Expert: Marc Rubin, RPh Asthma Educator - 9/18/2010

Question
QUESTION: hi. i am a 17 yr old running high school xc and i have exercise induced asthma. i have been taking advair 250/50 and it was working at first when i was slower but now that im getting faster its not working. my asthma attack was so bad that when i went to a big race a couple days ago they had to tear my number off for me and then take me out of the line because i couldn't even  stand up all the way without falling over. should i go back to my primary doctor or should i go see a lung specialist?

ANSWER: Hi Ashley,

See an allergist. You can locate a board certified specialist at http://www.aaaai.org/physref

Most people with EIA have asthma, not just exercise induced airway spasms.

Just for review:
1) begin fluid loading 2 hours before exercise, and continue fluid intake during event,
2) warm ups beginning ~ 15 minutes before activity
3) ALWAYS carry your rescue inhaler with you at all times, even during the event,
4) check your peak flow meter reading to be sure you are in the green zone BEFORE you even begin. If you are unfamiliar with a peak flow meter, get back to me.
5) be very aware of pollen conditions, temperature and weather changes.
You can get your specific pollen & mold stat daily sent to your email form http://www.pollen.com
In addition, for your knowledge, if a thunderstorm front is moving in, ahead of the front is a wall of ozone generated by the lightning. This is a strong asthmatic trigger.
6) be sure to get your annual flu shot!

If you have an attack, stay calm, focus and slow your breathing rate, and take your rescue inhaler. You can stay standing, or sit, but lean over forward to open up your rib cage. DON'T lay down.

This is a start. Keep me posted.

Sincerely,

Marc

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

QUESTION: i dont have a peak flow meter. can you tell me what it is?

ANSWER: Hi Ashleigh,

Something must have happened with the server. I sent out info on the peak flow the same day. Oh well.

Where a thermometer tells you your core body temperature, a peak flow meter gives an indication of airway restriction,or how closed down your airways have become.See attached picture.

http://www.bodyhealthguides.com/wp-content/uploads/2009/11/Miniscule-Electrical-

Until you're lungs are in good shape, the meter will come with a chart that gives you what your ideal value is for your age, gender and height. It is an approximate, not necessarily the correct number for you, but a starting point. As your lungs improve, and the inflammation is reduced, you test yourself to determine YOUR personal best. This is repeated every 6 months until you are 25 years old, when your lungs stop growing.

When you are doing well, your meter reading should reflect 80 to 100% of ideal target. That is the GREEN zone, like a stop light. 50 to 79% is the YELLOW zone, a warning that your lung function is diminished, and you should take a rescue treatment with your inhaler. That should bring your back to the GREEN zone in 15 to 20 minutes. Below 50% is the RED zone, here, you are in danger, need an immediate treatment, contact your MD, and possible go to the ER.

Here are two guides to Peak Flow Meters. The second device is the type I prefer, but the first link is more in depth:

http://tinyurl.com/6h4g9

http://global.respironics.com/UserGuides/AsthmaMentor.pdf

A final consideration is the creation of an "Asthma Action Plan", a plan of action you and your physician create that guides you specifically how to respond to your lung function. It has a place to note your response to your peak flow readings, but also classifies your lung function by symptoms. Feel free to print out and take to your doctor. A copy of the completed guide should be given to your coach:

http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf

Let me know if you have any questions. We can next work on triggers for you to watch for.

Sincerely,

Marc

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

QUESTION: well why do you think that my doctor has never said anything about a peak flow meter to me before? i know what my triggers are but i am not going to stop running and swimming just because of my asthma. but my doctor recently increased all of my medicines . i am on the 500/50 advair and i am to take four puffs of my inhaler before i run.

Answer
Ashleigh,

General practice physicians: pediatricians, family practice, internists, are all trained in the diagnosis and specific treatment of disease. Their training takes them to a certain level, after which they should be referring the patient to a specialist who has a much deeper training and knowledge base in a specific area. Allergists have as a component of their training sports medicine. At the AAAAI website, there are two articles, one on sports related asthma:

http://www.aaaai.org/patients/publicedmat/tips/exerciseinducedasthma.stm

http://www.aaaai.org/patients/topicofthemonth/0708/

It is a difficult job for a general practitioner to keep up on all the different illnesses that can strike the human body. It is not a failing of the doctor, but a reality of the complexities of medicine. This is why there are specialists: narrow focus, much greater depth of knowledge.

If your doctor is upping you to Advair 500/50, it is definitely time to see a specialist.

To perform at your best, you must take control of your asthma, or your performance will suffer, and you risk personal harm. There are many professional athletes with asthma....but they got there because they got their asthma under control.

Get to a specialist. I'll be happy to continue to help you. I coached soccer for 10 years, and worked with asthmatic athletes. Half of the treatment is not medicine, but knowledge. You need to learn more to succeed.

Talk to you soon!

Marc