Summer 2012, Vol. 10, Issue 2



Breathing Freestyle

 SwimerBy Laurie Ross

“By the time an athlete has spent a decade preparing daily for the Olympics, there is a certain grace in competing. During my races, I typically felt a oneness with my body, the water, and my soul.  Swimming felt masterful, effortless, light, blessed… like swimming was a part of me … until the last 10 or 15 yards. Then it’s pure guts, keeping the stroke together, arms, legs, lungs burning, chest tightening, driving for the wall.”

Nancy Hogshead-Makar knows what it feels like to win – she earned three gold medals and a silver medal in swimming at the 1984 Los Angeles Olympics. Like all great athletes, she also knows what it feels like to lose. But what she didn’t know was that the end-of-the-race tightening was asthma.

“I’m from humid Florida,” she explains, “and I didn’t swim as well in California outdoor pools, with its dry air. I didn’t know why at the time, I just thought maybe it was the time change or maybe I was ‘choking’ psychologically. I tended to do well at the beginning of the competition, and then taper off. I swam four events, prelims and finals, before my last race, the 200 butterfly. Standing on the racing block, I was retracting, having a hard time getting a full breath, to get to the top of the breath, and it took a lot of effort to do so. Those last few meters of the race were very painful as every cell in my body cried out for oxygen. I missed a medal by .07 of a second. That’s an eyelash! A blink is .25 of a second!

“I had been having regular, predictable symptoms for about 10 years,” she says, “despite having a father who is a physician, a brother with asthma, and eight years of world-class competitions with physicians on deck, watching me cough. When I was finally diagnosed after the Olympics, all the pieces came together. It made sense. No wonder I coughed in practice. No wonder I needed to warm up more than my teammates. No wonder I got ‘bronchitis’ frequently. No wonder I didn’t swim as well in dry climates. I thought I had small lungs – in fact, they’re enormous: 8 liters, which is about double for a woman my height.”

Lung Power

At the last Olympics Games in Beijing, almost one in four Olympic swimmers had asthma. According to James Miller, MD, chair of the Sports Medicine Task Force for USA Swimming and a member of the FINA Sports Medicine Committee, there are several reasons for this:

“First there is a baseline incidence of asthma in the athletic population. Secondly, many athletes with asthma are encouraged to take up swimming due to the beneficial effects of hydration, humidity, and the physiological benefit of oxygen exchange in the supine [horizontal] position. So, there is a selection of asthmatics who are being directed to aquatic sports. Finally, there is the problem with the exposure to chemicals in poorly balanced air/water environments.  When out of balance, chemical byproducts hover over the water exactly where the athletes are breathing. A simple rule is that if you can find the pool by following your nose, the pool is not in balance. These same chemicals tend to be irritants to airways.”

Dr. Miller says there have been problems in the past with asthma actually being over-diagnosed. “The use of inhalers in swimming reached an alarming level 8-10 years ago when it seemed that you could not walk across a pool deck without stepping on someone’s inhaler,” he recalls. “How many had asthma? No one really knew, since typically a parent or athlete would tell their medical practitioner that they had coughing or felt tightness during their workout and the common response was to try a bronchodilator inhaler to see if it helped. Since everyone else had one, rarely did the athlete want to discontinue it – ‘just in case it helped’.”

Now, World Anti-Doping Agency (WADA) rules can require a strict documentation of the diagnosis of asthma in order to be able to use certain bronchodilator medications particularly at the higher concentrations – a diagnosis that Miller says is critical to the athlete’s long-term health.

“You do not want to use a medication that is not indicated,” Dr. Miller says. “Every medication has side effects. However, if an athlete has undetected asthma with low levels of chronic inflammation brought to the surface by exercise, that athlete must have the baseline asthma addressed. Treating the allergies, addressing the inhaled toxins and/or treating the lung inflammation make a tremendous difference in athletic performance and long-term health. Untreated chronic lung inflammation can cause irreversible damage to the lung that resembles chronic obstructive pulmonary disease.”

From 1984 – 2012

One of today’s outstanding Olympic swimmers with asthma is Dara Torres. Four years ago she stunned the Olympics audience by winning five medals in Beijing and becoming, at age 41, the first U.S. swimmer in history to compete in five Olympics – teaming up with Nancy Hogshead in 1984 then coming back to compete in 1988, 1992 and 2000.

After the birth of her daughter in 2006, she began training for a comeback in 2008 and discovered she had asthma. At press time, Dara was well on her way to making the 2012 U.S. team as well. Follow her progress on www.daratorres.com.

Swimming With Ease

Whether you aspire to be a recreational or professional athlete, there’s no reason asthma should keep you out of the pool or off the court. However, what these elite athletes have found is that “no pain, no gain” doesn’t apply to asthma symptoms.

Breathing is fundamental to all activity – and once you get your symptoms under control and understand what makes asthma worse, then you can move on. Here are Nancy Hogshead-Makar’s 10 steps:

  1. Work with a physician to develop a personal, detailed medication regimen that works for you, and then stick with it.
  2. Use a peak flow meter. Many people with asthma don’t act on their early symptoms because they don’t recognize them as asthma. Prior to using a peak flow meter, I could only tell I was having asthma after I had lost 40% of my lung function. I couldn’t act because I couldn’t self-assess.
  3. Pre-medicate. Don’t wait until symptoms appear.
  4. Check the air quality. Look for allergens, pollution and weather and know how they interact with your particular case of asthma.
  5. Wear a mask, like a bandana, over your nose and mouth to warm and humidify the air when it’s dry or cold.
  6. Take a long warm-up. Take advantage of the “break through effect” of a sustained gradual build-up of exercise intensity.
  7. Stay hydrated. Drink small amounts throughout the exercise.
  8. Use breathing exercises. Asthma is not caused by improper breathing, so any breathing technique will not cure asthma. However, it will help you get a more efficient, more relaxed breath.
  9. Cool down. Stopping exercise quickly can sometimes bring on asthma.
  10. Re-medicate if necessary. I only need to re-medicate if I’m just getting over a cold, if it’s very dry outside or if I’m competing and really hitting it hard. But a personal asthma management plan will evaluate the need for this possibility.


Ask the Allergist: Oral Allergy Syndrome

WeberBy Richard Weber, MD

Q: Sometimes my mouth tingles when I eat melons – is this a food allergy?

A: It’s a kind of allergy called oral allergy syndrome, tied to the fact that some fruit and vegetable proteins are genetic cousins to certain pollens, like ragweed. So people allergic to pollen may experience symptoms when they eat related foods – such as cantaloupe or watermelon with ragweed allergy or apples with birch tree – especially during pollen season.

Q: What symptoms would you notice and are they dangerous?

A: The most common is a little tingling of the lips or itching in the mouth. Most of the time it doesn’t go beyond an annoyance.

Unlike proteins in peanut or shrimp, known to cause serious allergic reactions, these fruit proteins break down quickly when exposed to enzymes in your mouth or stomach so they are unlikely to be absorbed into your bloodstream and cause a more generalized reaction. There are reports that the severity could increase, but is it common? No.

As with all allergy symptoms, however, I would advise someone who experiences these symptoms to see an allergist.

Richard Weber, MD, board-certified allergist with National Jewish Health, is president-elect of the American College of Allergy, Asthma & Immunology.

Hear a podcast interview with Dr. Weber on food allergy at  www.allergyandasthmarelief.org.


FDA’s Proposed New Paradigm

FDA_logo

 

The Federal Register isn’t high on the average person’s reading list. It is the official Daily Journal of the U.S. government where federal agencies post announcements for public response: www.federalregister.gov.

On February 28, 2012, FDA posted a “new paradigm” for public consideration – one in which routine diagnostic and treatment decisions would shift from our physicians to patients and pharmacists and/or other technologies.

FDA believes that “routine monitoring, blood tests and determining whether or how well a medication is working, or adjusting doses” could be managed by pharmacists or technologies, which would free up prescribing practitioners’ time for “more seriously ill patients” and would “reduce the burdens on the already overburdened healthcare system and reduce costs.”

To achieve this goal, FDA proposes making prescription medications for asthma, anaphylaxis, migraine headaches, diabetes, hypertension and others available without a prescription.

Before you start thinking this means FDA no longer considers these conditions serious or that you’ll have easier access to medications at a lower cost, read closely. FDA’s introducing new hoops and hurdles called “conditions for safe use” otherwise known as “kiosks, technical aids in pharmacies or on the Internet” in which the patient is guided through a series of algorithms for self-diagnosis and drug recommendation right on down to the printed “permission slip” to purchase the drug “with pharmacist intervention.” This way, “a pharmacist, or consumer (notice we are no longer called patients) could then use the results to determine whether a certain drug product is appropriate.”

Pharmacists would assess whether we have any conditions or risk factors (they’d need access to our “private” electronic medical records) that would prohibit use of a drug or assist us in choosing between various products sold at that pharmacy.

If that’s not enough, FDA is also considering whether the same drug could be available as both a prescription and nonprescription product!

Come on! We think pharmacists are great but they are not our doctors!

March 22-23, 2012, FDA hosted a public hearing at which pharmacy and pharmacist organizations dominated the podium. They eagerly supported FDA’s concepts as actionable and economically feasible without need for additional medical training. They showed slide presentations of technologies that would change the way we shop for better health – for ourselves, our children, our elderly parents – without medical care provider guidance. Nirvana not.

Pharmacists want to be reimbursed (higher health insurance premiums/taxes) or otherwise compensated (higher drug prices) for counseling customers. Someone would have to pay for kiosk space and counseling areas.

Should something go wrong, pharmacists said they won’t be held responsible because they are not physicians. Consumers would have to seek legal remedies through the product manufacturer (pharmaceutical or device company).

Mind you, FDA produced no evidence for their proposed “new paradigm” but asked the public to detail “what types of evidence would be needed to demonstrate that certain drugs could be used safely and effectively in the nonprescription setting with conditions of safe use heretofore not described.” What?

The lone voices of reason at the public hearing were Allergy & Asthma Network Mothers of Asthmatics, American College of Allergy Asthma & Immunology, American Medical Association and the Food Allergy & Anaphylaxis Network/Food Allergy Initiative.

It’s not like patients asked for this. It’s not like we need it. The most difficult part of managing asthma and food allergies is during the learning curve where routine visits (which are never routine) and specialized allergy testing matters! There’s a reason we’re not given unlimited refills for medications – we require periodic monitoring just like our teeth and eyes need periodic check-ups.

The longer our symptoms smolder uncontrolled, the more damage to our airways and ultimately, the more medication and medical services are needed. Chah ching. We don’t need vending machine medical care.”

AANMA funded and conducted the Allergy & Asthma Families Care survey in which 500 respondents were given the option to select among various medical care providers, pharmacists, friends and themselves for diagnostics, routine and emergency care. Score big for physicians (94%), allergists (94%) and zero for pharmacists, friends, and self.


Head South of the Border

By Chef Michelle Austin

 

Crank up some salsa tunes because we’re heading south of the border. They’ll be asking for seconds when you serve these always endlessly adaptable, incredibly edible Bang-Up Burritos and Simple Salsas!

 

Oh – and while we’re talking:  My recipes are meant to become YOUR recipes! Let me know what works or what you did to substitute one ingredient for another.

 

Send your creative cook comments to editor@allergyasthmanetwork.org

 

Have fun, be creative and mix it up tonight!

burritoBang-Up Burritos

  • 1/2-cup small-cut turkey sausage, ground turkey or chicken, or vegetarian alternative, such as soy crumbles
  • 1 tbs. diced onion
  • 1 tbs. diced pepper (red or green)
  • 1/2-cup finely chopped lettuce
  • 1/4-cup pinto, black or refried beans
  • 1 oz. sharp cheddar cheese or soy alternative
  • 1 spinach or whole wheat wrap
  • 1 tsp. olive oil or margarine (can use cooking spray alternative)
  • Hot sauce garnish (optional)

Directions:

Heat olive oil or margarine in a pan. Saute onion and peppers; add salt, pepper and any other veggie desired. Add meat or soy crumbles.

Spread sautéed mix on wrap; add cheese; roll and fold.

Garnish with salsa and hot sauce (optional)

* Suggested variations: add broccoli or spinach

salsaSimple Salsa

Salsas are made with a variety of fruits and vegetables these days! Try adding citrusy, firm fruits like mango and pineapple. Corn, cucumber and smoked peppers are favorite vegetable ingredients for salsas.

  • 2 medium size tomatoes (dice and remove seeds)
  • 1 white Spanish onion, chopped
  • 1 jalapeno chili minced
  • 2 tbs. fresh chopped cilantro
  • 2 tbs. fresh lime juice
  • Salt and pepper to taste

Directions:

Chop and mix all ingredients together; refrigerate until ready.