Expert: Marc Rubin, RPh Asthma Educator - 12/26/2008

Question
QUESTION: Hello Kathleen,
THe real reason I'm writing is to clear something up once and for all.  I've had what is called exercise induced asthma for many years.  Especially in cold weather especially if I exert myself... there is some wheezing coughing, but this clears up shortly.  I've never had to bother with an inhaler, because my symptoms vanish quickly and I'm not bothered that often unless as I said through exertion.
People I know (non medical, and this being the key word), say I'm in danger of pneumonia may even die from it, because periodically I do have congestion in my lungs. and of course they tell me about emphysema and any other lung condition you can name.  Like I said I've been going through this for many years, now I'm told I'll drop at the first sniffle.  I had a cold and my breathing was labored but it soon went away. I guess what I'd like to know is your thoughts on this,  and why on some mornings, I wake up with much congestion & coughing.  It stops once I get up and move around.  But on other days my lungs are clear no phlegm no congestion or coughing. Why is it some days I have no lung congestion and other days do.  is this because I've been prone during the night. allergies etc. I also would like to hear about holistic treatments...thank you for your time.


ANSWER: Hi Jan,

I think you need to be aware that ~90% of patients who have been told that they have EIA, actually have asthma, and not just from exercise. You would fall into that group. Please note that asthmatics have a larger number of mucus producing cells in their lungs, and when inflammation increases, you produce a lot more phlegm.

Other triggers for asthma attacks are: viruses and molds, cold dry air, smoke (e.g: cigarettes, fire places), dust, pet dander, pollens, cleaning agents, perfumes, acid reflux...  Only two bacteria actually cause an increase in lung inflammation: Mycoplasma pneumonia and Chlamydia pneumonia, both treatable with common antibiotics.

50% of controlling asthma is directly related to prevention measures: flu vaccine, increased hand washing during cold virus season, and avoiding the other triggers. For the cold air, wear a scarf over your mouth and nose to raise the temp and humidity of the air you breath.

Biologically, everyone's bodies produce anti-inflammatory steroids (cortisol). But the levels vary during the day. They peak early afternoon, and are at a very low point ~ 4am. Which leads to the fact that lung function goes down due to this, and you have more difficulty breathing when you wake up due to the increased inflammation. Oh, by the way, if you have pets, for this reason they MUST be kept out of the bedroom, to reduce the dander levels which raise your lung inflammation.So you can now see that you don't simply have EIA.

Most deaths due to asthma are due to patients not keeping their rescue inhalers with them at all times. This is for 2 reasons: 1, asthmatics frequently have difficulty perceiving the degree of impaired lung function, and 2, you don't know if you will enter an environment with high levels of "trigger" which could bring on a severe attack, and you have no medication to bring it under control.

I urge you to see an allergist to find what all your triggers are, and to assess your lung function. With your history, you may only need to revisit once a year. You can also get proper guidance on addressing lung infections. Then when your friends meddle, you can tell them you appreciate their concern, but you are under the care of a specialist. With proper health care and education, your risk of dying from pneumonia is only marginally higher than theirs.

Regarding holistic treatments, there are some, but the research is not there. What is crucial is using cleaning chemicals, paints and other compounds that are non-irritating. Avoid bleach, and use paints and stains with markings indicating low VOC's (Volatile Organic Compounds). Treating asthma is a 50/50 proposition: a balance between education and trigger knowledge with the appropriate use of medication.

For educational materials, go to : http://www.aaaai.org, http://www.acaai.org, http://www.chestnet.org, http://www.thoracic.org, http://www.lungusa.org

I hope this helps you. Enjoy the holidays!

Sincerely,

Marc

P.S.: Kathleen has removed herself as an expert in this category.

---------- FOLLOW-UP ----------

QUESTION: Marc, first, I'm sorry re; thanking you.  I didn't know it was you, and I wasn't here so I just read the response yesterday.  But I would like to mention that Yes, I know EIA is Asthma.  It's just that I don't have asthma attacks, I'm bothered only when I exert myself, especially in cold weather.  It just lasts a few minutes, sometimes just coughing.  And I can't run up stairs, or walk fast up stairs etc. As I said just lasts a few mins.  I don't need an inhaler, mainly because I don't have attacks the way some asthmatics do.  And I've been told inhalers are not safe.  Especially compromising the heart.  My triggers are simply exertion.  otherwise I'm never bothered with it.
My question was during the year sometimes in the spring I"ll wake up with congestion other times, I don't....now that it's winter ( I live in New England) it's cold and lately it's been mild.  I have no congestion at all. but probably in the spring maybe in the summer it will come back. then it goes.
thank you very much for your info.  Again sorry I didn't respond right away.


Answer
Hi Jan,

The only inhalers that are potentially unsafe are the long-acting bronchodilator versions of albuterol (Serevent and Foradil). They are unsafe when they are the ONLY controller medications taken for persistent asthma. The national guidelines specifically state that they are to only be used as add-on therapy to inhaled steroids, since they by themselves, do not decrease inflammation in the lungs.

One component of asthma is the fact that asthmatics have a greater number of cells in the lungs that produce mucus. When you have a seasonal variant of asthma, you only have increased congestion in the time of the year that specific triggers are present, which sounds exactly like your case. You may see improvement in this by just having your doctor prescribed Singulair to be taken orally, during these periods. Singulair works by blocking release of certain chemicals known to increase lung inflammation. It is worth trying, and the side effect profile is very low.

I hope this may help you. Have a happy and healthy new year.

Marc