Mr. Asthma

Question:

x-posted to sci.med.cardiology > Ten months ago I went to my family doctor because suddenly I couldn’t walk > across the street without huffing and puffing and feeling as if I had just > run a hundred yard dash.  I had a stress test and failed it.  I got a beta > blocker for high blood pressure, and Isosorbide for what I’m not sure.

Isosorbid is a nitrate, for angina (heart pain).   A > few days later I went to the emergency room with extreme deep chest pains. > I got the full treatment for a heart problem including an angiogram (not > that good but ok for now).  The shortness of breath didn’t improve so later > I was sent to a pulmonary specialist. > I was prescribed with asthma.  I had chest x-rays and a cat scan of the > chest, blew into a few different machines, and was placed on Albuterol ( 2 > puffs 4 times a day), and on Vanceril, ( 2 puffs twice a day).  I was kept > on the beta blocker and on the Isosorbide.  After a few months of no change > in my condition, the Beta Blocker was changed to Zestril.  The beta blocker > was affecting me and there was definite improvement with the change to > Vanceril.

Some high blood pressure meds like beta blockers can cause asthma. Vanceril is a steroid inhaler that treats inflammation of bronchial tubes cause by asthma. If asthma is not well controlled or gets worse the dose of Vanceril needs to be increased; or a stronger steroid inhaler used, like Pulmicort or Flovent. – Hide quoted text — Show quoted text -> This is my problem.  I go to the Pulmonary Doc every 2 months but I have > never gotten much better.  I am a tall overweight senior ex football player > and coach but have always been in exceptional physical condition and kept it > by playing tennis at least 4 times a week. However, now I don’t want to do > anything! Sitting is my best activity, even a shower in the morning leaves > me gasping for breath for a while. Some days are better than others, even > some weeks are better than others, but I’m not satisfied that I can’t get > better.  I have tried going off the inhalers to see what happens. > I don’t see that much change.  My flowmeter stays within a 400-500 liters > range.  The Doc says I should lose weight. ( He’s not the one sitting > staring at the wall all day) > What is my next step with the Doc?  I’m not experienced enough about asthma > to know what kind of questions to ask him, or the kind of tests to ask for. > I’m also not experienced enough with asthma to know what the limits are.  I > read everyone’s notes here an you all seem to have great variances in your > asthmatic condition.  I seem to stay quite steady.  My chest hurts all the > time. I can remember from football what shortage of oxygen feels like to the > body and I’m there all the time.  What are the steps I should be taking? > What am I looking for? > I hope someone can give me some good advice and I thank you in advance for > it.  I would see it faster if you would direct e-mail me at > Thanks, Don

Was your asthma diagnosed using lung function tests? Peak flow measured before and after adminstering a bronchodilator, a 12% improvement indicates the possibility of asthma. Your symptoms sound more like heart trouble than asthma, especially the chest pain and need for nitroglycerine for angina. If you are a smoker you must stop. Losing weight would be a good step but the important thing is to lose fat and improve body composition for a lower percent fat, ie lose fat, gain muscle. It’s important to continue exercising even if just walking. Get some athletic shoes to ease the stress on feet and joints. How is your cholesterol? I think you would benefit from a 2nd opinion from another cardiologist. Your ‘asthma’ might just be ‘cardiac asthma’, which isn’t really asthma at all. Also a 2nd opinion from another pulmonologist. Another way to go is check in at a major medical clinic, like the Mayo Clinic in Rochester, MN, for a complete evaluation. Ellis

Response:

Most people eat lots of times out of habit more than hunger. There are also lots of people who feel some need to clear a plate whether hungry or not. If you limit your food intake to times when you’re actually hungry, stop eating as a form of entertainment, and stop when you’re satiated you’re well on the way to a more reasonable weight. Dieting only works if the diet you choose is one you can stick with for a lifetime. The rest only make your weight bounce up and down and are not helpful for the long haul. – Hide quoted text — Show quoted text – > I agree if there’s something relatively easy one can do, like cutting > soft drinks out of one’s diet, one should do it. > OTOH, if one is eating reasonably well, I don’t think it’s healthy to > get to the point of being actively hungry (even mildly hungry) in > order to lose weight.  In other words, I favor changing eating habits, > but not eating less food than one needs in a day. > There are studies that show that weight lost only by dieting doesn’t > tend to stay off.  (There are also studies that show being fit and > overweight can be okay, health-wise, while than being unfit and thin > is more of a problem–but that’s for the general population and the > issues may be different when asthma is involved.) > I guess it depends on how important relatively quick weight loss needs > to be–if a half hour a day of exercise is going to mean only losing a > pound or two a month, that’s okay with me.   > But I’d imagine there can be medical circumstances where this isn’t an > acceptable rate–something to consult with one’s physician on, > perhaps.

Don Elton Columbia, SC http://www.midcarolina.org

Response:

>Excercise is important to good health but it’s a very poor way to lose >weight. On my treadmill, walking at 3 mph (a pretty fast walk – much >faster and you’re running) for 20-30 minutes will buy you about 100-150 >calories. You’d need to do this for about 90 minutes a day to lose 1 lbs >per week which is normally about all someone should try to lose unless >they’re already over 300 lbs when losing 2 – 2.5 might be better.

Don seems to be forgetting a few pertinent points.  Yes, theoretically, you are only using up 150 calories while walking half an  hour.  (By the way, 3mph is considered ordinary walking speed, not particularly fast.)  But, in the process, you are elevating your metabolism for sometime thereafter, and building muscles which will increase your body’s ability to burn calories even while resting. > Well, I’ll put in a vote for exercise as the route to weight loss–it > might be slower, but tends to last longer–after most diets, your body > tends to gain weight faster as it tries to recover from the recent > "famine."  Of course, as you say, exercise is not always possible. > (Of course, depending how it’s done and on current eating habits, > dieting isn’t always healthy, either.)

I agree entirely.  In fact, I would say that dieting is almost never healthy.  Not only are people setting themselves up for regaining the original weight and more (after the "famine"), but it does absolutely nothing to improve aerobic capacity, which is obviously the important factor in improving life for asthmatics (any most everybody else).   Alix

Response:

Reposted from dejanews, x-posted to sci.med.cardiology > Ten months ago I went to my family doctor because suddenly I couldn’t walk > across the street without huffing and puffing and feeling as if I had just > run a hundred yard dash.  I had a stress test and failed it.  I got a beta > blocker for high blood pressure, and Isosorbide for what I’m not sure.

Isosorbide is a nitrate, for angina (heart pain).     A > few days later I went to the emergency room with extreme deep chest pains. > I got the full treatment for a heart problem including an angiogram (not > that good but ok for now).  The shortness of breath didn’t improve so later > I was sent to a pulmonary specialist. > I was prescribed with asthma.  I had chest x-rays and a cat scan of the > chest, blew into a few different machines, and was placed on Albuterol ( 2 > puffs 4 times a day), and on Vanceril, ( 2 puffs twice a day).  I was kept > on the beta blocker and on the Isosorbide.  After a few months of no change > in my condition, the Beta Blocker was changed to Zestril.  The beta blocker > was affecting me and there was definite improvement with the change to > Vanceril.

Some high blood pressure meds like beta blockers can cause asthma. Vanceril is a steroid inhaler that treats inflammation of bronchial tubes cause by asthma. If asthma is not well controlled or gets worse the dose of Vanceril needs to be increased; or a stronger steroid inhaler used, like Pulmicort or Flovent.   > – Hide quoted text — Show quoted text -> This is my problem.  I go to the Pulmonary Doc every 2 months but I have > never gotten much better.  I am a tall overweight senior ex football player > and coach but have always been in exceptional physical condition and kept it > by playing tennis at least 4 times a week. However, now I don’t want to do > anything! Sitting is my best activity, even a shower in the morning leaves > me gasping for breath for a while. Some days are better than others, even > some weeks are better than others, but I’m not satisfied that I can’t get > better.  I have tried going off the inhalers to see what happens. > I don’t see that much change.  My flowmeter stays within a 400-500 liters > range.  The Doc says I should lose weight. ( He’s not the one sitting > staring at the wall all day) > What is my next step with the Doc?  I’m not experienced enough about asthma > to know what kind of questions to ask him, or the kind of tests to ask for. > I’m also not experienced enough with asthma to know what the limits are.  I > read everyone’s notes here an you all seem to have great variances in your > asthmatic condition.  I seem to stay quite steady.  My chest hurts all the > time. I can remember from football what shortage of oxygen feels like to the > body and I’m there all the time.  What are the steps I should be taking? > What am I looking for? > I hope someone can give me some good advice and I thank you in advance for > it.  I would see it faster if you would direct e-mail me at

  > Thanks, Don Was your asthma diagnosed using lung function tests? Peak flow measured before and after adminstering a bronchodilator, a 12% improvement indicates the possibility of asthma. Your symptoms sound more like heart trouble than asthma, especially the chest pain and need for nitroglycerine for angina. If you are a smoker you must stop. Losing weight would be a good step but the important thing is to lose fat and improve body composition for a lower percent fat, ie lose fat, gain muscle. It’s important to continue exercising even if just walking. Get some athletic shoes to ease the stress on feet and joints. How is your cholesterol? I think you would benefit from a 2nd opinion from another cardiologist. Your ‘asthma’ might just be ‘cardiac asthma’, which isn’t really asthma at all. Also a 2nd opinion from another pulmonologist. Another way to go is check in at a major medical clinic, like the Mayo Clinic in Rochester, MN, for a complete evaluation.   Ellis

Response:

I agree if there’s something relatively easy one can do, like cutting soft drinks out of one’s diet, one should do it. OTOH, if one is eating reasonably well, I don’t think it’s healthy to get to the point of being actively hungry (even mildly hungry) in order to lose weight.  In other words, I favor changing eating habits, but not eating less food than one needs in a day. There are studies that show that weight lost only by dieting doesn’t tend to stay off.  (There are also studies that show being fit and overweight can be okay, health-wise, while than being unfit and thin is more of a problem–but that’s for the general population and the issues may be different when asthma is involved.) I guess it depends on how important relatively quick weight loss needs to be–if a half hour a day of exercise is going to mean only losing a pound or two a month, that’s okay with me.   But I’d imagine there can be medical circumstances where this isn’t an acceptable rate–something to consult with one’s physician on, perhaps.

Response:

Excercise is important to good health but it’s a very poor way to lose weight. On my treadmill, walking at 3 mph (a pretty fast walk – much faster and you’re running) for 20-30 minutes will buy you about 100-150 calories. You’d need to do this for about 90 minutes a day to lose 1 lbs per week which is normally about all someone should try to lose unless they’re already over 300 lbs when losing 2 – 2.5 might be better. Cutting 500 cal per day out of a typical 3000 cal per day diet is very doable if you think of that 500 cal as exchanging two non-diet drinks for diet drinks or skipping 2 candy bars per day or 1 hamburger per day and so on. – Hide quoted text — Show quoted text – > Well, I’ll put in a vote for exercise as the route to weight loss–it > might be slower, but tends to last longer–after most diets, your body > tends to gain weight faster as it tries to recover from the recent > "famine."  Of course, as you say, exercise is not always possible. > (Of course, depending how it’s done and on current eating habits, > dieting isn’t always healthy, either.) > Either way, I wouldn’t attribute the bulk of your problems to weight > just yet, or assume that things may not be controllable.  I’d sit down > and talk with your doctor about the lack of change, and ask what can > be done.  It doesn’t sound like the’s done much in the way of > adjusting your medication, for example (different doses and different > meds work better for different people). > If your doctor tells you it all hinges on you losing weight, and isn’t > willing to explore other things for you at whatever weight you’re at > now, I’d get a new doctor. > Weight loss, if done right, is a very slow process–and may or may not > ultimately help enough.  There are other things that can be explored > sooner, and that should be. > No reason you should have to feel miserable for months and years while > the doctor waits for you to lose weight. > Another thought: getting a referral to an allergist.  I’d still see > the pulmonologist too, but an allergist can help you find out whether > there are any specific triggers to your asthma, which you can then > work on avoiding or reducing your exposure to them.

Don Elton Columbia, SC http://www.midcarolina.org

Response:

> Excercise is important to good health but it’s a very poor way to lose > weight. On my treadmill, walking at 3 mph (a pretty fast walk – much > faster and you’re running) for 20-30 minutes will buy you about 100-150 > calories. You’d need to do this for about 90 minutes a day to lose 1 lbs > per week which is normally about all someone should try to lose unless > they’re already over 300 lbs when losing 2 – 2.5 might be better. > Cutting 500 cal per day out of a typical 3000 cal per day diet is very > doable if you think of that 500 cal as exchanging two non-diet drinks for > diet drinks or skipping 2 candy bars per day or 1 hamburger per day and so > on.

This is off topic so I don’t want to get into a full blown thread but how many people eat a 3500 cal. diet?  2000 is the recomended average diet unless I’m mistaken.  I’ll agree that Americans eat too much but I don’t think you should assume 3500 cal. Dave

Response:

Well, I’ll put in a vote for exercise as the route to weight loss–it might be slower, but tends to last longer–after most diets, your body tends to gain weight faster as it tries to recover from the recent "famine."  Of course, as you say, exercise is not always possible. (Of course, depending how it’s done and on current eating habits, dieting isn’t always healthy, either.) Either way, I wouldn’t attribute the bulk of your problems to weight just yet, or assume that things may not be controllable.  I’d sit down and talk with your doctor about the lack of change, and ask what can be done.  It doesn’t sound like the’s done much in the way of adjusting your medication, for example (different doses and different meds work better for different people). If your doctor tells you it all hinges on you losing weight, and isn’t willing to explore other things for you at whatever weight you’re at now, I’d get a new doctor. Weight loss, if done right, is a very slow process–and may or may not ultimately help enough.  There are other things that can be explored sooner, and that should be. No reason you should have to feel miserable for months and years while the doctor waits for you to lose weight. Another thought: getting a referral to an allergist.  I’d still see the pulmonologist too, but an allergist can help you find out whether there are any specific triggers to your asthma, which you can then work on avoiding or reducing your exposure to them.

Response:

Dear Don, There is a test called the methocholine challenge test which is pretty definitive for diagnosing asthma.  Have you had it? If not, please ask your pulmonary specialist about it.  Pulmonary function tests and spirometries are important (you’ ve had them), but the methacholine challenge test will tell if it’s asthma or not. Some of what you describe sounds more like  heart problems – and that can certainly exacerbate asthma, from what I’ve read. Maybe you should think about getting a second opinion?  It seems to me that there should be more they can do for you. Take care, Catherine

Response:

You didn’t say what your weight is but weight is definitely a factor in your breathing. The more weight you have the more work it takes to do the breathing and the more breathing you have to do to support the metabolism of the extra tissue. Further, there’s no guarantee that your asthma can get better – without seeing your PFT’s it would be tough to tell how much of your breathing difficulty is due to asthma and how much is due to weight. If you are suffering from sleepiness limiting your activity level then sleep apnea should be looked for as it’s a very common cause of excessive daytime fatigue, particularly in people who are overweight. There are some asthmatics (rare) who never get under decent control in spite of all the proper care in the world but even then weight loss will help. Activity level and excercise have a little impact on weight but 90% of weight control is by controlling what enters your mouth. It takes a difference in intake of 3500 calories to lose a single pound. That’s a heck of a lot of excercise – perhaps more than you’d do in a month. The goal should be to lose 1-2 lbs per week so your diet is something you can maintain long term and not something that loses you some weight this month to just gain back next month when you’re off the diet. A 1 lbs per week weight loss is attained by just cutting 500 calories a day from your intake. (i.e. switching from regular to diet pepsi twice a day). – Hide quoted text — Show quoted text – > Ten months ago I went to my family doctor because suddenly I couldn’t walk > across the street without huffing and puffing and feeling as if I had just > run a hundred yard dash.  I had a stress test and failed it.  I got a beta > blocker for high blood pressure, and Isosorbide for what I’m not sure.  A > few days later I went to the emergency room with extreme deep chest pains. > I got the full treatment for a heart problem including an angiogram (not > that good but ok for now).  The shortness of breath didn’t improve so later > I was sent to a pulmonary specialist. > I was prescribed with asthma.  I had chest x-rays and a cat scan of the > chest, blew into a few different machines, and was placed on Albuterol ( 2 > puffs 4 times a day), and on Vanceril, ( 2 puffs twice a day).  I was kept > on the beta blocker and on the Isosorbide.  After a few months of no change > in my condition, the Beta Blocker was changed to Zestril.  The beta blocker > was affecting me and there was definite improvement with the change to > Vanceril. > This is my problem.  I go to the Pulmonary Doc every 2 months but I have > never gotten much better.  I am a tall overweight senior ex football player > and coach but have always been in exceptional physical condition and kept it > by playing tennis at least 4 times a week. However, now I don’t want to do > anything! Sitting is my best activity, even a shower in the morning leaves > me gasping for breath for a while. Some days are better than others, even > some weeks are better than others, but I’m not satisfied that I can’t get > better.  I have tried going off the inhalers to see what happens. > I don’t see that much change.  My flowmeter stays within a 400-500 liters > range.  The Doc says I should lose weight. ( He’s not the one sitting > staring at the wall all day) > What is my next step with the Doc?  I’m not experienced enough about asthma > to know what kind of questions to ask him, or the kind of tests to ask for. > I’m also not experienced enough with asthma to know what the limits are.  I > read everyone’s notes here an you all seem to have great variances in your > asthmatic condition.  I seem to stay quite steady.  My chest hurts all the > time. I can remember from football what shortage of oxygen feels like to the > body and I’m there all the time.  What are the steps I should be taking? > What am I looking for? > I hope someone can give me some good advice and I thank you in advance for > it.  I would see it faster if you would direct e-mail me at > Thanks, > Don

Don Elton Columbia, SC http://www.midcarolina.org

Response:

Ten months ago I went to my family doctor because suddenly I couldn’t walk across the street without huffing and puffing and feeling as if I had just run a hundred yard dash.  I had a stress test and failed it.  I got a beta blocker for high blood pressure, and Isosorbide for what I’m not sure.  A few days later I went to the emergency room with extreme deep chest pains. I got the full treatment for a heart problem including an angiogram (not that good but ok for now).  The shortness of breath didn’t improve so later I was sent to a pulmonary specialist. I was prescribed with asthma.  I had chest x-rays and a cat scan of the chest, blew into a few different machines, and was placed on Albuterol ( 2 puffs 4 times a day), and on Vanceril, ( 2 puffs twice a day).  I was kept on the beta blocker and on the Isosorbide.  After a few months of no change in my condition, the Beta Blocker was changed to Zestril.  The beta blocker was affecting me and there was definite improvement with the change to Vanceril. This is my problem.  I go to the Pulmonary Doc every 2 months but I have never gotten much better.  I am a tall overweight senior ex football player and coach but have always been in exceptional physical condition and kept it by playing tennis at least 4 times a week. However, now I don’t want to do anything! Sitting is my best activity, even a shower in the morning leaves me gasping for breath for a while. Some days are better than others, even some weeks are better than others, but I’m not satisfied that I can’t get better.  I have tried going off the inhalers to see what happens. I don’t see that much change.  My flowmeter stays within a 400-500 liters range.  The Doc says I should lose weight. ( He’s not the one sitting staring at the wall all day) What is my next step with the Doc?  I’m not experienced enough about asthma to know what kind of questions to ask him, or the kind of tests to ask for. I’m also not experienced enough with asthma to know what the limits are.  I read everyone’s notes here an you all seem to have great variances in your asthmatic condition.  I seem to stay quite steady.  My chest hurts all the time. I can remember from football what shortage of oxygen feels like to the body and I’m there all the time.  What are the steps I should be taking? What am I looking for? I hope someone can give me some good advice and I thank you in advance for it.  I would see it faster if you would direct e-mail me at Thanks, Don

Response:

- Hide quoted text — Show quoted text – > Ten months ago I went to my family doctor because suddenly I couldn’t walk > across the street without huffing and puffing and feeling as if I had just > run a hundred yard dash.  I had a stress test and failed it.  I got a beta > blocker for high blood pressure, and Isosorbide for what I’m not sure.  A > few days later I went to the emergency room with extreme deep chest pains. > I got the full treatment for a heart problem including an angiogram (not > that good but ok for now).  The shortness of breath didn’t improve so later > I was sent to a pulmonary specialist. > I was prescribed with asthma.  I had chest x-rays and a cat scan of the > chest, blew into a few different machines, and was placed on Albuterol ( 2 > puffs 4 times a day), and on Vanceril, ( 2 puffs twice a day).  I was kept > on the beta blocker and on the Isosorbide.  After a few months of no change > in my condition, the Beta Blocker was changed to Zestril.  The beta blocker > was affecting me and there was definite improvement with the change to > Vanceril. > This is my problem.  I go to the Pulmonary Doc every 2 months but I have > never gotten much better.  I am a tall overweight senior ex football player > and coach but have always been in exceptional physical condition and kept it > by playing tennis at least 4 times a week. However, now I don’t want to do > anything! Sitting is my best activity, even a shower in the morning leaves > me gasping for breath for a while. Some days are better than others, even > some weeks are better than others, but I’m not satisfied that I can’t get > better.  I have tried going off the inhalers to see what happens. > I don’t see that much change.  My flowmeter stays within a 400-500 liters > range.  The Doc says I should lose weight. ( He’s not the one sitting > staring at the wall all day) > What is my next step with the Doc?  I’m not experienced enough about asthma > to know what kind of questions to ask him, or the kind of tests to ask for. > I’m also not experienced enough with asthma to know what the limits are.  I > read everyone’s notes here an you all seem to have great variances in your > asthmatic condition.  I seem to stay quite steady.  My chest hurts all the > time. I can remember from football what shortage of oxygen feels like to the > body and I’m there all the time.  What are the steps I should be taking? > What am I looking for?

One of the problems is that beta-blockers tend to make asthma worse, and asthma drugs tend to make BP worse.  You need to get your doctors to coordinate on this.  Then, you lose weight by eating less; I know it is a real pain, but, having gone from fairly physically active to really inactive myself in the past year, the only answer is to eat less.  Make up for feeling hungry by eating lots of low-cal things like lettuce and celery.  Try swimming for exercise, many asthmatics don’t have as many problems with it.  Above all, keep at the docs until they find a treatment program that works. Chris Owens

Response: