Expert: Marc Rubin, RPh Asthma Educator - 10/25/2011

Question
I am 23 years old, weight 270lbs. Asthma as a child but nothing since I was 9 years old. I went to the ER for rapid breathing as well as difficulty breathing. I lost feeling in my arms and legs. My blood pressure was high, heart rate was 171 but my oxygen was 100. After several hours of breathing treatments, both albuterol and xopenex, nothing was working. They did a chest x-ray. Showed slight pneumonia, started on steroids and antibiotics. They admitted me for 5 days. Echo of heart showed an overactive left ventrical but they said that would not cause any of this. Heart rate never went under 100 while I was there and up as high as 180. My blood pressure was a little high but not bad. My temp was around 100.9. All blood work came back normal. Blood gas test showed normal. Oxygen was always at 100. CT scan of chest showed no blood clot. They discharged me. I still am having a lot of difficulty breathing, hard to even talk and can not catch my breath, fever of 101, heart pounding out of my chest. Nothing is helping - do you think this could be more than just asthma? All they sent me home with is steroids to tapper off of and xopenex inhaler. No antibiotics because they didn't feel it was an infection. I do not know what to do. I do not want to go back to the hospital for them to not do anything for me but I can not breath. I can not get off the couch or even talk without being out of breath. Any suggestions?

Answer
Hi Lisa,

I'm certain that the doctors informed you that your weight is a major part of your issue. When you lay on your back, all that stomach weight is pushing back against the muscle sheet below your lungs ( it is called the diaphragm)which is trying to pull your lungs downward to open and fill with air. It is as if an adult weighing 140 lbs is sitting on your stomach.

To look at that specific point, to help you breath, not laying flat, but in a reclined position would be helpful. That way the weight would not be pressing directly on the same area your lungs are trying to open to. A living room chair that reclines with a support that comes up from the from for the legs would be ideal.

To begin to help you loose weight, one thing you must eliminate is pop. One of my customers went to strictly drinking water and milk for fluids, and was loosing 1-2 pounds per week. It is generally what your target should be since more aggressive weight loss methods usually fail.

Bottom line, weight loss is not an option for you. The strain on your heart is tremendous, and further complications like diabetes will likely develop, all reducing your quality of life. Don't do this for others, do this for YOU so you can have a better life. Include in your dieting exercise EVERY day. Start with going for walks. Maybe 1/2 to 1 block. If you get exhausted, stop and rest. The weight didn't just appear overnight, and you just have to think about slow, steady progress. Ignore the negative comments from people around you. As I said, do this for YOU.

You didn't mention your race, but I'm concerned about the fact the emergency room used albuterol & Xopenex, but not Combivent (albuterol + ipratropium). Although not commonly seen, but occurring a bit more often in Afro-Americans, is a genetic variation where albuterol does not work, but ipratropium does. The standard of care in en ER is to use Combivent (which comes under a few names)in treating a patient with an asthma attack, because yo don't have time to check genetics, and AFTER the patient is brought under control, switch to albuterol. THEN, if that doesn't work, they would use the plain ipratropium inhalation. If that therapy works, then you know the patient has that gene issue, and the proper drug would be used from that point forward as a reliever. Talk to your doctor about his.

I hope this helps.

Sincerely,

Marc