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Breathe Better: Understanding Asthma
By Stephen C. Gangemi, D.C
June 2001
Asthma, including exercise induced asthma (EIA), is the diagnosis given
to more and more people everyday, with athletes making up a large number
of people added to this prevalent group. This condition is defined as
a spasm or constriction of the bronchials causing diminished airflow resulting
in wheezing, tightness of the chest, difficulty breathing, and sometimes
coughing. When the vital capacity, or the total volume of air that can
be forcibly exhaled in one breath, does not change or decreases with exercise,
the person most likely has EIA. The vital capacity should normally increase
with exercise. Almost all people with asthma will have EIA, but those
with EIA do not have a problem with breathing unless exercising.
Athletes of all ages are given the diagnosis of EIA as they suddenly develop
these breathing difficulties that appear out of nowhere, ("Just started
one day while I was running." or "I never had this problem before.")
These symptoms are thought to have no specific origin. There are over
ninety different easily prescribed anti-asthma medications on the market
today, and EIA is commonly diagnosed and treated with prescription drugs
with no attempt to understand the underlying processes which cause the
problem. This article will shine some light on the matter.
There are currently six different categories of anti-asthma medications.
Which individual drugs will work for a given patient depends on what is
causing the asthma symptoms. The medication isn't going to cure the asthma,
it will simply help the person manage it better. One of the clues used
to help an individual truly overcome the cause of their asthma is to see
what medication benefits them most. If they are not on a medication yet,
then it's important to fully investigate the origin of the asthma, so
it may be dealt with at the source. Although asthma is a symptom of the
lungs, there is most always not a primary lung problem to be dealt with,
but a problem from another area of the body affecting the function of
the lungs. Likewise, the medications used to combat asthma have been developed
to treat the areas of the body that are thought to cause the constriction-spasm
symptoms of the bronchials.
So what is causing the asthma and how do you go about fixing it, or
at least dealing with it to the best of your ability? The answer depends
on what is triggering your asthma. What is causing your asthma can be
completely different from what is causing your friend's asthma, even though
your symptoms appear to be identical.
The majority of asthma medications developed are made to enhance adrenal
gland function. The usual mediations in this category are albuterol (Proventil,
Ventolin) and Epinephrine (an adrenal gland derived hormone), though there
are many more. When the adrenal glands are under a lot of stress, whether
from training too hard or too often, emotional stress, nutritional stress
(too much sugar, caffeine, alcohol, poor diet), or a combination of these,
then the adrenal glands slowly become depleted over time. The adrenal
glands are responsible for many important functions in your body. They
help with your electrolyte balance; they help manage hormone levels; they
determine how you manage your glucose and energy levels; they influence
how you repair your joints and fight inflammation; they affect your mood
and even your sleep. These are all things my articles have addressed in
the past. The big idea here is that if one important organ isn't working
as well as it should, you can have many symptoms going on. You can drive
yourself crazy going from one doctor to the next trying to understand
and fix each problem separately, but many times they are all closely related.
That is why I have talked about an athlete not sleeping well, not being
able to get over an injury, and having a problem managing electrolyte
imbalances while training or racing, all as a result of one process not
working as well as it should. Asthma can easily enter the picture here.
This explains why suddenly having asthma symptoms one day while heading
out for a run is really an end process of a longer period of depleting
your reserves. The stress has caught up with you and to deal with it effectively
and get over it, you need to understand why it is there and where it is
coming from.
Other times, the asthma is a result of the adrenal glands, but from a
different part of the gland, the adrenal cortex. This type of asthma can
be influenced by insulin insensitivity and carbohydrate intolerance (addressed
in the April 2000 issue). The medications used to help deal with the asthma
are those such as Flovent and Aerobid. Treating this asthma at the source
involves investigating the adrenal glands, the pancreas, and the diet
of the individual.
When an individual is helped by Atrovent, an anticholinergic medication,
there is a problem with the balance between the sympathetic and parasympathetic
nervous system. This is many times associated with an adrenal or stress
pattern in the body that has gone on for some time and the body is having
trouble recovering.
Not always is asthma a result of adrenal gland depletion. In the case
where the asthma is triggered by histamine, an allergic reaction must
be sought as the culprit. Antihistamine medications such as Intal (cromolyn)
and Tilade will show a beneficial effect, but to get to the bottom of
this type of asthma, the reactive chemical or allergy must be identified
and treated. Many times this is a reaction to a food that was eaten two
to three hours before exercise, but the reaction could be from ingesting
the offending food over a period of time long before the exercise. Eliminating
the food (or sometimes chemical sensitivity) from the diet and helping
the individual's immune system overcome the stress can result in dramatic
changes is health and performance. This type of reaction is very, very
common (along with the adrenal gland issues).
Then there are those in the smaller categories that have asthma as a direct
result to the lungs in which case something is triggering the lungs directly.
This could be from a chemical or environmental sensitivity/allergy (sulfite,
strong perfume, pollen/grasses). Aerolate is one example of a medication
used conventionally to help this reaction.
A fairly new type of medication known as a leukotriene modifier is out
now (Zafirlukast). It is used to combat inflammatory conditions that are
much stronger than those resulting from a histamine reaction. Fighting
this type of inflammation as well as most inflammation in your body is
something I will talk about next month.
Whether you have asthma or EIA it is important to know what is triggering
your asthma and how to treat it effectively. Sometimes it is easy to help
a person get over their asthma by treating the underlying processes which
cause it, especially if they just started having symptoms. Other times,
a more thorough investigation is needed to understand what is at the base
of the problem. But whatever the case, as the asthma cases are skyrocketing,
you now have an understanding of how you might get your second wind.
Dr. Gangemi has a private practice in Durham, NC. He works extensively
with athletes and all individuals to treat and prevent injuries and optimize
their health and performance through holistic means. Dr. Gangemi is a
5-time Hawaii Ironman qualifier and finisher. He can be reached at 919-419-9099
or through e-mail at DrGangemi@Mindspring.com.
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