Expert: Marc Rubin, RPh Asthma Educator - 1/2/2011

Question
A couple times a month i will start having trouble breathing and get a rash either on my back or chest or both. I don't think the rash is acne because it will go away after a couple of hours. I do have asthma and allergies. Environmental and food allergies. And I'm on Advair and singulair to help control my conditions. I am not sure if it is my allergies because it is cold where I live at this time of the year... Could it be a type of mold that is causing my allergies to act up? Do I need to get a stronger dosage of the medicine I take to help control the symptoms?
Could it be that I am allergic to my medicines? But I think that's highly unlikely,, I've been taking them since I was about 9 years old and I am now 14. Which makes me think that maybe I need a higher dosage because I have been taking the same amount for the past 5 years.

Additional information:
I was previously at the doctors in November because my mom thought I could of had an pneumonia. He gave me an antibiotic to help fight the infection. Now it's two months later and I am experiencing the same symptoms.. trouble breathing and yellow-colored mucus, some wheezing, but now I have a sore throat too. Is it just my allergies and asthma?

Answer
Hi Jamie,

Sorry for the delay. AllExperts did some program modifications that had an effect on my receiving messages.

Now, back to your problems.

Your rash, in all probability, is directly related to your asthma, in the sense of how your body reacts to "triggers". There is a cell type that is in the lining of your nasal passages, as well as your throat and lungs. These are called "mast cells", and they contain the chemicals which, when released, cause all of your asthma symptoms. Guess what, they are also in the outside skin layer. It is not uncommon for patients with asthma to also have eczema or psoriasis. The fact that it only lasts for a few hours is great, and it may be an indicator of trigger exposure for you. It clears up after you get out of that environment.

Regarding your medications and dose, above 14 years of age, the Singulair dose would be 10mg every night. The Advair dose would be dependent upon the degree of impairment you have with your breathing. If you use your reliever inhaler less than twice a week during the daytime, and you wake up less than twice a month at night, then, under the latest guidelines, your physician may consider cutting you back to only having the inhalation steroid component of the Advair, rather than both drugs. The steroid only product is Flovent, which is also taken twice a day. If your doctor felt this may be appropriate, another consideration would be to change you to Pulmicort Inhaler as the steroid. The advantage would be once a day dosing, thus simplifying your life.

To address allergy to your meds, have you provided me with all that you are taking, not just daily, but as needed? Of what you indicated, very unlikely.

Where I do have a concern lies in three areas: 1) what type of home do you live in? Basement, attic, new or old construction (over 20 years old), and any pets? In cold weather, we close up the windows, push dry, potentially dusty air around, and maybe even use a humidifier with a moisture element that has not been replace, that has become full of mold. These need to be addressed. 2) Do you drink plenty of fluids in this dry, cold weather? Your lugs dry out more quickly, making them more sensitive, as well as more difficult to get rid of the garbage that you inhale since the mucous becomes thicker, and 3) stupidly, parents allow their kids to go to school sick, and you get exposed to those germs and viruses. Avoid them when possible. Be sure to get your yearly flu vaccine too!

Control of asthma has two components: 1) proper medication and device technique with inhalers and sprays, 2) avoidance of triggers which can affect you. If you are going somewhere where you know in advance there are issues (dogs, cats, etc.) it would be advisable to take an antihistamine in advance.  ALWAYS carry your quick relief medicine.

Need more help, just get back to me.

Good luck!

Sincerely,

Marc