Expert: Marc Rubin, RPh Asthma Educator - 3/23/2011

Question
QUESTION: Hi

Thanks again for your useful reply.

my doctor agreed to try Singulair for ten days start from tomorrow. But the Cromolyn is not available here in Malta and he asked if you know the supplier so we can contact him. is there any similar medicine which does the same job??

about your question, our team leader is good at coaching and finding the best bike position. when i'm fully recovered from my chest infection he's gonna do a program for me.

my doctor told me i can do light training from tomorrow

Thanks Again :)))
Owen

ANSWER: Hi Owen,

I've been at a pulmonary conference this week. Tomorrow afternoon I'll send you a full list of various Cromolyn products. Also, I'd like to see how you would do with vitamin D3 supplementation. Asthmatics have a tendency to have low levels, which contribute to a lack of control, and as an added bonus, cyclists tend to develop osteoporosis, so it would also be good for your bones. Dosing is Vit. D2 (ergocalciferol) 50,000 units, once a week.

Talk to you shortly.

Marc


Crazy week: in 5 days ~ 700 miles of driving!

1) Typo Correction: Ergocalciferol is Vitamin D2
2) Both Intal Inhaler and Tilade Inhaler (a modified form of cromolyn) have been discocntinued by the manufacturer due to the propellant used is no longer approved worldwide. Although most metered-dose inhaler meds have been updated to the new propellant, the manufacturer of Intal and Tilade has chosen not to resubmit the products in the new form. Therefore, the only option on this drug would be to use the nebulized form. This would require the purchase of a nebulizer unit (the small, hand-held ultrasonic units run over $100 USD). The plug in versions can be bought for ~$50-$80 USD, although I don't know how much they would cost over there.

How are you doing?


Marc

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

QUESTION: Hello

many thanks for you're reply, sorry i'm replying late but i was busy too, not with that mileage because we need a busy month to cover all those miles here in Malta.

i'm feeling great again thank you. the Singulair helped allot i feel better in the morning. do you think it's best to take it before the workout instead before i sleep since i'm using Cromolyn before workout? still not racing yet, i don't want to rush into it, even the weather will get warmer

i will speak to my doctor on Friday.

Kindest Regards
Owen

thanks for your help!!

Answer
Hi Owen,

Since you were able to get the Cromolyn, at this point, stick with night time dosing of the Singulair since you are sleeping better. Improved oxygen exchange at night will give your body a better rest and more energy during the day. See how it goes for the next couple of weeks. If this improvement remains, you may wish to try the Singulair 1 hour before riding, but monitor your peak flows from this point forward in the early morning when you arise, and see what happens to those readings after switching to 1 hour pre-ride. See which way gives you the best overall benefit.

I just got off jury duty, and will be leaving in the morning for vacation. I'll be returning April 3rd.

Talk to you then.

Sincerament,

Marc

(How'd you like that Maltese! :-)