Expert: Marc Rubin, RPh Asthma Educator - 11/6/2009

Question
QUESTION: i am 16 and i have excerise induced asthma . i run cross country and track. After every one of my 5k's i have a really bad asthma attack.this season it is much worse than last fall. i have to have someone holding me up so i dont fall backwards, someone holding my arms up above my head, someone giving me my inhaler and sometimes when my coach can she is over there trying to help me breath again. I take adavair but it takes like a week to work normally but i took it for two weeks and it didnt help at all. i am also on proventil hfa for my inhaler. is there anything i can do to prevent my asthma attacks. i dont want to quit cross country or track but i have asthma attacks about three times a week normally and the attacks just wear me out i dont know how much longer i can keep having asthma attacks! please help

ANSWER: Hi Ashleigh,

For starters, most patients with exercise-induced asthma (EIA) also have allergic asthma. I'm hoping you are seeing an allergist who can properly assess that issue.

Now, here are some basic pointers for you to follow before I get into additional issues, and
assuming where you live is getting colder and dryer outside, here is what I'd suggest for you to start with:

1) Beginning 1 hour before running, begin fluid loading, and continue ingesting fluids during the run. If you don't presently have one, a runners belt which holds ~ 4 small fluid containers will help keep you hydrated. When the lungs get dry, as with mouth breathing, they get more "twitchy". Dick Pond Athletics is a good source for this, as well as other running gear:

http://www.dickpondathletics.com/istar.asp?a=3&dept=ZRA&class=FUEL&sortby=&numpe

2) With the colder, dryer air, it will definitely be of benefit to wear a neck gator. If you are not familiar with this, it is a turtleneck sweater, but without the sweater. Generally made of micro-fleece, they cover your mouth and nose to maintain a warmer, moister environment:
a) http://www.ehow.com/how_2162469_wear-neck-gator.html
b) http://www.onlineearpops.com/store/index.php?main_page=product_info&cPath=74&pro

(Note: a Google search for neck gators will provide you with a wide variety of prices)

3) Do about 10 minutes of warm-up exercise, like running in place, before venturing out. Also, do a 5 minutes cool-down upon return. It will aid in adapting your body to the transitions.

Okay now, next is doing a self-evaluation of your lungs before going out. Do you have a peak-flow meter? If yes, have you re-established your "personal best" measurement in the past 6 months?  If you are not familiar with this inexpensive device, it is a tool to help ascertain if your lungs are having increased airway restriction. The scale is set up to give results like a STOP light: Green (80-100% of Personal Best), Yellow (50-79% of Personal Best), and Red (below 50%). Paired up with an Asthma Action Plan, which you set up with your doctor, it is how you approach treatment, and allows you to properly prepare for dealing with situations you have already dealt with. Here are some links for you to follow:

Peak Flow Meter:   http://tinyurl.com/6h4g9
Asthma Action Plan:  http://tinyurl.com/q5j2v

I'm glad to see you are on a controller medication (Advair), but you need to understand the role it plays. It contains two medications, a bronchodilator (salmeterol), which begins working in 20-40 minutes, and lasts ~ 12 hours. The second medication is a steroid (fluticasone) which reduces the inflammation and swelling in the lung tissues. Noticeable improvements in inflammation appear in ~ 4 weeks, and reach maximum benefit in 6 months. Advair needs to be taken twice daily, every 12 hours, continuously. As with ALL inhalation devices, proper technique is imperative to achieve maximum results. Follow this link to review technique:

http://www.advair.com/asthma/learn-about-advair/learn-about-advair.html

Important to note in regards to sports and steroids: inhalation steroids ARE NOT the anabolic steroids which are abuse by athletes.

It is quite possible that you may need additional medication to get you under a higher level of control, and reduce your risk of attack. Singulair, an oral tablet that is normally taken at bedtime, has been approved as a preventative treatment for EIA. You would take it ~ 1 hour before running.

I'm hoping that you ALWAYS carry your Proventil-HFA with you. If you find it difficult to carry while running, it may hep to get a cellphone case to hold it, and clip it to your waistband. Additionally, I don't know if you were instructed on the proper maintenance of the unit. These new HFA inhalers clog more easily, and need to be taken apart and the plastic portion run under warm water to clean. Shake out, and leave to dry overnight before reassembling. Also, as I stated above with Advair, technique is EVERYTHING. Here is a link for meter-dose inhalers:

http://tinyurl.com/9hgl7z

Please note, with an MDI, S L O W inhalation is essential, not a quick gasp.

In addition, during an attack, you need to relax and breath slowly. Anxiety can worsen the episode. Never lay down, but either lean forward with your hands on your knees, or a similar position sitting.

Please let me know how this goes. Keep in mind, you should be under the care of a specialist to get optimum results. As a team, you will succeed. 15% of Olympians are asthmatics. It is all about understanding your condition and taking control.

Here is a link to find a specialist: http://www.aaaai.org/physref/

Sincerely,

Marc






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

QUESTION: well the thing is i am not seeing an allergist and my doctor has never mentioned a peak flow meter to me. but i have a asthma attack all times of the yr no matter what the weather is. why do i get so tired after a asthma attack? i always feel exhausted after i have one.


Answer
Hi Ashleigh,

You are not getting very good medical care. Sad to say, but a recent study by the American Academy of Allergy, Asthma and Immunology found that nearly 75% of general practitioners are not treating their patients by the asthma guidelines. This appears to be the situation in your case. Time for a new doctor. But to guide you to a new general practitioner, first use the resource:

http://www.aaaai.org/physref/

Once you have been evaluated by the allergist, ask for a recommendation for a local practitioner that the allergist feels to have a good handle on treating patients with asthma.

Now, then reason for your exhaustion is that with the lung inflammation and constriction, you are getting a poor exchange of oxygen, not only during the day, but even worse at night, disturbing your rest. I'm providing you with an image of what takes place in the airways of your lungs. With good medical care, you'll become a new person.

Asthma Airway Image: http://www.ngis-ga.com/images/asthma_airway_3.jpg

If you'd like, I offer an online asthma education program that teaches you how to take control of your condition. There is no charge whatsoever for this, as well as no advertising. To enroll, send me a return note, marked PRIVATE, with your name (first initial of last name is fine), your email address, and your birthdate.

Once you are under proper medical care, within weeks you will begin to feel like a new person, with a noticeable improvement in your athletic performance, in a addition to quality of life.

Let me know what you think.

Sincerely,

Marc