Expert: Marc Rubin, RPh Asthma Educator - 4/15/2009

Question
QUESTION: i am a 16 yr old female cross country and track runner in september of 2007 my doctor diagonosed me with exercise induced asthma. this fall we went back to the doctor because after my cross country(xc) race i would have severe asthma asthma attacks. i was then prescribed advair it worked after a week and helped  a lot but then i kept forgeting to take it at night because you have to take it at morning and night i would take it in the morning but forget at night so it stopped working i haven't gone back to my doctor yet but before i did i was wondering if there is any asthma medicine that only has to be taken once a day? i am also taking albulterol for my inhaler. i live in the U.S. and like in a relatively small county. My only things that cause a asthma attack is hard running please help. i am tired of having asthma attacks after i finish my xc race please help me breath again! thanks

ANSWER: Hi Marie,

Is the doctor who prescribed the Advair an allergist?

Most patients with exercise induced asthma (EIA), have typical allergen induced asthma, it is just that the biggest trigger is exercise. Part of the issue is that you are taking in large quantities of pollen and mold enriched air which triggers a higher level of inflammation and spasm. Skin testing would confirm this. Let's assume this also applies to you, in which case our goal would be to reduce lung inflammation.

While Advair is taken twice daily, (Advair is a combination of an inhaled steroid + a long acting version of albuterol), Pulmicort Flexhaler can be taken once a day. Also, there are two other drugs that are beneficial to EIA, Intal Inhaler, and Singulair tablets.

Intal (cromolyn) stabilizes the lung cells to reduce the risk of reaction from outdoor pollen and molds. It has no effect on heart rate or blood pressure. It would be taken ~ 15 to 30 minutes before exercise. IF you had an attack, you could still take albuterol for rescue.

Singulair, while normally taken at bedtime, could be use also, but taken about an hour before exercise. It blocks the release of chemicals which inflame the lungs.

You would still be carrying the albuterol rescue with you during the event. Actually, you should ALWAYS have it with you, exercise or not.

Now, let us address your preparation:
1) always begin fluid loading ~ 1 hour before running, and continue drinking fluids while you run. I'm hoping you are already doing this. If your lungs get dry, they also become more reactive, so this is very important. If you don't do this, stores that support runners gear sell belts with a number of small water bottles attached. This way you do not have a single large bottle bouncing around.

2) always warm up before you begin running, and take a 10 minute cool-down afterwards, e.g.; jogging in place. This allows a better temperature transition for your lungs.

3) if it is cold outside, wear a neck gaitor ( http://www.amazon.com/Classic-Polar-Fleece-Neck-Gaiter/dp/B000MEBLKM ). They are generally a fleece tube that you wear around your neck to pull up over your mouth and nose to breath in warm, moist air. They cost ~ $14 at sporting goods stores. Cold air is a definite asthma trigger.

4) if you don't have one, get a peak-flow meter. It is a tool that evaluates lung function. They run about $25. You re-evaluate your personal best every 6 months, since your lungs keep growing until you are 25. Here are instructions on how to use one: http://tinyurl.com/6h4g9

It shows you how good your air flow is out of your lungs. It is keyed like a stop light into Red-Yellow-Green zones. If you are not familiar with this, get back to me, and I'll go into it further.


I hope this helps you. Good luck chasing your dreams :)

Sincerely,

Marc


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

QUESTION: actually it was not a allergist that prescribed it to me it was my primary care physican. but the thing is i dont have allergies. i know you said that excerise induced asthma you have regular asthma and have other triggers but i have never had an asthma attack not from running. Why are my asthma attacks so bad? it takes me at least 5 minutes to get my breath back! can you explain the peak-flow meter please i have never heard of one!

Answer
Hi Marie,

Unless you have been skin tested, you cannot say with certainty that you do not have any allergies. Also, only about 10% of people with EIA just have pure EIA.

A peak flow meter is a plastic device that measures the force of air you exhale in a maximum exertion huff. They come with a chart that gives the average predicted score depending on age, gender and height. It is a good starting point, but for best effect, you determine "your" personal best.

I prefer the testing to be done between noon and 2pm, when your lung function is the best. First, slide the indicator down to zero. then,either standing or sitting down, you inhale deeply, put the device in you mouth without blocking the opening with your tongue, then huff as hard and fast as you can. Do this 3 times. take the best of the 3 readings. Do this for 2 weeks. From this, the highest number you achieved is your personal best. There are usually sliders that you adjust to reflect how you are doing. Lets say your personal best is 300.
Adjust the green slider to 80% of that score to 240. Then slide the yellow slider down to 50% of the 300, or 150.

From 80 to 100 % is considered the "Green Zone", or normal breathing function. 50 to 79% is the "Yellow Zone". This is where your lungs have an increase in inflammation, and you should take an albuterol treatment. After 20 minutes, I'd expect you to be back in the green zone. Below 50% is the "Red Zone". This is where your lung function is poor, you need to immediately take your albuterol, and let your doctor know immediately. This is a potential emergency.

Lung function varies during the day. It is at its lowest in the middle of the night into early morning, then improves and peaks about 2pm, and heads down again after midnight. This applies to everyone, not just asthmatics. It is normal for your peak flow meter to give results in the low green range when you wake up. If it is in the yellow range, again, take an albuterol treatment.

Also, you will find that when you have a viral infection, since viruses increase lung inflammation, you should expect a decrease of peak flow readings during this time.

Whether running, playing soccer, swimming, or any other active sport, if your levels are in the yellow zone or below, don't continue until you are back in the green zone.

The medications I informed you about are beneficial regardless of allergy induced asthma or EIA. The more you learn about your asthma, the better able you are to take control. 15% of Olympic athletes have asthma, and they also win ~ 15% of the medals. It is all about being smart and taking control.

I'd really like you to see an allergist at least once, for a proper evaluation. Knowledge is your most powerful weapon, and will protect you from mishaps.

Here are some sites for more info on asthma:

http://www.aaaai.org/patients.stm

http://www.aaaai.org/patients/publicedmat/tips/exerciseinducedasthma.stm          (specifically on EIA)


Let me know if I can be of more help.

Sincerely,

Marc