Expert: Marc Rubin, RPh Asthma Educator - 5/28/2009

Question
Marc,
My son is 17 and has EIA. He takes 2 puffs of Proair 15 minutes before a sporting event. Near the end of a game, when he has been running hard, he will have an asthma attack very suddenly. The trainer gives him the inhaler for the emergency, but its a scary event and I am very concerned. He was using Flovent in the morning and night in addition to the Proair before the event, but that didn't affect this scary outcome. I have read that Singulair taken 2 hours before the event may work better, and use the Proair only if there is a problem. We have been told by the doctor not to use the Proair inhaler more than once in a 4 hour period. HELP!
Thanks.

Answer
Hi TK,

A few questions first before I can go into the best approach to reduce your sons' issues.

1) Since the majority of patients with EIA have allergic asthma, has your son been evaluated by an allergist? There are 3 things to look at: a) on a complete blood count test (CBC), the eosinophils are elevated beyond the normal range, b)spirometry testing with either methacholine challenge, or a retest following an albuterol treatment to check for lung reactivity, and c)ideally a skin test series, to see what he is reactive to.

2) What sport is your son playing? Also, does he also play indoors and have this problem? There used to be a sports facility in my town that was shut down due to high levels of mold. Not a place where someone with asthma would want to go.

3) What medication does your son take on a daily basis? When he received the Flovent and Pro-Air, was he given VISUAL instruction into proper technique?

4) Does your son have a peak flow meter? If yes, does he know that he must update his "personal best" value every 6 months?

5) Where specifically do you live? Do you monitor pollens and air quality conditions?

6) Besides taking Pro-Air before the event, what else does he do to prepare beforehand, and how does he cool down?

This will give me a better handle on the approach we will need to take.

Regarding the doctors comment that Pro-Air should not be repeated in less than 4 hours...yes it can be, BUT, this would be a strong indicator that your son is in poor control, and the doctor is concerned about a very severe attack. It doesn't seem he is being very proactive in reviewing treatment options. My guess is that you've seen my postings regarding asthma and Olympic/professional athletes. We can work through this, and the key component is increasing knowledge through asthma education.

I'll be watching for your response. I should be able to respond by tomorrow evening.

If I see you have an event today (Saturday), I'll give you a quick guide before the thorough follow-up.

Marc