Running, Asthma and Darth Vader

Do you like running? But do you run out of breath and sound like Darth Vader when you run? Maybe you have asthma.

a03989a796436feaceba9bd166717542

Recently my cousin, who is a budding journalist in the Philippines, asked me questions on the subject of asthma and running, knowing that I am a lung specialist as well as a runner. He said that he was writing it for a fitness website. I would like to share them here.

1. How does asthma affect people? What does it do to their bodies?

Asthma is a condition in which there’s two main components, (1) narrowing of bronchial airways (bronchoconstriction) and (2) swelling (inflammation) causing edema and production of extra mucus. These can cause the difficulty breathing and wheezing, making you sound like Darth Vader. These attacks can be intermittent and reversible, and triggered by exposure to certain allergens.

asthma-airways_lg

2. Can everybody have asthma?

No. It is most likely genetic or familial predisposition that leads to one’s having asthma. For example, there are certain triggers that can cause an asthmatic attack, like house dust mite, but not all people will react to it. It is like an allergic reaction, where a predisposed person’s immune system overreact to the trigger.

So if you have asthma, you can partly blame your parents and the genes they passed on to you.

I’m not sure if Luke Skywalker have asthma too (“Luke, I am your father” – Darth Vader).

3. What are the common causes of asthma?

There is a wide gamut of asthma triggers and can differ from person to person:

A. Inhaled allergens – like house dust mite, pollen, cockroaches (I hate cockroaches), indoor and outdoor fungi/mold, pet dander (I feel sorry for pet-lovers if their beloved pet cause them their asthma attacks).

B. Respiratory infections – common cold and other viruses, or bacterial infections

C. Inhaled respiratory irritant – cigarette smoke, pollution and smog (like in Manila!), certain chemicals like volatile gases that can be at the work place, and even (cheap?) perfume. If you have a co-worker that has a body odor, you can tell them to take a shower for it can trigger your asthma. Just kidding.

D. Hormonal fluctuations – like in pre-menstrual and menstrual period in women; it can be part of pre-menstrual syndrome!

E. Medications – like beta blockers (metoprolol) that is use as an antihypertensive or in heart patients.

F. Physical activity – exercise

G. Emotional state – anxiety, sudden upsets. Yes being dumped by your girlfriend can cause an asthma attack!

H. Temperature and weather – cold air, hot humid air, wet conditions (which can increase respiratory allergens in the air).

asthma-triggers-01

4. What are the symptoms of asthma?

Most common symptom of asthma is difficulty in breathing, with sensation of chest tightness. You feel like you have a rubber band around your chest. When more severe, wheezing ensues. If really severe, it can lead to respiratory failure. A persistent cough can be a symptom of asthma as well, which is from the constriction of the airways.

5. Can it be prevented?

Yes. Avoiding the triggers as what I mentioned above. Also by using medications such as inhalers, especially the inhaled corticosteroid that kind of stabilizes the membranes of the respiratory tract of an asthmatic, so it won’t be so reactive. This lessen the attacks.

6. What’s the cure for asthma?

No cure for asthma. If you have it, most likely you’ll have it for life. Sorry Darth Vader. But we can control or minimize the symptom or lessen the attacks through avoidance of triggers and through medications. Asthmatics can do whatever they want and can live a “normal” life if their asthma is well-controlled.

7. Can running trigger asthma?

Yes. As any other form of exercise can.

8. Can a person still run if he/she is an asthmatic?

Yes. Even though exercise is a potential asthma trigger, it should NOT be avoided.

9. Can running help a person fight asthma then?

Yes. Aerobic exercise strengthens the cardiovascular system and may lessen the sensitivity to asthma triggers.

However, it is important for persons with asthma who are not in a regular pattern of exercise to build-up their activity level slowly to minimize the risk of inducing asthma. Also, if exercise is your asthma trigger, use your “rescue” inhaler (like albuterol meter-dose-inhaler) 5 -10 minutes before you exercise to preempt the attack. And if you have an attack while exercising, you can use the inhaler again.

hdc_0001_0001_0_img0031

Jackie Joyner-Kersee, an Olympic medalist, uses an inhaler after running

10. Can a person run if he/she has an asthmatic attack or episode?

Yes and no. If the asthma attack is pretty mild, you may be able to endure it. However if the attack is significant that you’re wheezing, I would recommend to take it easy for that day.

11. How long should a person run after he recovered from an asthmatic attack?

No fast rules. You can sense when you’re ready. Listen to your body.

12. What’s your advice to people with asthma who wants to enjoy running?

Continue running. But you may want to run when it is not so hot and humid, (or too cold if you’re not in the Philippines). Or run in areas not so polluted or smoggy. That is maybe doing it early in the morning.

Also avoid stray dogs. Not because it can trigger your asthma, but it can chase you!

13. What should runners with asthma remember during their runs?

Have your rescue inhaler handy during your runs. It easily fits in even the smallest pocket of a running shorts anyway.

If there’s a lot of dogs in your area, you can carry a pepper spray too to ward them off. Just don’t mistake it for your inhaler!

And most importantly, have fun!

10271295_10152441525929666_2444131673329699477_o-300x168

This is how to defeat asthma and Darth Vader.

(*photos from the net)

The Test

He sat there fidgety in his chair inside our exam room, while I reviewed the test that he just performed.

He was a lanky 18 year-old kid. He just graduated from high school. Full of hope and full of dreams. His whole life is ahead of him.

Perhaps he was really patriotic and wanted to defend the name of this country that he loved so much. Or perhaps he was born to serve and wanted to be a hero. Or perhaps it was really his dream to pursue a career in this field. Or maybe this was his only way out of a difficult life.

Whatever his purpose was, he wanted to join the military.

He already applied and was seen at the Military Entrance Processing Station (MEPS). But there was one problem. In his medical history, he had childhood asthma, even though he claimed it was only mild and in fact he said that he had no more asthma attacks since he was 11 years old. An active asthma will most likely disqualify him from entering the service.

And that was what brought him here to our clinic as a referral. He needed to pass a breathing test.

The breathing test is called Methacholine Challenge. It is a sort of breathing “stress test” where we try to induce an “asthma attack” on the subject. We let them inhale an increasing concentration of methacholine, which can cause bronchoconstriction. If we see a reduction (20% or more) from their baseline number after the challenge, the test is considered positive. That signify that they have asthma.

As I examined the kid I could feel the tension in the room. I could almost hear his heartbeat even without placing my stethoscope on his chest. I could sense his anxious sighing. His pleading eyes were looking at me, searching, as I pondered on the result of his test.

His future career hung in a balance. It was me and the result of the test that were standing in the way in his pursuit of his dream.

But why was a dream crushed before it even had a chance to take-off? How do you break a bad news without breaking a heart?

The result of his test was positive.

I laid it down to him as gentle as I could. I knew he was devastated, though he tried not to show it, at least not obviously. But I knew as well that there was no words of encouragement I could muster to change the results of the test.

Maybe someday he would come to know why it was not meant for him to be a soldier. Maybe someday he would find satisfaction in a different career he never dreamed of. Maybe. But today, it was all disappointment.

I swear I saw tears welling in the corner of his eyes as he left our office. Or maybe it was in mine.

tears_of_sadness

(*photo from here)

Debunking Folks’ Medical Advice: Part 2

Here are more old folks’ medical advices that I remember receiving personally or hearing from somewhere else, while I was growing up. Let us examine if there’s medical validity behind these folks’ counsels.

1. Huwag mong hayaang matuyo ang pawis sa iyong likod, ito ay sanhi ng pulmonya.

Do not let your sweat-soaked clothes dry up on your back, you will have pneumonia.

Pneumonia is an inflammation of the lungs usually caused by an infection. This is most commonly due to virus or bacteria, that gained access to your lungs through inhalation or aspiration. Frequently, a healthy immune system is able to fight off these organisms that invade the lungs. However, it can sometimes be overwhelmed, and the result is pneumonia.

We catch viral pneumonia when we are exposed to somebody who is infected with it, when they cough or sneeze and spread the germs in the air and in things around them. Most of the bacteria though that causes pneumonia, already inhabit our mouth and throat, and are just waiting for you to let them in into your lower respiratory tract. Our body’s defense mechanisms (like cough reflex) and immune system keep them in check.

Getting wet in the rain or letting your sweat soaked clothings dry up on you, does not cause pneumonia. Some experts have examine if these can lower our immune defenses, but current medical studies indicate that they do not.

So don’t worry about having your sweat-soaked shirt dry up on you. Just be considerate of other people who will have to put up with your stinky smell, so might as well change your smelly shirt. And go ahead and play in the rain, just watch out for the lightning!

2. Huwag mong pahamugan ang bunbunan ng bata, baka ito sipunin.

Do not let the head of the child be exposed to dew, he will catch cold.

Colds are caused by respiratory viruses. Again, we catch them if we are exposed to people who likes to share their viruses, even if you don’t want them. If you don’t breath at all, you may prevent inhaling the virus, but is not recommend for obvious reason.  And if you caught the virus, please don’t share it further by taking proper precautions, like covering your mouth when you cough or sneeze and by frequently washing your hands.

Being exposed to the night dew is not a direct cause of colds. However if your putting a hat or covering the head of a child because of frigid temperature, then that is something else, and that is very appropriate.

3. Huwag kang matutulog ng basa ang buhok, at baka ikaw ay mabulag.

Do not sleep with your hair wet, you will go blind.

There is no medical truth to this. I believe this advice is perpetuated by older folks who don’t want to get the pillow wet, which can get wet anyway with drool. The only thing you will get by sleeping with wet hair, aside from wet pillows, is waking up with bed head hair. However, a bed-head-hair-look is considered fashionable and stylistic nowadays.

If you wet your hair with kerosene, then that is a different story.

4. Huwag mong paglaruin ang mga bata sa init ng araw, at baka sila magkakuto.

Do not let you kids play under the heat of the sun, they will have head lice.

Head lice is an infestation caused by a parasitic insect, Pediculosis capitis. These parasites feed on blood like mini-Dracula. Head lice is spread from direct head to head or close contact from an infested person. Sharing a comb, headgear, beddings or clothings are the most common ways of spreading this.

The sunlight does not cause lice. In the contrary it may even help get rid of it. Hanging bedsheets in the sunlight might help kill lice and its eggs. But exposure to sunlight alone will not kill these parasites in the human scalp, unless you get very high UV light and reach very high temperature, like when you migrate to Mercury.

There have been many folk remedies suggested like vinegar, mayonnaise, olive oil, and butter (sounds like making a salad in your head!). The scientific evidence on these home remedies are not clear. I would recommend you ask your doctor for the proper treament of head lice.

So let your kids play in the sun. Just remember exposure to too much sun causes sunburn and skin damage, and in addition, increases the risk of developing skin cancer later on in life.

5. Huwag umupo sa nakabilad o maiinit na upuan, dahil ito ay sanhi ng balisawsaw.

Do not sit on seats that are hot or exposed to the sun, it can cause frequency or dysuria.

Frequency and dysuria are often times symptoms of urinary tract infection (UTI). And  UTI are caused by bacteria that have gained access into the urethra and bladder or even up to the kidneys. Women are more prone to UTI than men due to their shorter urethra. Sitting on a hot seat has nothing to do with this.

The only people that I would like to be in the hot seats  are the corrupt politicians, and may they suffer balisawsaw.

6. Kumain ng  butiki para mawala ang iyong asthma.

Eating house lizard is a cure for asthma.

Asthma is a chronic lung disease that causes inflammation and narrowing of the airways. The exact cause of asthma is not fully understood, though experts believe it is a combination of many factors, like genetic predisposition and certain environmental exposures.

There is no cure for asthma, but it can be controlled with treatment. Treatment includes medicines like inhalers as well as preventive measures by avoiding the known triggers of asthma, like smoking, dust (house dust mite, which is in the dust is a well known trigger) and extreme temperatures.

A  grilled house lizard is not a cure for asthma at all. It may be a cure for a hungry stomach.

7. Uminom ng tubig dagat kung ikaw ay may sipon o ubo, upang ito ay gumaling.

Drink sea water when you have cough and cold, for this will cure it.

I have heard that parents especially in the provinces, tell their children when they have a cough or cold, to go and swim in the ocean, and take a gulp of seawater while they are in it. This may be that the ocean in the provinces are clean and clear. I don’t think any parent will advice their kid to take a gulp of water from Manila Bay (might as well drink from the toilet bowl!).

This is an interesting advice. Saline water (not necessary ocean water), has a lot of medicinal uses. It is used to irrigate the nose and the sinuses in patients with nasal congestion and obstruction. Hypertonic saline is also given as a nebulization (inhalation of mist) in patients with chronic lung disease, especially in Cystic Fibrosis, to break and loosen their phlegm. Gurgling warm salt water can also soothe a sore throat.

In spite of medicinal usage of saline water, there is no medical facts behind the advice of drinking ocean water to treat cough and colds. As a lung specialist, I am not recommending drinking seawater. And certainly I am not recommending inhaling it, that is called drowning!