Ask Dr. White

Published June - 3 - 2009Print This Post

drwhite1 Dear Dr. White,

My 16-year-old daughter’s exercise-induced asthma is getting worse. We want to increase her lung capacity to keep her lungs strong, but she can’t do aerobic exercise anymore without her chest tightening up unbearably. She takes Allegra, Nasonex and Symbicort for her allergies and we’re going to try allergy shots, but that seems like so much medicine for a body to take at such a young age. What can we do?
S.B.

Dear S.B.,
Many parents share your feeling that multiple medicines seem like a lot for a young person to have to take. Let me offer you a slightly different perspective, however.
Symbicort and Nasonex are topical corticosteroids, meaning they deliver medication directly to the parts of the body that are affected by allergy – in this case, the lungs and the nose. Before we had topical corticosteroids, doctors used to treat asthma and allergies with systemic corticosteroids like prednisone – medication that is swallowed or injected and then circulates throughout the body through the bloodstream.
Prednisone is effective (and important in many cases), but it causes a lot of undesirable side effects, such as growth retardation, cataracts, elevated blood sugar, osteoporosis and mood swings, to name a few. We can reduce these effects by delivering the medication directly to the organs that need help. After all, why should your fingertip, or any other body part, receive as much steroid as your asthmatic lungs?
So, while daily use of Nasonex and Symbicort may feel like a lot of medication, as far as the body is concerned it’s a lot less than taking a tiny prednisone tablet daily.
My own philosophy is that we need to do whatever it takes, including medications, to allow a child to interact normally with his or her peers. Otherwise we invite additional behavioral and/or medical problems.
I think you’re on the right track with starting allergy shots. Allergy shots work by making the body less allergic over time, and the shots offer the person with allergic asthma the best chance of improving to the point where medications can be greatly reduced, or possibly eliminated.
You’re also on the right track by encouraging regular exercise. Exercise doesn’t actually change lung function, but it can enhance how efficiently we use oxygen. Thus, a person who is in good physical shape feels less short of breath than a person in poor physical shape. What’s more, lack of exercise can lead to obesity, which can make asthma worse and less responsive to medication. A disproportionate number of children with asthma are overweight, and it’s not clear whether the obesity leads to the asthma, or, more likely, whether the child notices shortness of breath with exercise and slowly turns into a couch potato to avoid breathing problems.
If your daughter is experiencing chest tightness with exercise, you might want to check with your doctor about using albuterol or levalbuterol before exercise, which helps prevent symptoms in many individuals. Review her inhaler technique with her doctor to be sure that she is using the device effectively; without proper inhaler technique, a lot of the medication dose can be lost. I’ve seen a number of people who were having problems despite taking all the right medicines, but who got much better after adding a holding chamber and improving their inhaler technique.

Martha White, MD, is a board-certified allergist and director of research at the Institute of Asthma and Allergy in Wheaton, MD, and medical editor of The MA Report. Do you have a medical question? E-mail editor@aanma.org, or write to Ask Dr. White, AANMA, 2751 Prosperity Ave., Suite 150, Fairfax, VA 22031.

This article first appeared in The MA Report for May 2009, AANMA’s award-winning newsletter for people with allergies, asthma and related respiratory conditions. Click here to read The MA Report online. Download MA Report for May of 2009

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