So two hospitalization in just two months has me and my Pulmonologists scratching our heads as to what it is that keeps causes my asthma to spiral out of control so often. As has been the case in so many of these bad flares that Ive had over the past few years since relocating to Crockett, Calif, I didn’t have a cold or lung infection and wasn’t experiencing any abnormal emotional stress that precipitated these attacks. That really only leaves one other type of trigger, namely.. ALLERGIES! Could the fact that I live in the sneezing and watery eyes capital of California have anything to do with it? Could it be that my environment is fueling some of these really bad exacerbations ? Well, it’s sure starting to look that way.
Not so much my indoor environment, though keeping the dust at bay is a never ending battle ( and we won’t even mention my furry friends), but rather my outdoor environment. It appears that I am more allergic to the trees and other greenery that surrounds my home (and basically the entire neighborhood), than I previous thought. Making things worse is the fact that I walk OUTDOORS ( not a fan of indoor health clubs). I live in a Beautiful little town, too bad it’s killing me.
Allergy triggers would sure explain a lot of things, including why I ended up in the hospital after only 3 of the 8 full and 12 half marathons Ive done. If it were just the walking or the exertion that was making me sick, I would end up in the hospital after every race. It turns out that courses of these 3 particular race all had excessive greenery. Ive also had more than one Pulmonologist tell me that because Im exerting myself while doing these long walks that I’m inhaling a lot more allergens and pollutants into my lungs. . Hmmm…maybe there’s something to these theories after all.
Ive had allergies my entire life, most asthmatics do. In fact, up until just recently I carried an epi-pen with me just in case. More times than not though, my body is usually slow to respond to allergens. Unlike most hay fever sufferers, because I dont always get that instant feedback when I’m exposed to certain t (ie, symptoms like acute wheezing, chest tightness, etc), I have a tendency to dismiss or downplay them as primary triggers for my asthma. The only substances that really evoke an immediate and nasty respiratory type response out of me are things like dust, smoke, and strong fragrances. Exposure to tree and grass pollens, dust mites and/or atmospheric conditions such as extreme temperatures and high humidity tend to produce a much slower response in me. Confusing the issue even more, is the fact that I rarely have an increased eosinophil count when Im hospitalized for asthma. Nor is my IgE elevated, both of which are red flags for allergic type asthma. At the same time though, my skin test reactions are off the charts and I usually have pretty enlarged nasal polyps, another sign of allergic asthma. With all these conflicting signals, you can kinda see why Ive discounted the allergy theory for so long. Well, not anymore.
Ah, but as I get older and wiser I’m learning that not every asthmatic responds the same way. High eosinophil counts are usually a result of a MASSIVE allergen exposure. The allergic response in many chronic asthmatics tends to be more insidious in nature, and is not always reflected in elevated blood counts. The allergic response usually manifests itself in the form of gradual, and often prolonged airway inflammation and/or irritation, which can lead to mucus plugging, airway narrowing and air trapping. Sometimes it takes hours or several days for asthma type symptoms to start showing. In a person like myself who already has severely obstructed airways, this can lead to disastrous results.
Interestingly (and despite having normal IgE levels at the time) in 2009 I was placed on Xolair , which is used to treat severe allergic asthma. After receiving 150mg injections every month for a full year, we decided to discontinue it because there was no notable difference in my overall health. Looking back on it now though, my living environment was quite a bit different then. I was doing most of my walking in San Francisco along the waterfront or in the city itself where there are very few trees and grass. Im wondering now if we should re-check my IgE level and maybe try Xolair again. The drug has come down in price, but is still incredibly expensive.
So now that I’m enlightened about all this, what am I gonna do?
Well, in a perfect world Id simply pick up and move to a town with less greenery, or better yet live next to the ocean. Unfortunately, I’ll probably never be in a financial position to do that, so the best I can hope in the meantime is to find a way to adapt and to limit my exposure.
To any sympathetic and wealthy philanthropists who might be reading this, if I can’t have a hermetically sealed Bubble to live in, a small beach house would probably work just as well
In the meantime I’ll….
Take Zyrtec everyday instead of just during the Spring season.
Add a steroid nasal spray.
Possibly re-start on Xolair injections.
Do Nasal washes everyday.( yuk)
Change my walking route to an area where there are fewer trees and grass.( ie the famous bridge walks).
Consider wearing a mask anytime I go outside( yeah, right. )
Not go outside at all on high pollen count days.