Asthma

[Petra S]

Hey, does anyone else have asthma and how do you deal with it?

I'm 50 yr old now and got asthma about 3 years ago. I grew up hiking, camping, and just generally screwing around outdoors. I've taken my older kids all over, and my family spends every summer in the middle of no where in Ontario, Canada.

I am taking up backpacking now as an adult hobby – no kids – and went on my 'first' weekend trip at the end of Jan in southern OH. It was in the 20's on Friday, into Saturday, which don't bother me, except for not being able to get oxygen from my lungs to the rest of my body. It was awful! I've hiked hills all my life and all of a sudden, I was huffing and puffing like middle-aged, out-of shape couch potato.

I had started a preventative course of steroids Thursday evening, and covered up my mouth with a fleece Turtle to not breath in super cold air. It didn't help. I ended up splitting off from the main group on Friday so I would actually get to the campsite before the next morning.

Saturday was better since the temp went up, the steroids had really kicked in, and I had a hot cup of tea to carry. I carry a cup around with me all the time now, because the hot liquid going down helps warm my lungs too. I still split off from the group though, so I would not hold anyone up/back on our way to our second campsite.

I've learned to start the steroids earlier and try and to bring something hot with me to drink, but what else is there? I can't be constantly stopping on the trail to heat up some hot water and besides, that only goes so far.

Any advice would be very welcome because I don't want to take winters off – that trail is calling too loudly for me to ignore.

[Roger Caffin]

You need to check this very carefully with your doctor, but rather than resort to steroids, which are always very chancy imho, you could try carrying a Ventolin inhaler. Walk as much as you can without using it, but if your airways get too constricted use one puff to open them up.

Cheers

[Petra S]

I'm on Symbicort 2x daily, Singular at night and carry Pro-Air with me.

[Tony Wong]

I am asthmatic too and I have been on allergy shots for 7 or so years.

Kinda funny, but I am allergic to all trees except willow and pine….all grasses, weeds, dust, dirt, dogs and cats.

I have a dog and I enjoy backpacking….and I have a large life insurance policy!

Fortunately, I don't have symptoms on the trail much.

I take Abuterol as needed, but sometimes, I will start out the day with two puffs as a preventative.

Hot drinks can help you, but really, it is about having moist air in your lungs to help.

You can try wearing a surgical mask while sleeping or hiking.

I have found that the cheap and disposable ones are not worth it as they break easily.

I have found ones at Home Depot that are used for dust or for when you are working with fiberglass insulation in the attic.

They have two elastic bands to secure them to your face and are durable.

No need for the really fancy ones with valves on them….just the cheap ones, but they are more durable.

I recall the one that I have used while doing yard work has a small bend-able metal strip the nose area to allow for a better seal, which helps with not fogging up glasses.

A bandana over the nose and mouth and help.

Either way, you are using your exhaled breath to recycle some of your own moisture to help with the air that you breath in.

What drugs are you on?

I have albuterol, pulmacort, and Advair. The Advair can be a replacement for pulmacort.

My wife is pulmonary RN and says that being 50 yrs old plus and suddenly getting asmthma is rare.

Former smoker?

Have you checked if there are environmental triggers there are for your asthma?

If you can provide some more info, I can run it by my wife.

Ulitimately, you will want to talk to your doctor about your medication and making some adjustments in dosage.

Note: Okay, see from a posting before my reply what your drugs are. Will run it by my wife. I would not fear the steriods too much. I have been on them on and off for 10 years or more. Not dead yet, but maybe I will pay for it down the road. Beats not being able to leave the house.

Tony

[Tony Wong]

Petra,

Here is what my wife wrote back:

How many times a day does he use Pro-Air? Pro Air is the same as Albuterol/Ventolin inhaler, manufactured by a different company, that's all.

Should take Singular the same time each day and not miss a dose as it will drop the peak levels in his blood.

Has he had a spirometry or peak flow test done?

Who's prescribing the medications? His primary care physician or a pulmonologist/allergist?

History or current use of smoking, or marijuana smoking?

Humidify the air. If a warm mist triggers, then use a cool mist.

***********************************************************************

Petra,

Also, an important issues is the status of your asthma.

Are you "controlled" by taking your meds daily and have that managed and the drugs at a constant/stable level in your blood stream for effectiveness?

In my case, I am completely UN-controlled. My symtoms rarely come up, so I have chosen to take drugs as needed, which is not a good way to manage my asthma.

Regarding if you are or were a smoker, I asked my wife about this and she says:

Current smoker means that's a huge trigger.

Former smoker means early onset of emphysema and there are other kinds of drugs to use.

Tony

[Petra S]

Tony, thanks so much for the quick response. Let your wife know that the he is a she :)

I had a very bad upper respiratory/sinus infection in Jan '11. I ended up with an awful cough. It came and went, but I finally went to see the family allergist 8 months later because the cough wouldn't stop. My PCP had no idea what it was. Well, I do have allergies – cat, pollen, weeds, grasses – but the cough came from asthma.

I had the whole round of test done and there is no doubting that I have asthma. The triggers can be anything from my allergies – they only make me sneeze once in a blue moon but do screw up my breathing – to stress and the cold air. A big change in the air pressure can do it too, i.e., when the seasons change.

Now for the answers to your wife's questions.

I only use the Pro-Air when I need it. It can be weeks sometimes without any problems to a couple times a day. For Instance, I use it as a preventative – once yesterday before playing laser-tag with my boys. I had no problem breathing. Today, when I shoveled, I used it before going out and then wore a fleece turtle over my mouth to breath through. For the 2 weeks before though, I don't think I used it at all.

I have an alarm set on my phone so I take the Symbicort 12 hrs apart and the Singular every night at the same time.

As I said, I have had the full battery of tests done, not just spirometry and peak flow. I switched from my allergist to a pulmonologist after being diagnosed because my asthma wasn't being controlled. My insurance is still screwed up so I only call him when I need prednisone. That's about 3-4 times a year.

No, I do not smoke anything. Once a long, long time ago, say about 30 yr, I was guilty of a little weed ;) every so often but that's it.

Humidity doesn't seem to play a part. I live in NE Ohio, where we have dry winters and humid summers. It's the cold that gets me.

I may never be able to do hills in cold weather and I will just have to adjust my hikes to short, relatively level distances. I am just trying to see what other backpacking asthmatics do to do what they want.

Be glad you have a wonderful wife who looks after you. I appreciate the her help and yours.

Petra

[Adam G]

There's not much you can do to avoid cold-induced bronchospasm other than avoid the cold. I would be cautious about taking systemic steroids for anything other than a severe asthma flare. Those are very toxic medications that definitely have their uses but need to be taken judiciously.

One thing you can try is a balaclava which can help warm the air that comes into your lungs. Also, you may have to work up to a weekend backpacking trip in that weather. Anyone's lungs are going to hurt at 20 degrees outside without getting used to it. Have you been doing day hikes at those temperatures?

[Tony Wong]

Petra,

Thanks for all the details.

Here is what Pat said:

As she's not using the Pro Air on a daily basis, she's actually not having any exacerbations or attacks.

Yes changes in air pressure can cause what may appear to be difficulty in breathing but it usually won't necessitate using Pro Air. On days like this, she should be documenting her daily peak flow readings. Infact, if she has never done a daily journal of daily peak flow readings (very similar to a diabetic recording daily blood glucose readings), then she should give it a go. This will help her understand how low her lung volume can dip on days when air pressure changes.

As for her medications and accessing a pulmonologist, she's on the right track.

She can do hills in cold weather. Take Pro Air before ascending and use a cotton material tp cover her nose and mouth in addition to a fleece. Cotton allows moisture to trap and stay warm whereas fleece wicks which means she will keep breathing in cold damp moisture.

The one breathing technique no physician teaches is what all smokers have had to learn. Purse lip breathing. Deep breath in through your nose with the mouth closed, and then pucker the lips and blow out candles. It pushes out more carbon dioxide.

All this being said, hopefully her insurance can dispense Albuterol inhaler instead of the damn Pro Air…….total rip off in the amount it costs for the damn Pro Air and how little it dispenses before it gets stuck !!!!

If I can be of assistance with her insurance questions, let me know.

-Pat

P.S. My wife works for a health insurance company and is a medical auditor, besides being an RN. She is really good at navigating health care. So if you need advice/help, please feel free to email us/her at [email protected]

Also, on the extreme side of things, maybe this could help you in very cold weather:

http://www.amazon.com/PSOLAR-Heat-Exchange-Mask-Full/dp/B0012PQ9AW/ref=cm_cr_pr_product_top

They make other versions of this will less head coverage, but the heat exchanger is the key thing.

Tony

[Sam Sockwell]

I am an emergency doc also certified in Int Medicine, plus I have very mild asthma. You need to discuss this with your PCP. Every patient is different in terms of what they need to use to control symptoms. All of the meds mentioned here help some pts but what you might benefit from needs careful working out with your PCP. If all you needed was an occasional puff or two from an Albuterol inhaler- the simplest case-you are an easy straightforward pt. For more than that work with someone who will be prescribing your meds anyway

Sam

[Ken Thompson]

I can't believe that Roger didn't notify anyone that this is the wrong forum for this discussion.

Community Support Forum

A place where BackpackingLight.com members can ask specific questions from the forum community about using the backpackinglight.com website or its forums, or other support issues not related to membership account maintenance (which should be referred directly to BPL Staff).

Searching here is hard enough without people posting willy nilly in any old forum.

[Petra S]

Ken, I took the forum at it's name – Community Support. After looking at the other forums, this seemed the best place to put my topic.

Where would you put this since you stated it doesn't belong here?

[Justin Baker]

"Community Support Forum
A place where BackpackingLight.com members can ask specific questions from the forum community about using the backpackinglight.com website or its forums"

>ask specific questions about using the backpackinglight.com

This is a technical support forum. People have been getting this confused ever since they bumped this subforum to the top of the page.

[Desert Dweller]

You didn't answer her question. Where should she have posted it?

"Where would you put this since you stated it doesn't belong here?"

I've not kept up cause I'm out backpacking but I guess the "health and backpacking" type of
thread request was squelched? Shame, so many good people here willing to help.

[Ian]

I think 'General Lightweight Backpacking Discussion' would be fine as there are other ongoing health related threads there.

[Petra S]

This is what I see when I look at my page – "A place where BackpackingLight.com members can ask specific questions…more" – so I took that as a place where things not related directly to gear, trails etc would go. The General Lightweight Backpacking Discussion forum didn't sound right when reading the Community Support title. Maybe the title of the forum or the beginning of the description should be changed to reflect the focus on website issues. I even read the bit about skirts before posting so I figured I was in safe territory.

Now I know where to post things besides gear.

[Petra S]

@ Adam I haven't found a balaclava that fits yet. I've got a very small head.

As for the steroids, if I am out in the cold for any length of time without either using the Pro-Air or doing preventative steroids, I will have an attack. I will not die, but I am very short of breath and really cannot do much of anything physically. On my trip, I was huffing and puffing, but when I was hiking on level ground or at the campsite I was fine. The steroids did just what they were suppose to do, prevent an attack.

As for working up to that temp, it won't work. Shoveling snow or walking the dog can do it too. My lungs just can't tolerate the cold anymore. :(

@ Sam I want to talk to my pulmonologist but since my asthma isn't covered yet – my insurance got Obama's extension – I am going the cheap route right now. I just want to hear how other people have handled their asthma.

Tony and Pat THANK YOU so very much for all the info/advice. I took a look at the mask on Amazon and the one by Talus looks very promising. I can use it all winter, not just for backpacking.

[Rick Adams]

My son was diagnosed with asthma at 11 years old. It took a while to learn how to deal with it properly. what we learned is that when properly managed, you should be able to do anything that is talked about on these boards. The boy is almost 15 now and just started racing mountain bikes, his coach has high expectations and had no idea he has asthma, because he smokes the rest of the team uphill. He ran cross country a couple seasons ago and couldn't finish a race.

The only thing that changed is how he managed it.

1) you absolutely should have a ventolin inhaler with you at all times, you can use it premptively if need be
2) Symbacort has different inhalers that provide different dosages, i want to say 80 or 160, check the package.
3) we found singular to be useless, try different anthihistimines like zyrtec or ??
4) we have a grandfathered catastrophic plan, we pay a $12k before our ins pays a dollar. You may have a similar limited plan. At our local CVS Symbacort was costing $223 for one month of the weaker mix. Our doc turned us on to Canada Pharmacy, we now get the stronger mix that lasts 2 monthes for a little over $100. Has a different trade name, and ships fed ex from turkey, but it is the same stuff.
5) You doc needs you to communicate with him so he can help you, probably by increasing your Symbacort dosage. You can lead a very full life with well controlled asthma, lack of control will severly limit you, kind of sounds like where you are.

[Rick Adams]

those triggers sound alot like non allergic rhinasitus. Basically an allergic response triggered by hot, cold, stress, smells, whatever. Could your sinus issues be the trigger for the asthma? I take Zyrtec 365 and double up for about 6 months of the year and it mostly controls the allerigic response caused by everything and nothing. Just a thought.

[Petra S]

Rick, thanks for the insight.

1. I always have a Pro-Air inhaler with me. It is the same med as Ventolin, albuterol sulfate. The concentration may be different though. I can check.

2. I am on the 160/4.5 Symbicort 2x a day.

3. I wasn't on Singular in the beginning. When I changed doctors, the second put me on it and it works for me. I notice it if I run out.

4. I don't have $12K to spend every year so while it sounds good, I can't do it. I pay $20/mon for the Symbicort right now. My budget is just very tight right now.

5. Which comes down to communication with my doctor. This backpacking trip is the first time I have ever encountered a time when my asthma really got in the way of doing something. I've learned how to stop attacks before they begin and just prevent any kind of shortness of breath. However, hiking up hills in the cold just got to me.

I'm glad your son is doing everything he wants to. That's what I'm trying to figure out how to do. I was just thrown for a loop when I found I couldn't do hills like I've always done before. That's why I started this posting.

Finally, I do have allergies, but don't have any other symptoms than sneezing 2x in a row about once a week. All the allergens just go straight to my lungs and screw them up instead. I've been on allergy meds and it did nothing for me at all.

Thanks for everything everyone!

[Kimberly Wersal]

I have had fairly mild exercise induced asthma for years– it's a little worse in cold weather. I take a huff or two on the albuterol inhaler (one of the original kind that I hoarded– expired years ago, but still better than the Proair!) and I'm good to go. Well, I don't need it anymore! Don't even bring it along backpacking. The reason is something nobody else has mentioned: dairy products…. A couple of years ago, I went to a Paleo style of eating and cut out all dairy products–Poof! No more asthma. I have found that many people with sinus/asthma problems are greatly improved by eliminating dairy products. I have NO digestive issues with dairy products, but adding them back into my diet starts the asthma symptoms back up…

[Petra S]

You're the second person who has said Pro-Air is worthless. My allergist prescribe it. I'll ask my pulmonologist about it.

As for dairy, I'm not sure if I could give it up. However, I will investigate it and see what I come up with.

Thanks!

[Rick Adams]

the one thing that lights my boy's asthma up in a heartbeat is sulfur related products. These products are often used in things like dehydrated apples to keep the color appetizing. I believe many folks with asthma suffer similar effects.

As a follow on to the previous poster, maybe some research into diet would be helpful.

[Kimberly Wersal]

Concerning the Proair: It's just an albuterol inhaler; the problem is the propellant (or lack thereof). Several years ago the government, in it's infinite wisdom, did away with the original style of albuterol inhaler. All of us asthmatics puffing on our inhalers were endangering the ozone layer. The newer replacement style inhaler just doesn't produce as strong a puff as the old ones, so you have may have to take an extra puff to get a good dose. I don't know if the Ventolin (same ingredient) is much better…. Nothing wrong with the actual ingredient, albuterol. I just happened to have stockpiled as many of the old ones as I could before they were discontinued. Fortunately, since I'm down to my last couple of inhalers, I almost never need them any more.

As for the dairy: I sure haven't missed it as much as I thought I would! I have a little yogurt occasionally, but do better if I don't eat it. It might be worth it to make the sacrifice for a week or two, just to see if you notice a difference.

Oh, by the way, what's the big fuss about what forum you post your question in? Sheesh.

[Petra S]

@ Kimberly

Thanks for explaining the difference between the inhalers. I knew they were made of the same active ingredient but thought one may be more concentrated.

I have no idea about the furrow my post is producing. If there is that much of a problem, then the name needs to be changed.

I'm going to do my research and see what I come up with. I teach chemistry and biology so I'm big on reproducible results :) I drink wine too which has sulfites so I'll look into that too.

Again, THANKS for all the help!

[Walter Carrington]

You have my sympathy.

I also developed asthma around age 50, from chemical exposures at work. Fortunately my triggers are seldom present on the trail. I also have a few allergies but they never trigger my asthma.

The inhaled steroids should normally be taken every day, not as a "a preventative course of steroids". People with asthma triggered by seasonal allergies can usually get away with stopping in the off season.

It can be useful to keep a time stamped log of exposures, symptoms, treatments, and peak flows. My doctors recommended taking peak flows at the same times every day (5 times per day); it makes it a little easier to do comparisons.

Figuring out what your triggers are is extremely useful. Avoidance of triggers is important and is the only thing that really works for me.

Cold or exercise are triggers that are difficult to avoid. After a particularly bad chemical exposure 10 years ago I thought I might have cold induced symptoms. Several things that are supposed to help:
pretreat with albuterol/ventolin/proair;
warm up with exercises inside before going into the cold if possible;
if warming up outside, do it gradually;
as others have said, warming incoming air with masks, etc., helps. Here's a decent overview of exercise induced asthma that largely applies to cold induced asthma: http://www.uptodate.com/contents/exercise-induced-asthma-beyond-the-basics

Something that seems to help with bronchoconstriction and jittery airways is relaxation techniques; I use self hypnosis. It helps me, but don't expect miracles.

Good luck and feel free to ask more questions.

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