Expert: Marc Rubin, RPh Asthma Educator - 12/29/2007

Question
Hello, I am 14 years old and was diagnosed with mild asthma when I was about 2. Since then, I have been on Singular, Advair, Albuterol, Pulmacourt. I was only hospitalized once. I play soccer, do gymnastics and run track but I notice that I get out of breath very easily. How can I tell if that is just being out of shape of whether it is my asthma acting up,

Answer
 I'd like to begin by commending you on being so actively involved with sports. It is so important for maintaining your overall lung health, as well as for your whole body. About 14 of Olympic athletes have asthma, so way to go!

My first question would be as whether you were born prematurely. Preemies have underdeveloped lungs, and in the early years of life, frequently contract an infection called RSV. It is not uncommon to outgrow this early form of asthma. Second, is the physician you've been seeing these past years re-evaluated your lung function with spirometry? If the answer is yes, that's great, except for the fact you probably do have asthma. If you have been evaluated by an allergist, even better to get the correct answer. My next question pertains to skin conditions. It is common for asthmatics, where the cause is allergic in nature, to have psoriasis or eczema.
 If from all of this, and a review with your doctor it is determined that you do indeed continue to have asthma, then from what you indicate, your therapy is in need of some subtle adjustments, as well as your workout routine. If you are not already currently using a nasal spray like Flonase, or Nasacort AQ, and yet you have an itchy, runny nose, your nasal allergic response is probably triggering your lungs to react. If you are already on Singulair with either Advair or Pulmicort, and still not in control, the NHLBI guidelines call for this to be referred to an allergy specialist.     Regarding your exercise/sports routine, it is important to do warm ups for ~ 15 minutes before exercise, and increase your fluid intake beginning an our before exercise and continuing through the duration. If you are outside, and the weather is cool or cold, I'd suggest getting a neck gator (a turtleneck sweater w/o the sweater part)to keep up over your nose and mouth, to warm the air you inhale. At the end, you need to do a cool down, so your body readjusts to the conditions. Furthermore, from a medication point of view, you may want to discuss with your doctor about pre-treatment with Intal, a drug which reduces the response to triggers which enter the lungs, and yet, does not increase heart rate, unlike albuterol. This would be best suited for track and soccer, where pollen and mold become a greater issue.
 Finally, become aware of pollen and air quality issues. The weather channel on the Internet, pollen.com, and some other web sites will give you daily reports as to weather conditions where you may choose to make other exercise choices for that day, or be extra careful, and don't push it. I hope you always have your albuterol with you, and I'd also advise carrying an inexpensive peak flow meter which you recalibrate every 6 months, to help monitor your lung function. Your doctor should provide you with what we call an Asthma Action Plan.Go to this site for a good copy: http://www.lungusa.org/atf/cf/{7A8D42C2-FCCA-4604-8ADE-7F5D5E762256}/AAP.PDF - It guides your therapy adjustment based upon symptoms and peak flow numbers. With all this, you should do terrific!