Asthma Update

OK .. I admit it, I’m getting a little discouraged. Not so much about my ability as an endurance walker, but more so about the way I’ve been feeling when I’m NOT walking. Since the middle of September, I’ve had a tough time climbing out of my yellow zone and I don’t really know why. I seem to be been more breathless than usual , experiencing almost continuous symptoms. Except for the three exceptional breathing days I had last week, I’ve been pretty much SOB to some degree, nearly 24/7 . My doctors will dismiss this as some sort of “prolonged exacerbation.” A nine week exacerbation? I guess it’s possible , but I doubt it.
In a typical year I get maybe a dozen flare ups , but they generally don’t last more than 2-3 weeks. Even those times times where I ‘ve been critically ill , I was still able to recuperate fully within a month to six weeks. I’m beginning to wonder if this current state of breathing is going to be my new baseline?

There can only be two explanations for what’s going on here; either there is something persistently irritating my lungs (ie environmental and/or non environmental factors like emotional stress) OR, my disease is just plain getting worse. I suppose, it could be a combination of both. (BTW , if you’re a non-asthmatic, I apologize for the medical mumbo jumbo)

In an attempt to rule out possible triggers and to regain some green days , I’ve been meticulously recording my pre& post workout PEFR’s ( peak expiratory flow rates) , and because I have a significant degree of small airway dysfunction, which is not always reflected in the peak flow readings, I’ve also been documenting the degree of perceived breathing difficulty that I experience before, during and after my walks. I ‘ve also temporarily eliminated low-dose aspirin from my medication list.

These are some of the things I know for sure:

* I definitely have an “exercise-induced” component to my asthma as evidenced by an average drop of 250 points in my PEFR’s , immediately following my walks. These results would indicate a significant degree of airway narrowing and/air trapping. After inhaling nebulized bronchodilators, my peak flows, at least partially , reverse back to baseline.

* I definitely have an allergic component to my asthma as evidenced by extemely reactive skin tests to common allergens. Oddly though, my circulating IGE levels are low and this has my doctors perplexed.

* Much like a person with emphysema, I’ve lost much of the elasticity of my lung tissue , so I tend to breath stack ( dynamically hyperinflate) proportionally , and over time, with exertion. This means that the longer , the harder , or the faster I walk, the worse my breathing gets. These results were also verified during an exercise stress conducted at UCSF clinical airway research lab last year. Again, I get at least partial relieve of the symptoms after taking breathing treatments.

* Because my baseline respiratory function is so low to begin with, it doesn’t take much of an insult to throw me over the edge. Something as subtle as a small change in barometric pressure or relative humidity can make me feel like I’m suffocating.

*Breathlessness sometimes makes me anxious which in turn can make my breathing worse. It’s a vicious cycle.

These are the actions I ‘ve taken:

* Ive reduced the frequency and distance of my walks. ( at least for now)
* I no longer start a walk if I’m in the yellow zone.
* I’ve added stress reducers and medication to quell anxiety
*Scheduled PFT’s , including lung volumes to see if there are any physical lung changes.

None of this really explains why I’m experiencing increasing breathlessness when I’m NOT exerting myself. But, at least it rules out fitness walking as the primary source. The last thing I want to do is to STOP Walking!…….

In about 10 days I’m scheduled to start on a six month trial of Xolair injections .This new drug is used primarily to treat the more severe forms of allergy triggered asthma. Maybe that will be the magic bullet I’ve been looking for.
I just want to retain enough lung function, so I can continue to walk and/or occasionally racewalk, and to be able to breath relatively easy when I’m not doing either.

Important note: Since I began exercising regularly nearly two years ago , my overall lung function has actually improved (my baseline FEV1 went from 30% to 40%) but the periods of severe breathlessness have worsened. Weird huh?
As my Pulmonolgist always tells me……..I’m an odd one.

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Most frequently asked question

"Can you have an asthma attack with a normal sat reading"?
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While it's a little unusual to see a person with a perfect O2 sat of a 100% during a severe exacerbation, its pretty typical to see sats in the 94-97% range. The reason for this, is that asthma is a disease of the airways , not the alveoli where gas exchange takes place. Most asthmatics dont desaturate during the early stages of an attack,unless theres a secondary problem such as pneumonia. You have to be extremely ill with asthma if your sats are low.

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