Expert: Marc Rubin, RPh Asthma Educator - 6/16/2010

Question
QUESTION: i have had asthma for almost three years. orginialy i was just on albuertol then they added advair because my asthma attacks were so bad that i can't even stand up by myself when i have my asthma attacks and stuggle greatly to breath when i am having my asthma attacks. i have trouble remebering to take the advair twice a day but if i do it works . but if i don't it won't work intill i take it for at least a month without missing a dose. is there anything else i can  take that i only have to take once a day? i am 17 and i need to control my asthma for cross country and swimming.

ANSWER: Ashleigh,

Right now, there is not a single product that combines the anti-inflammatory medication with the long-acting airway muscle relaxant. There is one that may be available later this year, but it is in pending status.

In addition, as your asthma gets under control (less swelling in your lungs) the doctor may feel he can step back from the Advair combination drug (assuming lung testing shows considerable improvement), and just use the anti-inflammatory drug. At that point, the doctor could switch you to Pulmicort Inhaler, which may be dosed once a day. It is EXTREMELY important right now that you take the Advair twice a day. It is taken every 12 hours, so if you get up at 7am, take it again around 7pm, but at least be sure to get that second dose in before bedtime. Lung swelling increases overnight, and can result in you waking up about 4am with difficulty breathing. The evening dose helps to prevent this from happening, giving you a better nights sleep, and much more energy, since you will be well rested.

It takes about a month for the anti-inflammatory to really start showing benefit. Before that, the reason you are feeling better is from the second drug in the combo that relaxes the muscles in the airways. People who only took this part of the combo without the anti-inflammatory had increased risk of dying, since the swelling was going on non-stop. Once under control, you may possibly need only the anti-inflammatory for control, with your albuterol for rescue, or before your athletic exercises.

DO you have a peak flow meter?

Do you fluid load starting an hour before athletics, and continue to drink while participating in the events?

Do you know if the people where the pool is at are very careful with the amount of chlorine in the water, and if it is an indoor pool, do they keep it well ventilated?

Let me know, and I'll give you additional guidance.

Thanks for your patience!

Sincerely,

Marc


Marc

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

QUESTION: no i don't even know what a peak flow meter is . and yes i drink fluids the whole day and even more during competition. i don't know about the pool since each meet is at different places and we practice at a different place than we race at.

ANSWER: Hi Ashleigh,

A peak flow meter is an inexpensive device that helps you monitor how your lungs are performing. Here is a complete explanation of what it is, and how to use one:

http://www.cchs.net/health/health-info/docs/1500/1545.asp?index=4298&pflag=1

They allow you to know how your lungs are doing, even before you begin your activities, and as you get exhausted, you will know whether it is fatigue, or your lung function going down.

They retail for ~ $20 to $25, although allergists often have them available for free. As an asthma educator, I have access to free ones also.

Glad to hear that you keep yourself well hydrated. Based upon that knowledge, I sense you are already aware of proper warm-up and cool down routines.

How is your breathing through your nose? Stuffiness? Does your nose seem to block up when your lung function also goes down?

Any pets at home?

About how old is your home? Do you have a basement?

Get back to me on these items please.

Sincerely,

Marc

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

QUESTION: i don't know about my nose i just am trying to keep breathing and not passing out. i have 2 dogs at home. and my home is 4 yrs old and no i do not have a basement.

Answer
Ashleigh,

It is extremely important that your dogs do not have access to your bedroom. There are not ANY breeds that do not aggravate asthma, and the presence of their dander in your bedroom has the effect of worsening your airway inflammation. My wife didn't believe me (she too is asthmatic), but after a doctor visit where her lung function was down 40%, I shampooed our bedroom, washed down the walls, changed to fresh linens, and put up a baby gate to keep our two dogs from the bedroom. She could not believe it (thought I was nuts!), but for the first time she could remember, she slept better, and woke up with more energy.

Our family room was her greatest offender after that. We recently got new couches after 15 years, and new carpeting, and now she is better all the time.

No basement, new home, no mold issues. GREAT!

Marc