ASTHMA: DO YOU HAVE IT?

Asthma

by Claire Dorotik

 

        The sun is out, and your favorite trail is lined with bright yellow California poppies. You quickly forget the argument you just had with your boss and the bills you have to pay. You also forget that it is pollen season.  But when you begin running, you start wheezing, and your chest feels tight. You can’t get enough air. You are having an asthma attack. 

 

          “When I would have an attack, it would feel like my chest was in a vice”, recalls Steve Warshawer, elite ultra-marathoner, and sufferer of exercise-induced asthma.   Asthma affects 14 million adults and seven million children in the United States, according to Dr Ashok Patel, leading pulmonologist at the Mayo Clinic, in Rochester, Minnesota.  The condition accounts for 52 percent of inpatient visits for children and adolescents in the US each year. The Respiratory Institute established by GlaxoSmithKline, leaders in asthma research, report that asthma causes two million emergency room hospital visits and five thousand deaths per year, in the U.S.  If untreated, asthma can cause permanent lung damage. 

 

Warning Signs

 

          So maybe you don’t even know you have asthma.  That’s not uncommon. Asthma is defined, as “chronic inflammation and constriction of the airways”, according to Dr. Courtney Crim, director of the Respiratory Institute.  Typical signs and symptoms include faster breathing, wheezing and coughing, a feeling of tightness in the chest, difficulty sleeping and a decrease in peak flow (the volume of air you can expel from your lungs). 

 

An asthma attack, however, is defined by symptoms including: difficulty speaking, increased heart rate, blue lips and, a peak flow reading that measures in the red zone and a lack of relief from your inhaler.  If you don’t know if you have asthma, this would be mean continued wheezing and coughing, even after slowing down, or resting.

 

At the Mayo Clinic, a correct diagnosis of asthma begins first with a thorough physical exam, complete with a medical history, and a lung function test.  A lung function test consists of both a spirometer reading, used to measure the amount of air you can expel, and a peak flow meter reading, used to measure the rate at which you can expel air from your lungs.  Your doctor might also give you a bronchodilator to see if your lung function improves. 

 

Should your lung tests show that your lungs are performing below normal levels, your doctor would need to rule out any other conditions that might cause these results.   

 

          If you are diagnosed with asthma, your doctor will then attempt to identify the type and class of your asthma.  The types of asthma describe the conditions that precipitate the symptoms and include: allergic, seasonal, exercise-induced, nocturnal and non-allergic.  The classes describe the frequency of the symptoms and include: mild-intermittent, mild-persistent, moderate-persistent and severe-persistent.

 

          Much ground has been made in understanding the causes of asthma. According to Dr. Courtney Crim, resident asthma expert and certified pulmonologist at the Respiratory Institute, asthma results from an interaction between the environment and genetics.

 

This is particularly the case with both seasonal and exercise-induced asthma.   Trees, grasses, flowering plants, pollen and mold can trigger seasonal asthma.   Trail runners, especially need to be cautious of windy days when the dust or smoke levels can trigger an attack.  However, in urban living—within 10 miles of heavily congested areas--second-hand smoke and respiratory infections can also bring on both exercise-induced and seasonal asthma.

 

Pull the Trigger

 

          Luckily, most asthma triggers are avoidable, but much of the asthma management depends on determining and removing them.  Common triggers include:

 

  • heartburn (gastroesophageal refux, or GERD)
  • chemicals in paint, adhesive, varnish, resin and laminates
  • enzymes in detergents, flour conditioners, pharmaceuticals and meat tenderizers
  • animal allergens and proteins such as dander, fur, hair, scales, saliva and wastes
  • flour grain and food allergens found in rye, wheat, seafood and egg products
  • respiratory irritants such as sulfur dioxide and smoke
  • indoor mold
  • pollen
  • exercise
  • colds and infection
  • weather

 

The Respiratory Institute suggests keeping a daily journal to help determine some of your triggers. 

 

Asthma treatment however, begins with medication.  Three types of medications are commonly prescribed for asthma: fast-acting bronchodilators, long acting bronchodilators and inhaled corticosteroids (ICS).   

 

Both ICS and long-acting bronchodilators are considered preventative, while short-acting bronchodilators are considered to be quick-relief.  While many runners with exercise-induced or seasonal asthma rely solely on the quick-relief inhalers, most treatment plans also involve a preventative treatment.  

 

New evidence suggests that if asthma is inadequately treated, it may get worse over time and lead to a long term decrease in lung function and even permanent lung damage. 

 

If asthma is treated properly, the quick-relief inhaler should only be used periodically.  Trail runners are often prone to overuse of their inhalers, as they spend more time exposed to pollen, dust and flowering plants than the average person.  Ideally, runners should only use their inhaler as a last resort, to prevent an attack.  And according to the Respiratory Institute, if you are using your inhaler more than twice a week, your asthma symptoms may not be under control.  

 

Runners who are susceptible to exercise-induced asthma should avoid exercising when pollen and dust levels are high or outdoors in the winter and should moderate their exercise intensity.   Those with seasonal asthma may benefit by avoiding exercise when pollen levels are high, such as in the spring, or when there is an increase in flowering plants. 

 

 

  Don’t let asthma keep you from enjoying the trails this year.  If you keep your asthma symptoms under control, you can maintain your lung function and running capacity.  Again, if you are wheezing or using your inhaler more than twice a week, see your physician immediately because you could be at risk of permanent lung damage.  And permanent lung damage can make that wheezing while running permanent.  As runners, we know that breathing hard is part of the territory; not being able to breathe, however, is unacceptable.

 

         

 

 

 

 

 

 

 

 

 

SIDEBARS

 

BREATHING EASY

If you have asthma, your doctor might recommend the lifestyle changes listed below.

  • Avoid breathing cold air. If you must run in the cold weather, wear a mask.
  • Avoid known allergens. These can be both seasonal and related to the time of day, such as early afternoon, when pollen counts in the air are high.
  • Warm up properly. Light exercise and an increased body temperature can help relax and widen your airways.
  • Change your environment. Move your exercise to a warm, humidified environment. Switch to indoor activities during cold weather, and consider swimming, which is recommended for people with exercise-induced asthma. 
  • Exercise regularly. Proper condition and fitness level can reduce your exercise-induced asthma symptoms.

 

 

 

EXTRACTING ALTERNATIVES

 

          Many asthma sufferers have found relief in the following herbal extracts.  These treatments are not a replacement for asthma medication, and you should consult your doctor before taking any of them:

 

  • Licorice Root Extract: Also known as Glycyrrhiza Glabra, this root extract is a bronchodilator and expectorant, meaning that it causes the bronchial tubes to expand, allowing for easier breathing.  The Physicians Desk Reference for Herbal Medicine (PDR) recommends dosages of 200 to 600 mg glycyrrhizin, which is the equivalent of 5 to 15 gm of the root.  Contraindications include chronic hepatitis, cholestatic diseases of the liver, cirrhosis of the liver, severe renal insufficiency, hypertonia, hypokalemia and pregnancy.

 

  • Garden Violet Extract: Also known as Viola Odorata, this flower extract is recommended for relief of asthma symptoms.  The dosage recommended by the PDR is 1 g orally, or 1 tbsp. of a 5 percent infusion (extract diluted with alcohol at a 1 to 19 ratio, extract to alcohol), taken 5-6 times per day. There are no known contraindications or side effects of this dosage.

 

  • Oregano Extract: Also known as Origanum Vulgare, this leaf extract is used for respiratory disorders, coughs and as an expectorant.  The PDR recommends 10-15 drops of an 1.0 percent oil extract in 8 oz. of water.  There are no known contraindications or side effects in conjunction of this dosage.

 

 

ONLINE RESOURCES

 

          For additional information about asthma and asthma related issues, visit these sites, or contact these organizations:

 

 

 

  • American Lung Association

800-586-4872

www.lunguse.org

 

  • Asthma and Allergy Foundation of America

800-727-8462

www.aafa.org

 

  • National Asthma Education and Prevention Program

NHLBI Health Information Network

301-592-8573

www.nhlbi.nih.gov/about/neapp

 

 

 

 

 

 

 

 

 

 

 

 

 

 

          Claire Dorotik B.S., M.A. is a wellness consultant and avid trail runner, living and working in Ventura, Ca.  She can be contacted at: geronimo559@yahoo.com.