Ask the Nurse

Our Asthma Clinical Nurse Specialist is in to answer your health-related questions regarding asthma self-care management.

Unfortunately, due to the large number of questions we receive, we may not be able to respond to all questions. We will, however, try to answer those questions that we feel offer the broadest interest. Please check back periodically to see if your question - or a related question - has been answered. And remember, these responses are for educational purposes only - they should not be substituted for advice by your doctor. If you have an immediate medical concern, you should consult your doctor. If you have an asthma-related home health care need, please e-mail or call us at 1-888-VNS-1-CALL (1-888-867-1225).

Disclaimer: All information is for educational purposes only and should not be substituted for advice by your doctor.

Question:
Hi. I am a 34 year old male. I have a hard time catching my breath when I am stressed out or very hot. Do I have asthma? How do I find out? What should I do?

Answer:
Not all breathing problems are related to asthma. If your breathing is only affected with stress, and you have never wheezed, you may actually be having anxiety attacks. These are common with stress. If you are having asthma, you will have shortness of breath, cough, activity intolerance and less effective air movement through your lungs. It would be a good idea to see medical provider during times when your problems occur to see if you are indeed having trouble. If the problem is anxiety, relaxation exercises will help. During hot weather, try going to a cool place and see if symptoms improve. With stress, try deep breathing, in through your nose and out through pursed lips--as if you are throwing a kiss. Also try relaxing your muscles in your body by flexing and relaxing each muscle starting with your toes and working your way up. For further advice, plan to schedule an appointment with your regular medical provider to examine your symptoms more thoroughly.

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Question:
I have been coping with asthma and have seen a large weight gain in the past three months. I took Prednisone for six weeks, but have been off for two months. I continue gaining weight for no reason. What I can do? I am so depressed.

Answer:
Depression itself can sometimes lead to weight gain. Prednisone use can certainly lead to an increase in appetite, thirst and can ultimately cause weight gain. When some people are ill and depressed they tend to exercise less and their body functions slow down. This can cause a rise in weight. It is important that you talk to someone about your problem and seek counseling for your depression. You may not be able to improve your weight until you deal with your feelings. Next, request a consultation with a nutritionist to begin a healthy weight-loss program. Some low-stress exercise should help, like walking, swimming or stretching. Exercise can also improve your breathing if begun slowly. Consult with your medical provider before starting any exercise to see if you can handle this. You should start slowly and be sure that you are under medical supervision at all times.

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Question:
I have a seven-year-old daughter who has asthma. She has not had an "asthma attack", but when she gets a cold she does have a hard time breathing. She's developmentally delayed and would have a hard time expressing if she had any problems breathing. How do I tell if her breathing is bad enough to require medical treatment? She uses a nebulizer everyday with cromolyn sodium inhalation solution twice a day.

Answer:
It does sound like colds are a "trigger" for your daughter. Children sometimes show outward signs of breathing trouble without being able to verbally express their difficulty. She may seem more agitated than usual, may be unable to rest and her heart and breathing rates may speed up. If you suspect that she is having trouble, someone who is trained to listen to children's breathing, like a nurse, doctor or nurse practitioner should listen to her with a stethoscope to determine if she is moving air in and out of her airways well. It may be that she needs a reliever during those times along with her cromolyn controller to help her through these periods. Please discuss this further with her regular medical provider.

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Question:
How does stress affect asthma and what can you do or take to reduce its effect?

Answer:
Stress can lead to increase in the symptoms associated with asthma. It causes an increase in the tightening of the muscles in the body, including those used to breathe and move air to the lungs. Stress can also make your heartbeat and breathing rate quicken, which decreases the air to the lungs as well. Some people get a tightness in their throat and chest with stress that can increase the perception of difficulty breathing and increase the severity of their asthma attack. It is a good idea to have an asthma quick relief medication -- like Albuterol or Maxair -- on hand in case these things happen. You should also practice relaxation exercises to decrease the effects of stress on your body. For example, think of a pleasant place or time, close your eyes and visualize yourself there and removed from the stressful situation. You can also progressively tighten and relax all of the muscles in your body, starting with your toes and moving up. Deep slow breathing can also help.

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Question:
I'm overweight and I have asthma. I like to walk and do some exercise, but just walking up a flight of stairs or dancing takes my breath away so much that I am pumping my medicine into my body for relief. I don't eat a lot and when I try to exercise, I get too out of breath and have to stop before I'm really started. Is there any relief for me?

Answer:
Swimming is a good exercise for persons who are overweight. If you are able to get to a gym or a place with a pool, several YMCAs have swimming programs specifically for adults. Rather than taking your pump every time that you feel out of breath, try relaxation exercises. During exercise, breathe in through your nose and out through pursed lips--as if you were blowing a kiss. If walking stairs causes shortness of breath, stop halfway up, do some deep breathing exercises, and continue only when you are breathing normally. Brisk walking on a flat surface in a cool place will help build your endurance and help in weight management. Some shopping malls have walking clubs, but you can certainly walk the malls on your own. The advantage to a shopping mall is that the air quality is generally controlled and constant. You might also consult with your provider to get some exercise stress testing done, and request a consult with a nutritionist to develop a healthy weight-loss program for you. There are several new pharmaceutical agents available to persons who are very overweight as well. It is important to exercise, even if it is in small bursts, eat a healthy diet, and use asthma medications sparingly to prevent serious side- effects of overuse. This will improve your overall health in the long run.

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Question:
I have a heart condition and now I have asthma. I have heard that the inhalers can trigger problems with the heart. Is this true?

Answer:
Yes, many asthma medications have significant effects on the heart. They can cause the heart to beat more rapidly, can cause the blood pressure to rise and may cause abnormal heart rhythms in susceptible persons like yourself, or with overuse. You should consult your regular provider whenever you are using a new asthma medication. If you are taking medications for your heart condition, your asthma medications may have harmful interactions if not considered together. You should never take over-the-counter medications or medications prescribed for a friend or family member for your asthma. Consult your heart doctor whenever your are considering a new medication or treatment.

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Question:
Does asthma worsen during the menstrual cycle?

Answer:
Some people report a change in their asthma with the period just before their menses. This may be related to a change in body hormones, or a change in anxiety related to premenstrual syndrome. Symptoms may worsen during this period, you may find that you are using your reliever medication pumps more often. If you are having specific changes in symptoms, discuss this in detail with your medical provider. Pregnancy may also change your asthma symptoms, for some people they worsen, for others they improve. It depends on the individual.

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Question:
When I was in my ninth month of pregnancy I developed severe asthma. In order to breath I needed to take Bronchaid, an over-the-counter medication, every four hours. Even on this medication I still had difficulty breathing. Could the medication and/or lack of air cause damage to my unborn child? My son has some learning delays. Could this be the result of my severe asthma?

Answer:
I am sorry to hear that your son has learning delays. As parents, we want answers as to why these problems occurred. However, it is impossible to determine the cause of your son's problems. In addition, the information you presented doesn't quite fit with a diagnosis of severe asthma. I suggest that you discuss your concerns with your OB doctor or midwife.

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Question:
My theophylline blood level is 10.2. What can be done to increase the level other than increasing my medication, Slo-bid, to 600 mg daily?

Answer:
The most important thing you can do is to follow your provider’s and pharmacist's directions. Avoid missing doses by establishing a system. For example, some people keep a diary and record the medications when they take them.

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Question:
My six-year-old old grandson has asthma attacks almost everyday. His parents have two dogs and two birds. Can this be a factor? He uses a spray and Prelon and other prescribed medications, but I am worried by the frequency of the attacks. Otherwise, he looks good and eats well.

Answer:
You've asked an important question. Pets that clean themselves, (dogs, cats, and birds) may trigger asthma attacks. A protein in the pet's dander and saliva is the culprit. The dander becomes airborne and sticks to vertical surfaces such as walls and curtains. People are often very reluctant to get rid of the family pet. The first step is to determine if the pets are triggers for your grandson.

To help identify triggers:

1. Start a symptom diary. Record the day, time, location and activity associated with your grandson's attacks. After a few weeks, look for patterns. Where in the house do the attacks most likely occur? Do attacks occur more often at home than school? What happens when he spends the night at a friend's home (without pets)? Patterns will help in identifying his triggers.
2. Allergy testing may be used to confirm if the pets are triggers for your grandson.

1. The best strategy is to remove the pet from the house. Wash all vertical surfaces well. It may take several months after the pet is removed before the dander is removed.
2. Other strategies to reduce the trigger:
   1. Remove the pet from the child's bedroom and wash all vertical surfaces well.
   2. Bathe the pet regularly in pet shampoo that was made to reduce dander. Other pet shampoos will only make maters worse.
   3. Use a HEPA air filter in the furnace and air conditioner and a HEPA air cleaner. The HEPA filters will help remove the dander from the air.

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Question:
There is a strong possibility that I am pregnant. My husband and I are trying and I am right now in the third week of my cycle and I am experiencing small cramps on my right side. I am asthmatic (allergic asthma) and I have been having dyphnea for several weeks. I am following a treatment with Albuterol and triamcinolone acetonide. I am a runner also and I got an asthma attack in the middle of a six-mile run, which has never happened before. Right after the run I took my Albuterol inhaler and I felt better but I am concerned that I might have harmed the baby (if I am pregnant) by running under that respiratory condition. Could I do substantial harm even at the early stage of gestation?

Answer:
As many as 10% of pregnant women may have asthma. In general, asthma that is controlled well in pregnancy isn't associated with increased fetal problems. The goal in pregnancy is to control the asthma symptoms. It is very unlikely that the asthma episode you described would be harmful to your baby. However, to be on the safe side:

• Let your medical and OB/GYN provider know that you are trying to become pregnant. Ask if the medications you are taking are safe in pregnancy. Mostly every common asthma medication is considered safe and effective in pregnancy but ask anyway.
• Pace your activities on how you feel. Regular exercise is important in pregnancy but your tolerance may vary. Discuss your exercise routines with your medical and OB/GYN provider.

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Question:
My son is nine years old. He's been asthmatic since he was two months old. During the winter he has this constant dry cough even though he doesn't wheeze. What causes the cough? What can be done for this?

Answer:
A constant cough is often a specific type of asthma called cough variant. Many children with asthma never wheeze, but rather cough and never seem really comfortable. This type of asthma can be worse at night, and can sometimes get worse with exercise or exposure to allergens. If your child is coughing persistently more than twice a week, or wakes with a cough more than twice a month, he may need to have changes made to his treatments. Many children need to be on controller medications daily to prevent symptoms like coughing and wheezing. If the child is not on a daily medication for prevention of this persistent coughing, you should see his medical provider to discuss the possibility of starting one.

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