Expert: Marc Rubin, RPh Asthma Educator - 7/5/2009

Question
I am a 37 year old woman with no history of asthma. I have smoked since I was 14 years old about half a pack a day. 5 months ago I got Pertussis. It was the worst thing I have ever had to deal with and have quit smoking. The whooping cough lasted the full 100 days and has subsided. I find I am now left with asthma. The doctor put me on advair 250mg 2x daily and ventilin as needed. I have not been able to excersize for this whole time as when I try to do anything I have a full blown asthma attack. I was taking the advair daily and noticed that I have now gained 20 lbs probably a combo of the steroids and quitting smoking, so I have stopped taking the advair ( bad idea? is there anything else that wont make me gain weight? )  I have noticed with the heat and not taking the Advair that I am having mini attacks and having to use the ventilin alot more. My lungs are super itchy in my back and the thought and feeling of not being able to breathe is driving me nuts! I want to be able to excersize again but am scared too as last time I had a full blown attack. Have you ever heard of someone aquiring asthma from pertussis and if so does it go away? Anything you can recommend for helping speed up the process would help! This is ALMOST as bad as having the whooping cough!

Answer
Hi Sandra,

First, are you being treated by a pulmonologist or a general practitioner?

Have you been through any pulmonary function tests, like spirometry?

The weight gain is predominantly due to smoking cessation combined with your present inability to exercise and burn off calories. Start watching your calorie intake closely. If you were on oral steroids, it can take a few weeks to loose the water weight it put on you.

You need to remain on the Advair. Although it provides early symptomatic relief with one of the two drugs in the device, it takes up to a full 6 months until the steroid component reaches maximum benefit.

My concern is that you may have 1) developed bronchitis after the pertussis, or 2) you are displaying symptoms of COPD (chronic obstructive pulmonary disease). This is why I asked if you were evaluated by a pulmonologist. With bronchitis or COPD, you would still be presenting with chest tightness and shortness of breath. Similar therapies are used, but the correct diagnosis is essential.

Congratulations on recognizing the smoking contributing to your issues, and your cessation. That effort is outstanding, and please, don't go back.

Regarding the heat. The hot air is also going to be dry if no moisture is added to it, and hot, dry air will stress the lungs. Increase your fluid intake, as well as utilize a room humidifier, especially in your bedroom at night. Make sure to keep the humidifier clean, so it doesn't build up any mold.

As you begin to feel better and wish to try exercise again, start by fluid loading 1 hour before exercise and continue fluid replacement throughout the exercise. Also, 15 minutes before exercise, take 2 puffs of your Ventolin. These preventative measures may get you through.

After you get back to me regarding the lead off questions, I'll follow up with some more information.

Sincerely,

Marc