Sunday, September 14, 2008

Asthma, What Asthma?

Since I can remember, I've been an asthmatic. My youthful problems with asthma were primarily allergen induced. Growing up in farm country west Michigan didn't help. I was allergic to most kinds of grass pollens. The worst antagonizers were tree pollens in the spring and mold. I remember helping a farm friend bail hay. I'd lose my voice, get tight in the chest, and break out all over with rash.

Grade school students in Holland, Michigan all took swimmers ed. Each year I just managed to pass beginners to advanced beginners, only to fall back to beginners the following year. Meanwhile, my classmates all progressed to higher levels of proficiency. My asthma was a primary culprit, but having a much higher specific gravity than my classmates didn't help either. I have always sunk like a rock in water.

Later in my teens, the asthma got worse. This included multiple emergency visits to either the doctors office or emergency room for adrenaline injections. Adrenaline acts as a bronchial dilator. I also started taking asthma maintenance drugs like theophylline. This stuff was like binging on Starbucks. It couldn't be healthy to take this the rest of your life, and it was not without potentially dangerous side effects. This prompted a series of allergy tests in preparation for allergy shots.

The theory behind allergy shots is simple, if not completely understood. You are injected with purified allergens at increasing doses, in effect toughening you up. The serum is custom made based on test results. The first vial is clear. The second has slight tint to it. The third looks like tea, and the fourth looks like coffee (not Starbucks dark though). Each vial is 10 times stronger than the previous. Injections were one to two times per week to start. A tiny amount of first vial was used for first injection. Then you wait for 30 minutes to make sure you don't go into anaphylactic shock. Next shot is slightly bigger dosage. By the time you finish the fist vial, amount in syringe is quite large. Then you start second vial that is 10x more potent, so dosage goes way down. You then ramp up through this vial. You keep doing this until the forth vial, which is dark colored with allergens. I could never get to very big dosage in fourth via, as my arm would swell way up and get hotter than blazes. I was on verge of having a much broader reaction.

After many years of injections, I was able to come in less frequently, maybe once every two weeks at maintenance level on fourth vial. A dramatic reduction was noticed in allergy induced asthma, although I still couldn't bail hay or rake up moldy leaves without problems. I was also still dependent on my rescue inhaler, although only sporadically.

Fast forward a few years. I started cycling and moved to New England. I discovered I still had asthma problems, but not allergen induced. They were exercised induced, called EIB (exercise induced bronchoconstriction). I still needed to use my albuterol before exercise to lessen the severity of EIB. Later when I started XC skiing, EIB was even worse. The cold, dry air was brutal on my lungs. I learned that many world-class XC skiers have this problem. I had many bike and ski races where asthma impacted my performance. Using the inhaler didn't always work.

A couple years ago, my doctor noted the imbalance between my "good" and "bad" cholesterol. My total cholesterol has always been low, typically less than 150. But the ratio was poor. He recommended I take Omega-3 supplements in the form of fish oil capsules. I started taking one a day. Subsequent blood work showed no improvement in HDL to LDL. Last fall I did a little research and learned that one capsule of generic fish oil is not enough. It has little EPA and DHA in it, the two Omega-3 fatty acid constituents. I also stumbled across references [1], [2] linking fish oil and asthma, particularly fish oil and EIB. Multiple recent studies suggest that Omega-3's can reduce EIB in some elite athletes dramatically. Other studies show Omega-3's do little in general asthmatic population. It seemed to benefit highly trained athletes the most.

I switched to a high potency fish oil supplement and started taking two a day this past winter. This tripled my EPA and DHA dosage. I did this primarily for HDL and LDL benefits and gave it little thought until half way through the cycling season. I was not having any issues with asthma. Typically, I would always use my inhaler before interval workouts and races. I completely stopped using it for training rides and even forgot to use it before a couple races this summer. I essentially became asymptomatic, probably to the point of having no worse bronchial constriction problems than someone who never has had asthma. Could it be after 12 years of cycling my asthma just abates all on its own? Asthma is not well understood, and it does come and go in people. There's no way to prove it, but I can't help but believe the addition of Omega-3 supplementation to my diet is behind this.

So this winter will be interesting. The cold air puts additional stress on the respiratory system when exercising. If ski training goes well without use of albuterol, I will probably let my prescription lapse. It would be really cool to be free from this scourge after 46 years if all it takes is simple, safe dietary supplementation.


Luke S said... a collegiate nordic skier, I have had minor problems with EIB before. If fish oil could help...well that would be great.

Anonymous said...

Go roll around in some hay or moldy leaves and let us know how it works out for you.

Mookie said...


Did the subsequent increase in dosage have any further effect on your cholesterol levels? I have been taking a complete oil supplement for a couple of years now and I swear it contributes to my well-being. Nice to hear you can finally chuck the inhaler.

Hill Junkie said...

The placebo effect is an ever present demon lurking in the folk remedy realm. At least there have been a few controlled studies showing asthma benefits in a very particular group. A few other studies were less conclusive. The way I see it, if a harmless folk remedy has a positive placebo effect, then why not take it? In the case of Omega-3's, it might not be just increase in Omega-3 intake, but rather increasing ratio of Omega-3 to Omega-6. American diet is 20-25x higher in Omega-6 fats than say a mediteranian diet where incidence of asthma is much lower.

I haven't gone in for a physical since upping the dosage. Probably won't for another year or so. Generally, the only reason I went in for periodic physicals was to get my Albuterol prescription renewed. If I don't need it anymore, there won't be as much motivation to get routine physicals.

Studies that show a positive correlation between Omega-3 intake and reduced EIB seems to work only for EIB, and not allergen induced bronchoconstriction. The hay and mold test could induce a flashback to the past. Over the years I've gotten pretty good at avoiding problem situations. Not sure I want to find out, but it would be a good "acid" test.