Expert: Marc Rubin, RPh Asthma Educator - 8/9/2009

Question
I am a 20-year-old female that has had difficulty breathing since the age of five. I grew up in an apartment in Phoenix and was taken to a doctor at age six, who placed me on a nebulizer for two years with Albuterol and saline, which did not help. At age 13 I had pneumonia in my left lung for about a month. At age 16 I saw an allergy specialist who tested me for asthma and I was able to inflate the monitor after three attempts. My breathing problems may be partly due to acid reflux, but my breathing is labored even when I haven't eaten or drank anything.

I am still suffering from breathing problems, pain in my joints, headaches, dizziness, lightheadedness and a blood pressure of 100/70 with pulse 92. In addition, I am also allergic to pollen. I was tested previously for about 100 different allergens and I was allergic to most. The allergy skin tests all came back positive.

I am going to a free clinic next week and I would like to know what questions I should ask and which conditions are most likely for someone presenting with these symptoms. I am not currently on any medications and I now live in Lynchburg, VA in a house and work at Macy's in a mall.

Answer
Hi Tina,

With your continued breathing difficulties, I'm disturbed that you have not been on any "controller" medications. These are medications taken on a daily basis, to reduce the inflammation in your airways. Products such as Flovent, Pulmicort, Advair, Symbicort, Singulair, etc, are covered by state programs, should it be you don't have any health insurance, and also at significantly reduced costs if you don't even have state aid.

The clinic should at least run a CBC with differential to see if allergic components are elevated. Also, although unlikely related, I'd have them do some testing for Rheumatoid arthritis. I'm concerned about the possibility that you have a very overactive immune system, and both these conditions are immune disorders. Your blood pressure is somewhat indicative of anxiety and stress. When you sit to have it taken, be sure that you have not had any caffeine in the past few hours (or smoked, although you didn't indicate that you do). Then sit for 5 minutes and relax, THEN have the BP taken. Do it this way for a number of days to get a consistent average. Your sensation of lightheadedness is most likely due to your asthma, and poor oxygen exchange. One piece of information you didn't supply, your race. In your message you indicated that albuterol did not work for you. There is a genetic variation in response to albuterol that occurs to a greater degree in the black population than in causasian or hispanic populations. If you never had any relief with albuterol, the physician should then try Atrovent (Ipratropine). If it works, then you have the gene variation. This variation only seems to affect the response to the fast-acting rescue albuterol, not the long-acting versions. If this too doesn't help, then there would be the need for a full reassessment of what your lung ailment is.

Hopefully soon, Macy's will provide you with health insurance. Once that is done, get yourself to an allergist/immunologist (with your past medical records, if possible, to get you under control.

I can now provide you with asthma education at no cost, through the company I consult for. If you are interested, just send me another inquiry with your email and your birthdate. You will then receive educational programs from Emmi Solutions. IMPORTANT: make the message to me PRIVATE so your information is not posted on the AllExperts site.

I hope this helps you. Get back to me with further questions if necessary.

Sincerely,

Marc