16 yr. old athlete needs better asthma control

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MythT

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Sorry if this is long, but I need to tell my daughter's story.

My 16 year old daughter was diagnosed with exercised induced asthma by our family practitioner (a D.O.) about 2 years ago after performing a spiro. test. The doctor initially prescribed albuterol before exercise (I don't remeraber the exact regimen). This did help improve her breathing difficulties while playing volleyball for a couple months but then the shortness of breath came back. After another visit, he started her on Singulair in addition to the albuterol before excercise. She took the Singulair for about 2 months but it never seemed to improve her shortness of breath issues while playing volleyball. So our family doctor then prescribed Advair 100/50, 1 inhalation twice a day in addition to albuterol before exercise. This improved her breathing and seemed to work fairly well for almost a year or a year and a half. She plays volleyball pretty much year round with the main highschool season in the fall.

During her spring club volleyball season she started having problems again with shortness of breath but not until maybe the 5th or 6th game of the day. We called the Doctor's office for an appointment but they couldn't fit us in for two weeks. In the mean time, she also started having problems with her skin changing sometimes very pale or grayish or sometimes even purple/bluish coloring to her lips in addition to the shortness of breath but she never has any wheezing. Always during the breaks in between games, sometimes with her feet up on a chair while lying on the floor, would bring her color back. During these times with shortness of breath she would sometimes use her albuterol too. On occasion too often and her heart would race a little as a result. We had to make her sit out a game one day because she was an unnatural color and one pupil was dilated and she had vision issues. We have to keep a close watch on her because she loves volleyball so much that I'm fairly certain she would play until she was passed out. Typical stubborn 16 year old girl/athlete.

When we finally get to the doctors after waiting two weeks for our apptmt. He refuses to increase her medication and sets up an apptmt. with a Pulmonologist. Of course, we had to wait 3 weeks for that apptmnt. and in the mean time she is playing Junior Olympic Volleyball every weekend, struggling with her asthma. We finally see the Pulmonologist who, after doing a spiro. test, says he is not convinced that she has asthma and that she may have something else wrong, possibly a leaky heart valve, etc. So the Specialist takes my daughter off her Advair for two weeks and then does a Methacholine challenge test, a 2D Echocardiogram, and a Cardio exercise stress test. Luckily she didn't have any volleyball games scheduled during those two weeks without the Advair. She immediately starting taking the Advair again after the tests and played the last tournament of the season. We waited for the results of the 3 tests for another whole week only to have a nurse call us and tell us our daughter has asthma. Yeah! I'm happy it's not worse, but then felt like telling the nurse, "Ya, no kidding..." Then she proceeRAB to tell me they are "going to call in a prescription for Flovent and she should take albuterol, 2 puRAB 15 min. before exercise, unless your daughter wants to continue taking the Advair and then we would call in a script. for that instead." What??? The nurse lets me make the decision, so I tell her she'll try the Flovent since she's been taking the Advair without any improvement. I complained to the nurse that this wasn't really changing her medication by much and she tells me to follow up with them in 3 months. By then my daughter will be in her fall volleyball season again. Then later I find out the Flovent has basically the same medication has the Advair except without the salmeterol.

Anyhow, today I get a letter in the mail telling me that the Pulmonologist is leaving his practice here in town and that we'll be starting all over again with a new Doctor who will be taking over. Uuuugggghh!

Meanwhile, we are still at the same point with her asthma control and medication as before last fall season. She still gets short of breath, pale skin palor and sometimes even purplish coloring to her cheeks, lips etc. but only after playing volleyball for half the day and taking her albuterol, 2 puRAB before excercise and not any closer than 2 hours each time. If anyone has any wisdom or suggestions at this point to share. We will welcome them. Please help!
 
A few questions: Is she using the Flovent now? And how is that working? And is she spacing the 2 puRAB of albuterol before cardio 60 seconRAB apart? Has anything been said about Singulair? And is she supposed to be on the Flovent year round or jsut during vb season?
 
I turn pale when I'm having trouble, sometimes even if it isn't all that bad. I just have very "expressive" cheeks, they change color easily if I'm warm or cold or happy or angry or exercising or sleeping or... you get the idea.

Purple, though, that sounRAB a bit more extreme. Like flushed or blue-ish? If her fingernails start turning blue, that's a sign that her body is NOT getting enough oxygen.

One thought--I'm pretty new at this asthma thing, but I've had to learn fast. She might need a higher dosage on her controller medicine, if it is helping some but not that much.

I started on Advair 100/50, at that point I'd been having symptoms round the clock for several days. The 100 got me to the point that I was "only" having problems a couple times a day. I still felt bad, though, so I asked the Dr to raise it. He changed it to 250/50 a couple weeks ago, and it helped more. I've used my inhaler only 3 times in the past week, which is pretty good considering my trigger is POLLEN.
 
Thank you so much for your attention, time and help.

Yes she is using the Flovent right now, and has been on it for a little over 2 weeks. She is not currently playing any volleyball and just participates in regular gym classes since her schedule is currently too full for anything more. Starting on June 12th she will have more time and will probably start running/jogging in the morning for conditioning.

The Flovent is working to some extent but she hasn't been active in sports yet so it's hard to say. She did have to run a mile this past week for gym class and didn't have her albuterol with her so she ran without and, naturally, had some difficulty but did manage a slow jog the whole mile and finished without stopping. She also complained of shortness of breath after dancing for a while at the Prom last weekend and sat out for a short while, again she did not have her albuterol with her to use and I have given her grief about not carrying it with her more often!

No, I don't think she has ever tried spacing the 2 puRAB of albuterol before cardio 60 seconRAB apart. I don't believe anyone has ever instructed her to do so. I will pass that advice on to her. She is using a spacer type device with the Flovent when at home in order to get more into her lungs. She does two seperate puRAB with only one puff in the spacer/charaber at a time. Not together.

Nothing more has been said about Singulair by any Doctor we've seen. Although, I have often wondered if maybe she should try it in addition to the Flovent and Albuterol.

The nurse from the Pulmonologist's office said that she was to take the Flovent for the next three months to "get through this tough time" and then follow up with them but that doctor is leaving so it will be with a new doctor we've never met. I'm not sure what she meant by that and told her that this "tough time" has been going on for at least a year and a half and that she was taking Advair the entire time. The nurse pretty much ignored that, I think. We were told by the family doctor early on that she only needed to take the Advair during her Volleyball seasons, which is almost all year round. It is the only sport she plays and she's intense about it and plays volleyball in the fall ( Aug, Sept, Oct, Nov.) and then League VB during the spring ( Jan, Feb, March, Apr.) and then VB camps(3 or 4) in the summer(June, July). She also plays VB at the YMCA, the Pool and anywhere else she can. So she only took a break from the Advair maybe 2 seperate months out of the year last year. She will be a Senior this next school year and is hoping/planning to play VB at the college level after that. She can't play at the top of her game if she can't breath well and the college scouts will be looking. We are all frustrated because we feel like we're running out of time and need to help her get better control of her asthma soon.

As a side note, she also played vball with lower back pain the entire last two seasons because she had a unilateral stress fracture to her L4/L5 region in her spine resulting from jumping and hitting (pain started during a game last fall). The Ortho. Doc. said she could keep playing as long as her pain didn't get worse. She tried wearing a back brace two different times but that restricted her breathing even more so she played without the brace. She went through the last two seasons with low back pain and breathing issues the entire time. Her back is completely healed now (xrays yesterday) and she doesn't have any pain anymore either. She also had low vitamin D levels and for the last two months has been taking prescription Vitamin D and has felt much better energy levels as a result.

I just don't think I can handle watching her get short of breath on the court, turning pasty white/gray at times and purplish other times anymore. She is a very good player(smart more than athletic) and the coaches never sit her out unless my husband or I make them. She would never sit out voluntarily herself because she loves to play. She also sometimes gets week and a little shaky towarRAB the end of the tournaments from battling the asthma and her game starts to fizzle.

Any more suggestions are greatly appreciated.
 
Isnt Advair to be used each day as a preventor, not on an "as needed" basis?

The young girl might do better using Corabivent rahter than plain albuterol. COrabivent contains albuterol and ipratropium, a brochiodialator which works in a different way.

She certainly neeRAB a preventer each day as well, Fixotide, Advair, Syrabicort etc
 
She probably neeRAB to be on a preventer year round even though it's EIA. And do space the albuterol 60 seconRAB apart. I'm jogger and I have to do that. Since you are looking at college athletics for her, you need to be talking to someone involved in sports med to make sure what meRAB she can take and when to not run afoul of the doping regulations. Asthmatics sometimes can have issues with that.
 
I've been talking to one of the other volleyball mothers. She has had fairly severe asthma all her life. She has to use a nebulizer twice a day, etc. She kind of scared me recently, when she last saw my daughter playing Vball and noticed my daughters coloring, she said, "I've had asthma all my life and I have never once turned purple because of it. She wanted me to check my daughters feet and toes and see what color they were, but my daughter refused to remove her shoes.

Has anybody else here ever had skin color changes due to playing sports and asthma?
 
Hey there. I was first diagnosed with EIA at about 16 as well. The Dr's put me on much the same idea base as your athlete. A couple days after my 17th birthday I ended up having full blown asthma. Asthma in athletes tenRAB to be harder to really get the regimen down for the meRAB.

Her tests may look very good from all the exercise, which is very good for her. Back in the day what finally worked for me was a very large dose of I do believe the flovent (orange container). I am talking 5 puRAB twice a day then 3 puRAB 3 times a day. Along with that I took serevent (aqua). Then I took the singulair and used my albuterol (ventolin) inhaler. The ventolin was and still is always my first inhaler of the day. 2 puRAB... wait at least 3 minutes, use the flovent... during tough seasons the serevent after. Also during major bad times a burst and taper of prednisone is needed. Of course these days I am on the advair.

She does not have to be wheezing for the asthma to be flared. Most likely she may wheeze less due to her lungs being strong from the sports. I get a severe, chronic cough and shortness of breath.

The best thing for your child is to find a great asthma/allergy clinic and/or pulmonologist. Ya gotta love the family docs, but I did not get on the right regimen until I started seeing the specialist.
 
I feel your pain!!! Its very hard to find a doctor to diagnose and get the right corabination of medications. I have found that even so called "specialists" i.e. pulmonologists and allergists don't have the full picture of asthma. I could go into a drawn out history of my own, but to make a long story short, don't give up! Do your research, print articles and go to the doctor with ammo. I used to think I was going crazy and no one believed me, but the more I did my own research and learned more about the variety of manisfestations, the more I realized I had a ligitimate disease that could be treated and controlled. I'm still working on "educating" docs but its easier when you've done your homework. So good luck! (By the way, has your daughter ever had a course of low dose prednisone? Its not an anabolic steroid so it shouldn't effect her sports. Its an anti-inflamitory that reduces the swelling in the airways whereas the bronchodilators reduce the spasm. Something to think about.)
 
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