hypersensitivity pneumonitis (HP), called extrinsic allergic alveolitis, is a syndrome characterized by diffuse inflammation of lung parenchyma and airways in response to the inhalation of antigens to witch the patient has been previously sensitized. The clinical presentation of HP have been categorized as acute, subacute and chronic. The patient with chronic HP may lack a history of acute episodes and usually reports the insidious onset of cough, dyspnoea, fatigue, and weight los. Read More

Mycoses 2018 Aug 6;61(8):534-542. Epub 2018 Apr 6.

School of Biotechnology, University of Jammu, Jammu, India.

Dermatophytes are considered as the main pathogens responsible for onychomycosis, but recently successive isolations of yeast-like fungi from the infected nails has led to consider these also as primary agents of nail infections. Trichosporon species which are non-candidal, basidiomycetous, yeast-like, anamorphic fungi are commonly isolated from soil but they are also emerging as important etiological agents of onychomycosis. Three species of Trichosporon viz. Read More

J Gastroenterol Hepatol 2018 Feb;33(2):338

Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China.

BMJ Case Rep 2018 Jan 6;2018. Epub 2018 Jan 6.

Department of Infectious Diseases, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.

A 59-year-old man with a history of peripheral vascular disease status post femoral popliteal bypass presented with critical limb ischaemia of the left leg. An arterial Doppler ultrasound showed an occluded graft requiring an above knee amputation. Five days after surgery, the patient developed fever, leucocytosis, significant stump swelling and pain, and serosanguinous discharge from his wound. Read More

Vnitr Lek Winter 2018;63(11):802-806

Extrinsic allergic alveolitis (EAA) represent a group of diseases, that develop in susceptible individuals after repeated exposure to usually organic inhalation antigen. Patient may be in contact with these agents both in occupational and in home environment, as well as during free time activities and hobbies. The course of the disease is highly variable - EAA may have dramatic symptoms with fever, cough and severe dyspnoea as well as may be presented with slowly increasing dyspnoea and chronic cough. Read More

Ann Acad Med Singapore 2017 11;46(11):439-442

Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Rev Iberoam Micol 2018 Jan - Mar;35(1):22-26. Epub 2017 Dec 26.

Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Mexico. Electronic address:

Background: Trichosporon asahii is a yeast-like fungus that has recently gained importance as a cause of opportunistic systemic infections. The pathogenicity and virulence factors of T. asahii remain largely unknown. Read More

Intern Med 2018 May 27;57(9):1281-1285. Epub 2017 Dec 27.

Department of Thoracic Oncology, National Hospital Organization Toneyama National Hospital, Japan.

A 59-year-old woman suffering from dry cough and dyspnea was admitted to our hospital. She had undergone concurrent chemo-radiotherapy five months earlier. Chest computed tomography revealed bilateral ground-glass opacities extending outside the irradiated lung field. Read More

Zhonghua Yi Xue Za Zhi 2017 Dec;97(46):3617-3623

Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.

To assess the efficacy and safety of transbronchial cryobiopsy (TBCB) for the etiologic evaluation of diffuse lung disease (DLD). Between December 2015 to April 2017, a total of 38 patients with DLD met the inclusion criteria for TBCB in the First Affiliated Hospital of Chongqing Medical University, and 35 of them consented to undergo the procedure under rigid or flexible bronchoscopy. On the tissues obtained from the 35 patients, histopathologic and microbiological evaluations were performed, and together with clinical and radiological manifestations, diagnoses were made and the efficacy of TBCB in the diagnosis of DLD was confirmed, and then therapies were planned accordingly. Read More

Pediatr Dermatol 2018 Jan 20;35(1):e86-e87. Epub 2017 Dec 20.

Department of Dermatology, Baylor College of Medicine, Houston, TX, USA.

Trichosporonosis is a rare, life-threatening, opportunistic fungal infection that affects immunocompromised individuals with neutropenia, particularly those with underlying hematologic malignancies. We present the case of a 10-year-old boy with acute lymphoblastic leukemia who developed a diffuse, morbilliform eruption in the setting of fever and pancytopenia. He was found to have Trichosporon asahii fungemia with widespread visceral dissemination, and his condition rapidly deteriorated despite treatment. Read More

Arerugi 2017;66(10):1236-1239

Medical Center for Allergic and Immune Diseases, Yokohama City Minato Red Cross Hospital.

We report two family members, a 64-year-old woman (patient 1) and her 37-year-old son (patient 2) diagnosed with summer-type hypersensitivity pneumonitis (SHP). Both patients had high serum titers of anti-Trichosporon asahii antibody. The patients lived in the same house and worked in the same barbershop. Read More

Ann Am Thorac Soc 2018 04;15(4):460-469

2 Watson Health Value Based Care, Truven Health Analytics, an IBM Company, Cambridge, Massachusetts; and.

Rationale: Hypersensitivity pneumonitis is a complex lung disease resulting from repeated inhalation of a variety of antigens. Limited data exist regarding its epidemiology.

Objectives: To describe the trends in the annual incidence and prevalence of hypersensitivity pneumonitis in the United States. Read More

Aerosp Med Hum Perform 2018 Jan;89(1):74-77

Mahakian CG. You're the flight surgeon: hypersensitivity pneumonitis. Aerosp Med Hum Perform. Read More

Respir Med 2017 Nov 2;132:226-231. Epub 2017 Nov 2.

Department of Respiratory Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address:

Background: Clubbing is associated with poor prognosis and is variably present in patients with idiopathic pulmonary fibrosis (IPF), but is also seen in other fibrotic interstitial lung diseases (ILDs). Little is known about the best methodology to assess clubbing in ILDs and, hence, the prevalence and clinical utility and clinical significance of clubbing. We therefore aimed to evaluate the agreement between different clubbing assessment methods in patients with fibrotic ILDs. Read More

Medicina (B Aires) 2017;77(6):517-520

Consultoría en Patología Pulmonar, Buenos Aires, Argentina.

In a series of nine patients with histopathological diagnosis of hypersensitivity pneumonitis, we retrospectively evaluated clinical data, exposure related factors, pulmonary function tests and chest computed tomography scans. A restrictive abnormality with reduction of diffusion capacity for carbon monoxide was mainly found. Chest scans showed fibrotic patterns in most cases; ground glass attenuation areas with mosaic pattern and consolidation in the rest. Read More

Mycopathologia 2018 Jun 1;183(3):585-590. Epub 2017 Dec 1.

Regional Medical Research Centre (NE Region), Dibrugarh, Assam, India.

Cutaneotrichosporon (Trichosporon) debeurmannianum is a rarely isolated yeast from clinical samples. Nine isolates of this yeast were identified from clinical samples within a period of 3 years from June 2012 to May 2015. These isolates were from blood and urine samples sent to a clinical mycology laboratory of a tertiary care hospital in Assam, North East India. Read More

Pol Arch Intern Med 2018 02 29;128(2):105-114. Epub 2017 Nov 29.

INTRODUCTION    Interleukin 27 (IL‑27) is a cytokine secreted mostly by antigen‑presenting cells. It is important for the immune polarization of T helper‑1 (Th1) cells, and its role in interstitial lung diseases (ILDs) and lung cancer has been investigated. OBJECTIVES    We assessed IL‑27 expression in the lower airways of patients with selected ILDs and early‑stage non-small cell lung cancer (NSCLC). Read More

Acta Oncol 2018 05 24;57(5):705-708. Epub 2017 Nov 24.

b Thoracic Oncology , East Carolina University , Greenville , NC , USA.

Occup Med (Lond) 2017 Dec;67(8):626-636

Department of Occupational Health, Sheffield Teaching Hospitals NHS Trust, UK.

Background: The waste and recycling sector is a growing part of industry. Whether health surveillance is indicated and how it should be undertaken is unclear.

Aims: To undertake a review of the literature to identify hazards to health, biological effects and occupational illnesses for workers in the sector. Read More

Arch Pediatr 2017 Dec 20;24(12):1271-1274. Epub 2017 Nov 20.

Pédiatrie générale, CHU Ambroise-Paré, AP-HP, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France. Electronic address:

Hot tub lung is a type of hypersensitivity pneumonitis caused by inhalational exposure to the Mycobacterium avium complex. We report the case of a 14-year-old boy presenting dyspnea with hypoxemia, whose medical history and clinical course helped make the diagnosis. Infectious causes were considered first, and antibiotics were initiated without success. Read More

Int Arch Allergy Immunol 2017 15;174(3-4):144-150. Epub 2017 Nov 15.

Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.

Background: Endobronchial valve (EBV) placement is an established lung volume reduction procedure aiming to improve lung function and exercise capacity in patients with severe emphysema. As EBVs consist of silicone and nitinol (a metal alloy of nickel and titanium), there are concerns that nickel ions might be released and could have a clinical impact in patients with a contact allergy to nickel. Based on a case with hypersensitivity pneumonitis (HP) after treatment with EBVs, we aimed to evaluate the in vitro nickel release from EBVs using inductively coupled plasma mass spectrometry (ICP-MS) and scanning electron microscopy (SEM). Read More

Clin Respir J 2018 Apr 28;12(4):1721-1724. Epub 2017 Nov 28.

School of Medicine, Tzu Chi University, Hualien, Taiwan.

Hypersensitivity pneumonitis is a potentially fatal immunological lung disease caused by occupational or environmental exposure to specific antigens. Here, we report on an obstructive sleep apnea patient whose hypersensitivity pneumonitis was aggravated because of the use of unclean continuous positive airway pressure equipment. This report shows that careful history taking is important when diagnosing hypersensitivity pneumonitis. Read More

In Vivo 2017 Nov-Dec;31(6):1221-1223

Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy.

A patient treated for 4 months with hydroxycarbamide (hydroxyurea) for chronic myelomonocytic leukemia was admitted to hospital for recently developed severe dyspnea and acute respiratory failure. The computed tomographic scan of the chest showed diffuse ground glass opacities, some centrilobular low-density nodules (resembling hypersensitivity pneumonitis-like pattern), and minimal interstitial reticulation of the subpleural region. The analysis of bronchoalveolar lavage fluid excluded infection, as did serological examinations. Read More

J Immunol 2017 12 1;199(12):3943-3951. Epub 2017 Nov 1.

Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195; and

Understanding functions of Foxp3 regulatory T cells (Tregs) during allergic airway inflammation remains incomplete. In this study, we report that, during cockroach Ag-induced allergic airway inflammation, Foxp3 Tregs are rapidly mobilized into the inflamed lung tissues. However, the level of Treg accumulation in the lung was different depending on the type of inflammation. Read More

Front Med (Lausanne) 2017 16;4:170. Epub 2017 Oct 16.

Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, United States.

Background: Chronic hypersensitivity pneumonitis (CHP) is a fibrotic parenchymal lung disease that occurs when inhalation of environmental antigens leads to immune dysregulation. Autoimmune features have recently been identified as potentially important among patients with CHP. However, the relationship between hypothyroidism (HT) and CHP is unknown. Read More

Orphanet J Rare Dis 2017 10 26;12(1):169. Epub 2017 Oct 26.

Department of Respiratory Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Nanlishi Road 56, Xicheng District, Beijing, China.

Dry cough, dyspenea and diffuse centrilobular nodules in both lungs of radiologic findings similar to hypersensitivity pneumonitis (HP) are rare initial presentation in chronic granulomatous disease (CGD). CGD is remarkable for increased susceptibility to bacterial and fungal infections as well as high sensitivity to inciting antigens such as Aspergillus species due to dysregulated inflammation. We identified three children who had an initial presentation mimicking HP and were subsequently diagnosed as CGD. Read More

Expert Rev Respir Med 2018 01 26;12(1):5-13. Epub 2017 Oct 26.

a Pulmonary Division, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina , Universidade de Sao Paulo , Sao Paulo , Brazil.

Introduction: Hypersensitivity pneumonitis (HP) is a disease with variable clinical presentation in which inflammation in the lung parenchyma is caused by the inhalation of specific organic antigens or low molecular weight substances in genetically susceptible individuals. Alterations of the acute, subacute and chronic forms may eventually overlap, and the diagnosis based on temporality and presence of fibrosis (acute/inflammatory HP vs. chronic HP) seems to be more feasible and useful in clinical practice. Read More

Ann Hematol 2018 Feb 14;97(2):371-373. Epub 2017 Oct 14.

Department of Medicine, Professorial Block, Queen Mary Hospital, Hong Kong, Hong Kong.

Wilderness Environ Med 2018 03 28;29(1):119-122. Epub 2017 Sep 28.

Environmental and Occupational Health Sciences School of Public Health and School of Medicine Louisiana State University Health Sciences Center (LSUHSC) New Orleans, LA.

Mem Inst Oswaldo Cruz 2017 Oct;112(10):719-722

Universidade Federal de Alfenas, Departamento de Microbiologia e Imunologia, Alfenas, MG, Brasil.

We report the first two cases of Trichosporon mycotoxinivorans infections in Latin America. We also conducted a literature review and a microbiological investigation, including that of clinical and environmental isolates. A 30-year-old man with chronic renal failure had disseminated infection after dialysis and a 15-year-old boy with cystic fibrosis (CF) had pulmonary exacerbations with positive respiratory samples. Read More

Intern Med 2017 Nov 25;56(22):3109-3112. Epub 2017 Sep 25.

Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.

We herein report the first documented case of acute hypersensitivity pneumonitis in which Candida guilliermondii was the possible causative organism. A young Japanese woman presented to our hospital with relapsing respiratory symptoms accompanied by high fever. A detailed interview revealed that the onset of the symptoms occurred shortly after using a humidifier in her home. Read More