Respiratory Therapist/asthma

Advertisement


Question
Hi,

Over the past year and half my allergies have gotten much worse and I have now developed Asthma. I take zyrtec, Singulair, Dulera 200/5, Mucinex and Protonix everyday now. I also have a Proair inhaler and an epi pen. I was getting allergy shots once a month for dust, pet dander and pollen, but my allergy doctor has increased the frequency to every 2 to 4 week (with the recommendation of coming closer to the every two weeks). I was on Advair 250/50 instead of Dulera, but my health insurance does not cover it anymore causing the change to be made. My asthma seemed better controlled on the Advair, but the problem may be the spring instead of the medication. My lung function overall when tested is good and my heart is good. I had tests to check both out when breathing became a problem. My asthma seems to get out of control every time start having sinus problems. I usually have to go to my doctor's office for a breathing treatment.

Here is my question now that you have some background on me. When my breathing issues started I decided to make an effort at becoming healthier. I have gone from weighing 260 pounds to 210 pounds. I am still overweight but not I am not done with my journey in that regard. I now run 5 to 6 days a week if my work schedule will allow it. I like running outside best even though it effect my breathing/ allergies. When I try to increase my pace my chest gets tight and my asthma starts acting up. I have tried taking my Proair inhaler before my run, and I have tried taking it after my run. I have not seen much change either way. Sometimes it seems like I do not need the inhaler at all for running and other times I have an asthma attack while trying to run. If I slow down the breathing calms down slightly, and I can usually stop or prevent the asthma attack when I feel it coming on. When I run I go three to 6 miles each time, and I do want to increase my pace. What can I do to help my breathing while I run?

Answer
Hi Annie,

I am  glad that you have decided to get healthy to help improve your allergy and asthma situation; good health will be your best ally.  

Breathing problems are not uncommon for asthmatic runners and worse for some than others but in most cases these problems seem to diminish with regular exercise and well-controlled asthma/allergies. You have a few more challenges due to your allergy situation. Sensitization to certain agents can enhance sensitization or sensitivity to other agents which can over-burden the immune system and reduce threshold response levels.  And, I noticed you are taking Protonix so I am guessing it is for GERD. GERD and asthma can certainly have an antagonistic relationship which can make them both harder to treat, and the treatment for GERD can also present some difficulties as well. Keep in mind that Protonix and other similar medications can increase chance of some infections, which the steroids also do, and it can also induce sensitization to food and drug proteins causing new allergies, and may decrease nutrient absorption.


Basically, my experience has been that asthma symptoms and course are so highly variable among individuals that it seems to be tailor-made in most circumstances. While the acute symptoms are similar in most cases the root cause, triggers, sensitivity, response to treatment, and other factors differ considerably not only between individuals but from time to time for the same individual. While the right medications help to mitigate symptoms in most people, at least to some degree, they will not cure it, and most medications are not without side effects especially with long-term use. Another problem is that sometimes you just do not know what works or does not work until you try it, and sometimes nothing works as well as you would like it to. What we do know is that  proactively addressing factors related to key steps in the asthma cascade may help to greatly reduce or eliminate adverse asthma effects and ultimately reduce reliance on medications. The earlier and more diligently these factors are addressed the more likely that long-term chronic effects can be averted.

Keep in mind that your threshold level for response to allergens and irritants can be variable and some days it will be lower and you may already have some inflammation / airway constriction component that will not be that noticeable until there is a challenge, like exercise,  and this can make breathing more difficult during running or trigger an asthma attack. Also, for various reasons, some days one or more of your medications may not be as effective.

I have listed a few of the problems that might more or less directly affect your breathing while running:
A common problem in exercise-induced asthma  is the inflammatory effect of  breathing dry and, or, cool air which can lead to bronchoconstriction.   Also, many people tend to mouth breathe  at some points during running to get enough air  and this will also introduce unconditioned air into the airways. And, when you have allergy related sinus problems it is likely that your sinuses are not functioning adequately to warm, humidify, and filter the air you breathe appropriately as it is, but while running much more air must be managed by your sinuses than usual. And, allergic rhinitis  can precipitate asthma symptoms  so this may be more likely if you run during, or around, this time.

Another potential factor is that, depending on where and when you are running, there may be a number of irritants and allergens in the air that also contribute to inflammatory effects.  For instance, vehicle exhaust contains a number of irritants that have the potential to precipitate breathing problems, especially in asthmatics and sensitive individuals.  High levels of ozone and many other environmental agents that may be present at different times of the day or seasonally can also trigger symptoms. There is a relatively high prevalence of endurance athletes with asthma and  evidence suggests that chronic exposure of the airways to  dry air and irritants during training may have a role in causation or promotion. And, an increasing number of Olympic athletes are asthmatic as well. Here too, it is believed that stressful training and chronic exposure to irritants are likely culprits. So for people that already have asthma, and sensitive individuals, these can be significant triggers. However, asthma does not stop them from competing or winning.

A third consideration is your intake of dietary fat. It has been shown that within hours after a high fat meal asthmatics show increased airway inflammation and a decreased response to abutter inhaler. This indicates that effects can occur meal by meal and gives some insight into potential  variability of effects as well as for chronic effects and periodic exacerbations as well. Specifically omega-6 fats, when not appropriately balanced with omega-3 fats, are thought  not only to contribute to worsening of asthma symptoms but may also be a causative component since the increase of these fats in the diet  correlate with the  greatly increased incidence of asthma in the population and may promote increased IgE synthesis which appears to have a role in mediating allergen-induced asthma.  

Aside from high consumption of bad fats it has also been shown that  some asthmatics have higher exposure to free radicals due to lack of adequate antioxidant protection and this can worsen the symptoms and the disease process. Free radicals also  This also means that they are less able to handle environmental exposure to free radicals that may be encountered during running.

And, running can be very stressful to the body, especially if you have a few extra pounds to carry , and stress tends to adversely affect asthma symptoms. You may just be pushing too hard right now. You may feel like you  can do it, and want to do it, but your body/breathing is just not quite ready to take you there because your respiratory fitness is not matched to your drive.  You may find that as you get closer to your optimal weight that running will be less stressful and you will be able to pace yourself more flexibly. And, all of  potential problems noted previously, and probably many others not noted, like variable hormone levels, are additive stressors. Keep in mind that at this point pushing yourself  beyond certain limits is not healthy because you may actually be causing more damage to your airways and your overall health.  On the other hand, altering some of these limitations may just involve relatively simple changes that eliminate the right steps in the cascade that may help your meds to work better and you to breathe better.

Keep a diary if you do not already. Dates, times, what you ate, when you ate, weather, environment, where you ran, how long, if you needed or used medication, how you felt before and after etc, etc. Anything that is pertinent to determining factors associated with symptoms and  improvement. After a while you may start to see a pattern that can help you to adjust things to get closer to where you want to be. Always keep that picture of where you want to be in mind; if you can see it you can be it.
But, importantly, you need to keep your goals flexible and health-directed rather than concrete distance, speed, or time goals since the real goal is to maximize your quality of health and life.

Do not run at all if you have sinus problems, especially allergic rhinitis, other allergy symptoms, are too tired, have not slept well, it is too hot or cold out, or your airways feel at all irritated. Running under these conditions is more likely to produce adverse effects.

You need to stay well hydrated, but not over-hydrated, especially when you run, by drinking fresh water  (not sports drinks*), preferably without added chemicals and not from plastic bottles. Bring water with you  and sip as directed by thirst or if your throat feels dry, keep your sinuses moist as well with a moisturizing nasal spray.  When you start to need to breathe through your mouth it is time  for a break. If your airways are not adequately hydrated you will have problems.  * according to Harvard Health Publications

Do not eat too close to run time, especially high-fat or sugary foods.  We need fats, but good fats and in moderation,  too much of any fat is bad,  When you eat be sure to eat healthy and fresh foods that are high in nutrients and antioxidants, like fresh fruit and vegetables, and are satisfying.  I do not personally usually like to take many supplements but I do find that quality vitamin C supplements can be quite helpful. Try to avoid foods and drinks with added sugar. A  really healthy diet may also help with GERD symptoms as well. Actually, if you have no restrictions that prevent you from juicing this may be a great way to get and abundance of highly digestible nutrients and antioxidant support once a day. Many people are finding this to be of great health benefit.  

Try to find a peaceful place to run where there are minimal irritants and allergens and plenty of fresh air. Although this is sometimes difficult and there is temptation to run anyway remember that it is only adding to the  burden not helping it. You might also try changing locations if you find that you have consistent problems at one location or do an alternate indoor activity if pollen counts or outdoor pollution levels are too high or you have already been exposed to a high irritant or allergen load that day.

Take extra time to warm up adequately and  get mentally prepared for your run and also be sure take time to cool down as well. Do not underestimate the value of a proper warm up and cool down. Pay attention to your breathing as you warm up to get clues on any problems that might be starting or any adjustments you may need to make.  It sounds like you already have a good ability to tell when your breathing problems are starting and stop them early. Really successful runners, with or without asthma, learn to sync their breathing with the type of running they are doing to get maximum benefit and do the least harm.  Being aware of your breathing as you run  allows you to be more flexible and sync it with your pace so you can run more fluidly.  There  are several links below that address proper breathing during running and other types of breathing exercises that might be helpful.

Sometimes more intense workouts of short duration punctuated by adequate periods of rest help to improve stamina and help your respiratory system to adjust to greater levels of activity when you are ready to pick up your pace. Keep the intensity and duration manageable for your condition, and do not overdo it.

Other things that might help:

Be sure you are using your rescue inhaler appropriately (and others as well). I have noticed that many asthmatics stick the inhaler in their mouth and sort of suck on it or take short quick breath while most of the medication impacts on the oral mucosa and a relatively small amount  gets into the airways.  We generally utilize a spacer  to help with this but if one is not available the inhaler is held about 2 inches outside of  open lips, breathe and out  and synchronize the actuation with a slow, deep,  inspiratory effort through the mouth only,  to get the medication deep into the airways  and then held  for at least 10 seconds. Wait a minute or so before the next puff.  I know you probably know how to do this just fine but I am surprised at how many people literally waste their medication and get no benefit.

If you find that Advair works better than Dulera check to see if your insurance company will provide it if is specifically ordered by your doctor.  All meds are not created equal even though they are supposed to be the same thing. It is important that if you use a medication it should work for you, as well as not against you, especially your rescue inhaler, so if you are using it properly and  are still having symptoms during running  be sure to discuss this with your doctor as soon as possible.  You  do not want to experience an asthma attack and have an inhaler that cannot rescue you. And if you  ever feel you are improving to the point you need less, discuss this as well.  

Your home and work environments need to be as dust, irritant , and allergen free as possible. Dust has become a problem because it not only contains dust mites which can be allergens but it also may contain any toxic assortment of chemical molecules adhered to it and which you then breathe in. You can kill dust mites on washables if your hot water heater is set to 120 degrees F or greater (there is potential for scalding at these temperatures). There should be no air fresheners, or volatile cleaning chemicals, and the air filter should be changed regularly. Interior air can be more  unhealthy than outdoor air under some circumstances so be sure to open the house up and let is air out, if possible, every now and then.

Of course I am just making suggestions, not giving medical advice for you to follow. Remember, no one knows your medical history, current status,  and needs more than you and your doctor so make sure you are following his/her advice first and foremost and make sure that your activity plans have your doctors approval before implementing them. You might want to write up a plan and have your doctor take a look at it and see if he/she has any suggestions. Also, remember to keep your diary up to date so you can optimize your activity and your health.

Finally, there is a link  (the first one) to  some  breathing exercises that may be beneficial. I have not personally used this method but there is good evidence  that indicates that they are beneficial for some people and in some cases have allowed people to reduce or eliminate rescue inhaler use and improve asthma symptoms. You can judge for yourself.  Also, communicate with other asthmatic runners and find out what problems they have had and what helped; it might save you from making the same mistakes.

You can find a short article  and a few video at the websites  below that might be of interest.
http://www.nytimes.com/2009/11/03/health/03brod.html/?_r=0&pagewanted=print
http://www.youtube.com/watch?feature=player_detailpage&v=5xyDn-duPW4
http://www.youtube.com/watch?v=4IxSrh-qNp0&list=UUrPXcxZE3s_U3p0kEpCTjag
http://www.youtube.com/watch?v=qEsrTk4o7h8
http://www.youtube.com/watch?v=acvnJ7ImMak running and breathing
http://www.youtube.com/watch?v=8-_NNCrrdus diaphragmatic breathing

The link below is to a website where asthmatic runners discuss what works best for them.
http://www.myfitnesspal.com/topics/show/1181811-asthmatic-runners
http://www.nomeatathlete.com/breathing-when-running/


Best of luck and Happy Easter!

Respiratory Therapist

All Answers


Answers by Expert:


Ask Experts

Volunteer


Stephanie Tyrrell

Expertise

Respiratory Therapy is a very diverse field encompassing many specialty areas. I have experience in many of these areas and I am willing to answer any question I feel competent to answer within the scope of my experience in the following areas: neonatal ICU and transport, pulmonary rehabilitation, sleep studies, BiPAP/CPAP therapy, Holter monitoring, EKG, ventilator management, chronic and acute respiratory diseases,(i.e. COPD, asthma, restrictive disease, ARDS (acute respiratory distress syndrome), pneumonia, etc) and therapeutics, arterial blood gases, and others. Please see my profile under Experience for a full listing of areas of experience.

Experience

I have worked in respiratory therapy for over 25 years in all facets of patient care including level 4 neonatal ICU and neonatal transport, Director of Cardiopulmonary, community health fairs and networking, staff therapist, pulmonary rehabilitation, sleep studies and BiPAP/CPAP therapy, Holter monitoring, EKG, cardiac clinics, pre and post cardiac surgery education and patient care, emergency and long-term ventilator management, chronic diseases such as COPD, asthma, cystic fibrosis; acute respiratory distress syndrome, emergency room, home and nursing home respiratory care. I also provided temporary staff to area hospitals through an allied health business I owned and managed, while also working as a staff therapist for the business.

Education/Credentials
Certified Respiratory Therapist, Registered Respiratory Therapist, Licensed RT, NRP ((Neonatal Resuscitation Program) certified, BS Biology/Botany, MS Environmental Sciences - Toxicology

Past/Present Clients
Thousands of in-patient and out-patient clients in the hospitals I was/am employed by as well as a number of local hospitals that utilized the services of my allied health business. I currently work as a respiratory therapist at a general hospital and a rehabilitation hospital.

©2016 About.com. All rights reserved.