Expert: Marc Rubin, RPh AE-C - 10/22/2009

Question
My 15 year old son was has spots asthma that flairs up mainly when the weather changes or he has been sick. He runs cross country 2-3 miles. He was doing fine when the temp was 100+ (N.Calif.), but recently has needed to slow down due to "tight chest", "very fast heart beat",and most recently pain/cramps along his left arm (fingers to shoulders).  His doctor RX 2 puffs alb.inhaler 30min before he runs.  Monday he said it helped,and ran without incident.....but by yesterday he had the above mentioned problems.
 They practice everyday and will be running a race in S.Cal this weekend.Any suggestions,should he be resting more w/the weather change?

Answer
Hi Darlene,

Has your son been skin tested for allergens? 90% of patients with EIB(exercise induced bronchospasm) have allergic asthma also. The variability can be due to changes in pollen levels, pollution levels, how hydrated he is before he starts, as well as during the event. In addition, if a storm front with a lot of lightning will be moving in, a large amount of ozone is created, and is pushed ahead of the storm. This will cause an acute flare-up.

Although the standard of care for prevention of EIB is as your doctor ordered, a difficult issue is the rapid heart rate caused by the medication. If he has not yet been allergen tested, I'd advise the use of Symbicort or Advair, on a twice a day basis. They both have a long-acting bronchodilator that is effective for 12 hours, plus an inhalation steroid to reduce the lung inflammation (this part is a slow process that takes weeks to improve). He would not need pre-treatment with albuterol, but would carry it with him in case of an attack. Also, if it is determined that he has an environmental allergic component to his asthma, I'd advise the use of the prescription product Cromolyn (Intal), to be inhaled 1/2 hour before running. It stabilizes the lung tissue to reduce the reaction that pollens and molds create. It is only effective for about 6 hours, but does not cause any increase in heart rate. Once again, he would still carry his albuterol during the run.

Another issue is his preparation. It is VERY important that he begins hydrating with fluids an hour before the event. During the even, he should continue to take in fluids. I don't know if he has these already, but they make small water bottles attached to a waist belt for runners. Also, he needs to both do warm-ups beginning ~ 10 minutes before the run, and cool down for another 5 minutes (running in place is fine). I'm sure that his coach has covered this with the team.

Finally, do you have a peak flow meter? This is an important tool to evaluate his lung function prior to running, as well as to determine his level of impairment during an attack. This is used in conjunction with an "Asthma Action Plan", that guides therapy based upon symptoms and peak flow readings. Follow these links for information on peak flow meters and Asthma Action Plans:
1) peak flow meter: http://tinyurl.com/6h4g9
2) Asthma Action Plan: http://tinyurl.com/q5j2v

Good luck tomorrow. I'm certain you'll have more questions, so feel free to get back to me.

Sincerely,

Marc