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Humidity, heat, exercise: trying to make sense of triggers
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Humidity, heat, exercise: trying to make sense of triggers

Hi everyone. I am hoping to get a sense for how humidity, heat and exercise affect others.

I am trying to find a pattern to the ebb and flow of my asthmatic symptoms. Basically, I just seem to have great difficulty breathing if I'm sweating a fair bit. High humidity seems to be the single worst thing: I typically cough first, find my breathing is labored, then eventually feel an almost crushing feeling in the chest. Exercising in heat (let alone humidity) causes me difficulty. Heat itself causes some difficulty after a while, even with lower humidity.

Going into the water at the beach on a hot day is usually great.

I originally thought I was having problems primarily due to pollens on hot days with winds from inland (I'm on the coast in Aus). Now I've been thinking about the pattern, I suspect it could be more the heat.

I have only recently been given asthma treatments for the first time. I was given some great advice here a while ago about treating allergy symptoms, which I continue to follow. I've recently been prescribed fluticasone/salmeterol for difficulty breathing. It helps my "baseline" a lot. However, it seems that when it's really humid, breathing remains difficult. We just had a (ex cyclone) tropical low move through recently and even in air-conditioning, I was in a bad way. Most of the time, though, air-con seems to help a lot, although not necessarily straight away.

If anyone experiences similar patterns, I'd love to know. As I say, hoping to learn the patterns so I can try to save a lot of suffering! Thanks all.
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Avatar_f_tn
Hello,
You are discribing very common asthma triggers.
- exercise
-heat/cold
-humdity (dry/humid)
-weather change

People varry with which extreme will trigger them.  Some people do better is dry air than humid air, while some people react to the dry air and are fine with humidity.

I have a small area of comfort where humdity is concerned.  Both extremes get me.  I first realized this in my allergist office for a check up.  I was put in a stuffy exam room.  The nurse was going to turn the AC (air conditioning) on, but I told him not to because I get cold very easily.  By the time the dr came in I was coughing constantly when I had been just fine minutes before.  She adjusted the AC and I was my coughing stopped when I could feel the cooler air.  However, if the air is too dry it will also get me.

Exercise is also a common trigger, especially if you are already having breathing difficulties.  Some people only have asthma symptoms with exercise.  This is called exercise induced asthma (EIA).  Many people will pretreat with their rescue inhaler before exercise to stop the symptoms.  If you are in an "asthma flare", you should avoid strenous exercise completely, and limit moderate to light exercise.  Your body will need rest to heal the inflamation (inflammation) in your lungs.  Exercising will cause more inflamation (inflammation).

Weather changes are also big triggers.  The exact cause of this hasn't been well explained yet.  Some people say that it is the air presure change.  Others suggest that lightning storms cause pollens in the air to be broken up into smaller particles so that they are inahled more deeply into the lungs.  My lung are just plain fussy.  Sometimes they will revolt when colder or hotter weather first moves in, but will adjust over a few days.  My doctor has me start treating myself if a significant weather change occurs, or if there is a severe storm.  A severe thunderstorm has triggered a major flare for me.

Educating yourself about asthma is your best weapon in fighting it.  You need to be familiar with common triggers.  Not just the ones you have experienced in the past, but all just in case you do react to one sometime.  Also, there are some subtle symptoms that people often over look.  If you are familiar with those, you can treat and preven bigger issues.  There are also some rare symptoms that you need to be familiar with.  There are some excelent resources out there, so keep looking.  Some places to start would be your contry's allergy, asthma and immunology certification board.  Often they have patient resources.  If you want to check out the US sites they are
www.aaaai.org   and
www.acaai.org
Also, check leading hospital websites.  In the US Mayo Clinic and National Jewish Hospital are two of the best.  

Take care and keep us posted.
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Avatar_m_tn
Once again, thanks so much for all the information. It really gives me a good feel for what I need to do.

It's really comforting to know that changes in weather affect people (irrespective of whether anyone has determined why). I have, for a very long time, had a lot of trouble with sudden changes from warmer weather to cool, with fronts. I just put it down to me being physiologically 'wired' to react to sudden changes. Now I suspect that it is triggering difficulty breathing, ultimately making my head foggy, or even leading me to be disoriented and often very on edge/anxious/irritable.

I have taken to carrying around something that measures both temperature and humidity to get a feel for it. It seems that (at least now while it's warm to hot in Australia) when the humidity pushes up toward 60, I start to have problems. I am really glad you mentioned low humidity, I have suspected I struggle when it gets down below 30 from records.

I'm really grateful for your advice about exercise. I walk and do weight training. Despite being able to bench press around 270 lbs max, I feel feeble some days when my breathing becomes very labored. This is more pronounced on days when it is hot and especically if it is humid. So I think I'm falling into the trap you warn about: when I'm already struggling to breath well, I need to avoid the really strenuous exercise. My heart rate goes up pretty high in bursts (with weights), of course indicating increased oxygen demands. I tend to push through it, but understand what you're saying: I need to do what I can to get the inflammation settled so I can recover, not keep exercising at that time I'm already having a flare up.

I'm using Advair/Seretide and have been making sure I've had some before exercise. In good conditions, this is working fine.

I also understand regarding less pronounced symptoms. I'm really starting to tune in to coughing and 'twitchy' & tight breathing (don't know how else to describe it). Perhaps because I don't have full blown (wheezing) attacks, I have never been diagnosed with asthma and I've had doctors put a lot down to anxiety. I most certainly get anxious: I can't breath well.

Thanks yet again bsml, you gave me great advice about more aggressive tratement of allergies, which has helped me. It's also helped my daughter, who persistently complains of difficulty breathing in one of our rooms. However, I need to get her more thoroughly checked. She's also prone to tonsilitis.

All in all, it is so great to make sense of some things. Particularly with humidity, it seems obvious that when it heads up above 60 in relatively warm weather, I will struggle. Some of the rest is still quite confusing, but I'll take your advice and keep reading up and keep thinking about the triggers.
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Avatar_m_tn
I hope you don't mind my asking one more question ...

Recently, when the tropical low came in, as I said above, I felt an almost crushing sensation in my chest, somewhat like my lungs and chest were trying to implode around/behind the sternum.

I had some Advair (Seretide here) and had another dose. It just didn't work as well as usual; i.e. my breathing didn't become easy. Apologies if this is a silly question, but in general terms, do asthmatics have attacks/flare ups that are too severe to respond to relievers? I suspect the answer is a fairly obvious yes, given some may have a trip to hospital (I once called an ambulance for a poor guy cleaning our house who had reacted to chemicals with a terrible asthmatic attack and waited with him for 15 or 20 minutes, which I'm guessing felt to him like a couple of weeks!)
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Avatar_f_tn
I don't mind you asking any question you have.

The problem with the Advair not working was probably different from what you suspect.  Advair is considered a maintence medication not a rescue medication.  For the type of situation you describe you need a rescue inhaler, some form of albuterol.  Before you get one of those you should discus asthma with your doctor.  Your symptoms do strongly suggest that you have asthma, but you do need a doctor's diagnosis.    Albuterol should work in 5 to 10 minutes.  Advair can take up to 15 - 20 minutes to work.  

You are correct that on ocassion, an attack needs medical attention beyond what albuterol can give.  This usually doesn't apply to sudden attacks, but to when the subtle symptoms have been ignored for a while.  He had probably been trying to keep working, ignoring breathing trouble for a while.  

Coughing is a more subtle symptom, but a restless feeling can also be a symptoms.  Here is a list of unusual symptoms I copied from another website.  Hopefull it will help you.
Unusual asthma symptoms may include:

rapid breathing
sighing
fatigue; inability to exercise properly
difficulty sleeping
anxiety; difficulty concentrating
chronic cough without wheezing (cough-variant asthma)

It really does sound like you have asthma.  If your doctor just wants to blame anxiety, you can request pulmonary function testing or a methacholine challenge test.  This way you can get the help you realy need.

Take care and I will be happy to answer any question you have.  I was where you are once too, and not that long ago (2 1/2 years), although I had been diagnosed 8 years before then.  My asthma had been mild, intermittent for the first 8 years of diagnosis meaning that I only had symptoms when I got a respiratory infection of some sort.  Two and a half years ago my allergies worsened, acid reflux worsened, and more exposure to the toxins in air freshners caused my asthma to go severe.  I had to learn about asthma quickly to be an informed patient.  The more you read and learn about asthma the more you will usnderstand.  

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Avatar_m_tn
Gotcha. I was told salmeterol is in the same class of drug as albuterol, but hadn't realised the long acting forms are not used as relievers. A pharmacist recommended I have albuterol on hand in the first place, whether or not I'd been diagnosed with asthma. I'll ask him, and also my doctor, about using it if symptoms flare despite advair/seretide (which is working great in general).

Thos are familiar symptoms -- sighing, coughing, restlessness, anxiety, difficulty concentrating are symptoms I experience often (and usually two or more in combination).

I'm very interested in what you say about air freshners. I have an instinctive & intense aversion to air freshners and perfumes.

At the moment, I am using advail (or seretide) as a trial rather than having pulmonary function tests. I put the decision in my doctor's hands, but said I'd have tests if she thought it worthwhile. Now, I can add this detail: the treatment has been very effective in general terms but there are days on which I still struggle. Unfortunately, the doctor I saw has the misconception that humidity tends to be beneficial for asthma, which I can plainly see is not true for all sufferers (but is for some). However, I typically see another doctor (but he's very busy) so I'll see what he thinks.
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Avatar_f_tn
It is kind of complex.  Salmeterol and albuterol are in the same class of medicines - beta2 agonists (simply put - broncho dilaters).  Salmeterol is a long acting beta2 agonist (LABA) and albuterol is a short acting beta2 agonist.  LABA's take longer to work and last 12 hours.  The short acting ones should work in about 5 - 10 minutes maximum and only lasts 3 - 4 hours.

About the air freshners - I am very reactive to any odor, even foods.  Air freshners are worse than most things.  I have done some research and it seems that air freshners contain small amounts of fermaldehyde.  Along with that certain chemicals in air freshners react with common indoor polutants to make ozone.  Many of the chemicals use in air freshners have been banned by the Food and Drug Adminstration in the US for human consumption.  Yet we will breathe them from air freshners.  There is also research being done on the molecules that produce the smells in any fragrance.  They are trying to decide if these molecules can be classified as allergens or if they are just irritants.

Some doctors will accept a test like you are doing as a means to give a diagnosis.  If the meds help, then it is asthma.  I think I would try not to see that doctor in the future.  A doctor that doesn't realize every asthmatic is different with different triggers is, well... dangerous.  The good doctors are the ones that are always busy. lol  

I pray that your test is successful and that you find the answers you need.
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Avatar_m_tn
I've just seen the doctor I normally see and he was basically satisfied that given ventolin opened my airways and allowed me to breath much more easily, there must have been some amount of obstruction. He explained the difference between the LABA and albutamol well. Basically, it's a matter of potency given the nature of the action.

Several years ago when I was experiencing a range of symptoms, including a really chronic cough, I wondered about the building in which I worked. I found it depressing how much formaldahyde comes from things like new furniture,(debatably) carpets and so on. Unfortunately, since we had a renovation in our house in 2007, I have smelt a (fairly subtle) odor upstairs (the new part) and it still remains stronger when it is warmer, obviously suggesting it is emitted. I'd guess it's the carpet, although I'm not sure. It's a little concerning that my daughter has recently complained of difficulty breathing upstairs. She has had some tonsilitis and could have had a viral infection. I don't think I'll do too much more research on chemical pollutants: I find it depressing and to a large extent there's not much you can do. I will be vigilant at home though. I would take the carpet out if I were really convinced it were the issue. I will continue to monitor how my daughter is upstairs over a period of time.

Anyway, the treatment continues to be great for me. I can breth so much more easily, I'm beginning to forget how much of a struggle breathing was for a period. It may be seasonal, and I assume that breathing difficulty has caused me more trouble while I had mild anemia. Difficult getting oxygen in added to difficulty transporting around the body must be a bad combination. I'm puzzled that I can't find much on the combination of anemia and asthma. I suppose if asthma is treated, then anemia is a similar proposition for someone with asthmatic symptoms. I'm still a bit surprised because it's now pretty clear I have asthmatic symptoms and they became a big problem exactly when I was anemic.

Now, things make so much more sense. Especially with humidity, symptoms are very predictable; and just avoiding exercise out in heat and humidity is helping a lot. I'm going to have to adapt to get the same exercise, but I'm sure I'll find ways. It's so great to make sense of things: it had come to the stage I was convinced myself that anxiety attacks were coming on out of the blue. Now I look back and realise I have been struggling to breath for a very long time. And I actually suspected asthma years ago. It is perhaps worse to have milder asthmatic symptoms, only in the sense that it can go on without being picked up. My doctor is great, he apologised he hadn't picked it up ... and although he "could have" it's pretty tough, particularly given (a) the symptoms probably wax and wane and (b) they were far worse while I was anemic.

I'm just glad to be able to breath easy ... for the most part! ...
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Avatar_m_tn
By the way, I am sure you know the difference between the LABAs and short-acting: that is what I understood from my doctor's explanation. He referred to a simple diagram to give a sense ...

The other interesting thing is that I gave up caffeine last November. I was in a really bad way after that. No doubt some of it was withdrawal, but the difficulties just didn't resolve very well over the usual course (of about a week or up to 9 days according to the research). Given there is evidence caffeine can act as a bronchodilator, I wonder whether I have been self-medicating for a long time. I thought it was strange that tea seemed to make me feel calmer. It could just be that it did so because it helped me to breath a bit more easily. I'm afraid, though, that caffeine affects my sleep way too much, so glad to be off it. These things are complex!
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Avatar_f_tn
I am glad that your doctor has given you the asthma diagnosis.  That will making getting effective treatment easier.  It is good that you are breathing easier.

You should know that many of the symptoms of anemia are the same as asthma.  Certainly if you are anemic and experience an asthma attack you will feel a lot worse.  You need to make sure that you get enough absorbable iron in your diet.

You have stumbled onto another truth.  Caffeine is in a group of broncho-dilaters related to theophyline.  I unknowingly used caffeine to self medicate for several years.  I had know idea.  I started having severe reflux issues and cut my caffeine intake to 1/3 what I had been drinking.  My asthma has been horrible ever since.  If I am having trouble getting control of an attack, I will resort to it at times, but I try to avoid it.  I have a friend that had small children with asthma (grown now).  She told me when they were young that if they had an attack while out they would stop and get them a coffee to reduce symptoms until they could get home to their nebulizer.

The last year was my absolute worst.  I just got back several tests that may have answers for me.  A GI test revealed that I have significant acidic and non-acidic reflux.  I also have two morphotype fungii isolated in a mucous sample.  One had to be sent to the state health department for identification.  I am schduled to get my Xolair shot today.  In the US the government requires an exam before the shot is given.  So I hope my doctor will discus these with me.  She also just got back from a conference and told me (I was paying for my allergy shot and she saw me) that she wrote my name in her notes several places.  She told me that she will be making changes in my treatment plan.  

I am glad that you are feeling better. Stay on top of things, and keep your anemia monitored so that it doesn't complicate the asthma.
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Avatar_f_tn
I dont have a question here, but wanted to thank you all for the info placed here. I am seeing a pulmonologist on the 28th for I was diagnosed with Emphysema and my new doc said thats not correct for my xrays are negative. He did blood work for alpha-1 and they check my antytripsens. It came back low. I did some of my own research as in even getting hospital chest xrays and the reports and googleing my symptoms and checking every lung disease and so forth to come up with possible allergic asthma. It even fits the upper back pain and lower. The difference in quick temp change and smells as in household cleaning chemicals and perfumes, dust(obvious) and so forth. The one thing I have of a symptom is a burning in my mid section as above my abdomen yet the bottom of my front chest cavity that goes all the way across and like on the inside straight thru to my back to where I have to like hold my breath and it hurts very bad. This happens almost every time I eat anything and sometimes just drinking water or when doing nothing as I sometimes awake at night due to the severity of the burning. Have any of you experienced this? Thanks
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Avatar_f_tn
Hi, I am glad to help.  Your symptoms sound more like acid reflux.  Many people have been miss diagnosed with asthma, but really have acid reflux.  When the reflux is controlled, their asthma like symptoms go away.  What makes me think that is the association with eating and the burning sensation.  This causes inflamation (inflammation) of the vocal cords and and lungs making them reactive to your triggers.  

This doesn't mean that you don't have asthma, but that you should try conrolling reflux first.  If it doesn't, you should see an allergist.

I hope that helps.
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Avatar_m_tn
Delayed response, but I actually had responded but was distracted.

Yes, I'm aware that symptoms of anemia and asthm are the same, thank you. I would say that they're described in the same way rather than being the same, at least for me. I have become more attuned to tightness in the airways, and the kinds of early symptoms you described. For example, if I start to cough while feeling difficulty breathing, I am finding this can mean some trouble. (Sometimes on the other hand, I cough but breath well, and the cough feels more productive in the sense of clearing the airways).

I'm finding that in some cases, difficulty breathing develops during the day and lasts. It seems (I could be wrong) this is more related to weather patterns. Other times, I have transient difficulty breathing (e.g. a local video store has evaporative air-conditioning and on hot days, it is really humid and I start coughing and can't breath, but resolves when I get out pretty quickly).

With anemia, I felt fatigued and had a general malaise. In hindsight, I'm pretty sure what was happening is that when asthmatic symptoms were worse, it severely compounded by the anemia, and it became quite debilitating. Not knowing what on earth was going on, it was very disconcerting.

Anyhow, I had a local, experience chemist put me onto bricanyl as a reliever. He suspected it would cause me less jitteriness than albutamol. He was dead right--it's way better for me. In fact, it's just great. On two occasions, I've been really struggling (despite seretide with the LABA) and bricanyl (terbutaline) has worked very well. On one occasion, I had a second dose four hours, and then it did make me feel "hyper" for an hour or so. Much better for me than albutamol, tho'.

Anyhow, I think I'll have the challenge test some time in the reasonably near future. Right now, after anemia and a recent colonoscopy/endsocopy, I just want to get on with life and avoid medical tests. But I think it would be interesting to see what the tests show, especially since I knwo in general the risks of false negatives (and positives) in most med tests.

Lastly, I'm fascinated that you were self-medicating with caffeine. I think I did so for 20 years! When I stopped caffeine last October, I couldn't understand why the withdrawal never seemed to end. I think some of it was classical withdrawal but then I was exposed to suffering entirely untreated asthmatic symptoms.

Did the tests on the mucus sample give you any answers??
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