Elevation a danger to asthma while on holidays?
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TinselPixie posted:
Hi. Planning a holiday within about 11 days, visiting relatives. Everyone wants to do sight seeing. I realized the sites, like Mt. Rushmore are at elevations of 5200-5700 ft. I read once asthmatics aren't supposed to go over 2500 feet. I've done okay at 3100 feet, just abit breathless on stairs but that was 15 years ago. Do I have cause to be concerned about going to higher elevations? My lungs, particularly the right weak one, has been constricted, burning on and off all summer due to intermittent forest fire smoke so it's not happy to begin with. Should I just forget going? Or go but in a wheelchair to avoid an oxygen debt from walking I can't replenish? Is it just too dangerous to go? I'm feeling constant stress since realizing I'd forgotten about altitude. Any ideas, suggestions, comments will really be appreciated. I went through a mountain pass once at 5200 feet and it was NOT a pleasant experience at all, I had to concentrate on my breathing and nothing else except to say "drive through this pass as fast as you can, get me out of here." I'm on Symbicort 200, 1 puff twice a day and it seems fine overall, no hospital visits in a decade or more. Suggestions, cautions, advice??? (It's a minimum 3 month wait to see my MD)
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sgbl88 responded:
Hi,
Asthma triggers are highly personal. Air pressure may not be a trigger for you. However, since you have been having trouble this summer with smoke, you may be more sensitive to air pressure and lower oxygen levels.

I went to Salt Lake city a few years ago and had no problems at that level, but when we went higher in the mountains like Park City, I had mild issues that were handled very easily with my rescue inhaler. I am generally very reactive to all asthma triggers. Air pressure changes of storms always trigger my ashma.

I would suggest that you call your doctor's office and ask about increasing your maintenance meds (Symbicort dose) or a pretreatment routine. They should be able to handle vacation modifications and percautions over the phone.

I hope that helps you, and that you have a great time.

Sonya
Jeremiah 29:11 For I know the thoughts that I think toward you, saith the LORD, thoughts of peace, and not of evil, to give you an expected end... Ye shall seek me, and find [me]
 
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Aqua14 responded:
I agree with Sonya; call your doctor and get guidance. It might also be a good idea to get a prescription of prednisone in case things go downhill. Then you will be reassured that you have what you need to avoid problems.

I don't think there's any hard and fast rule about asthmatics having to avoid a certain high altitude. In fact, I recall some fairly old studies showing improvement of asthma in children who were sent to the Swiss Alps for treatment.

Personally, I do suffer from altitude sickness, but that was something that predated my asthma. Thus, I know I'm going to have problems when I travel to places like Denver where it's a lot higher elevation than where I live. I take things slow, take ibuprofen for the inevitable headache, drink lots of (non-alcoholic) fluids, and get plenty of rest. I also cut back on exercise temporarily.

Hope some of these thoughts help. If you could take all the precautions you can ahead of time you'll probably lessen your stress and be able to enjoy the trip more. Take care & good luck. Judy
 
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TinselPixie replied to Aqua14's response:
Thanks both of you. I can try calling my MD's office. We're an underserviced area, half the town has no doctor so he's very busy. But it's worth a shot. He says I can double the Symbicort dose, I just usually take 1 puff not two to keep my med intake to the minimum. I think part of my breathing problems right now stem from allergy/rhinitis--my sinuses haven't been happy for months.

Prednisone--last time I took it for 7 days for a lung infection it worked great, dried out the lungs, but also swelled my face up and I gained 22 pounds in 6 weeks.

Well I shall see if I can get through to my MD at all. I appreciate hearing about your experiences with high altitudes...I can fly fine which is 10,000 feet pressurization with no problems. Perhaps the extra fluids, going slow and and rest will do it. Thanks!!!
 
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amcate replied to TinselPixie's response:
I agree with Sonya-it's very personal. I went from Houston at close to sea level to about 6500 feet (I'm simplfying this for brevity) to live. I had a hard time at first with getting tired fast-yoga routines I could do at lower elevations I was getting out of breath. In addition, my heart rate went up. It's still up although I've lived at high altitudes for more than 8 years now. But, the asthma itself did not mind, and in fact behaves better here than in Houston at lower elevations due to other factors (less ozone pollution).

Everyone is different and responds differently. Knowing how I respond, if it were me I would do as you are-increase the controller meds before going, be sure to have all rescue meds on hand (MDI and nebulizer) and be sure to have prednisone in my purse in case something goes wrong. I would find out where the nearest urgent care center is located where you will be traveling....then I would go and enjoy life.

I get out of breath easier and can't do as much at higher altitudes, but the asthma and peak flows stay the same and don't seem to mind in my individual case.

Hope your trip is good.
 
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TinselPixie replied to amcate's response:
Thank you for your detailed reply amcate. As I rather expected, I phoned my doctor's office and got a recording saying the office is closed until the 20th and we leave on the 15th. Story of my life with them. Anyways my doctor has never mentioned peak flow meters, nebulizers MDI's...not even sure what they are. I have one med for the asthma, the Symbicort and it seems to work well for me, It takes effect within 10-15 minutes when I need to take an extra puff.

I contacted a 24 hour health hotline here in Ontario and they said elevation should have no effect on asthma. They suggested I drop in on a doctor or clinic regarding my sinuses and possible infection. As I am currently stressed out and a bit under the weather, sitting 6 hours at the local Emergency Department among a bunch of sick people does not thrill me and will likely MAKE me sick. There are no clinics or other doctors available so, unless my health picks up somewhat I think I am stuck with just going and taking a chance with the med I have. Not thrilling but what else can one do?
 
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bresky replied to TinselPixie's response:
Hi TinselPixie

I understand your concern, I have never notice a change with altitude however I live in Manitoba which is a flatland. I have been to alberta to red deer and don't remember having much trouble with the altitude.

Do you use a netti part or nasal spray for your sinuses. You can get a nettie pot over the counter they work well to clean out your sinuses.

In Canada symbicort is approved as a rescue inhaler but not in the states. I am currently using symbicort 200/6 mcg 2 puffs 4 times a day to control my asthma but I am being followed closely by a respirologist.

Peak flows are a device you blow into to see what capacity your lungs have it often will show an attack before you become symptomatic. MDI or meter dose inhalers are inhalers such as ventolin that are in an aersol container often used as a rescue inhaler. A nebulizer is a liquid medication made into a vapour to open the lungs better with higher doses of medication then the MDI. Hope that helps.

Stress can also be a huge trigger for asthma and if there is a way for you to control your stress that would help control your asthma better. However saying that is easier then doing.

Make sure you have health insurance and your medical information for when you travel incase you need to use the emergency room.

Hope you enjoy your holiday. Sorry you can't get into your doctor any chance there is a walk in clinic close by.

Bre
 
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amcate replied to TinselPixie's response:
I am most familiar with moderate or severe persistent asthma. I am unfamiliar with Symbicort, but had assumed since your doctor told you to take two puffs instead of one puff it was a controller and you were doubling your controller medicine. Perhaps I was wrong and its a rescue drug.

In more severe forms of asthma, there are controller drugs which you take every day, and rescue medicines which you take if you have trouble. Like bresky said, the peak flow is a number that measures how open your lungs are. If it starts to go down, then you increase the controller drugs by doubling them. If it goes down a lot, then you add prednisone. By MDI, I meant meter dose inhaler, which I use CombiVent, a combination of albuterol and ipratropium bromide, which works within 20 minutes. Sometimes that will fail to reverse an attack, so I have to use a nebulizer, which is a liquid form of medicine you put in a machine and it goes into small particles which you inhale. My nebulizer is a small portable model, as I'm out of my home a lot. I carry it with me in situations where I might get into trouble in case the meter dose inhaler fails to rescue me.

Sorry for the confusion. By saying my peak flow does not go down in high altitude, I'm saying the asthma both in terms of symptoms like wheezing and in terms of objective measures like a peak flow number does not get worse with altitude. However, I do find I get tired more easily, as I suppose a lot of folks would.
 
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amcate replied to TinselPixie's response:
Controllers are medicines you take every day to prevent symptoms. Rescue medicines you take when you have an attack.

In more mild forms of asthma, though, perhaps doctors don't use both.

When a person has moderate persistent or severe persistent asthma, normally they get an asthma action plan, which I described mine above. It often takes time to get into a doctor, and having an action plan allows a person to adjust their medicines quickly to avoid an emergency and then the person follows up with the doctor as soon as they can. By quickly adding in medicines at the first sign of trouble, the hope is that more severe exacerbations can be avoided. My own plan is according to old national recommendations, and the recommendations in the US I've heard have changed since then, but I prefer to stay with what I know.

I do recall when I had a more mild form for a few years, I only had a controller and rescue med and no action plan as I didn't get into trouble. But that was a long time ago and I just remember when I got worse, the allergist gave me an action plan.

So, basically, having an action plan enables me to adjust and readjust medicines without having to go to the doctor first, but then I follow up with them at the first opportunity.

In more recent years, they've allowed me to follow up at regular intervals as opposed to every time I'm in trouble since I'm used to the plan and it's second nature now.

I was describing how I would adjust medicines in my case if I thought I might be exposed to a trigger. I would first double the controllers, then I would be sure all medicines I would need were on my person so I could follow the action plan quickly and effectively should things go bad.
 
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TinselPixie replied to amcate's response:
Thank you very much everyone! You've really given me a great education here. I appreciate it. I did check with a 24 hour health phone-in hotline we have in Ontario and they said altitude equals no problem for asthma. They do agree I have a sinus/allergies problem though and that's causing a cough and sore throat on and off. However I found that taking a Hall's cough drop yesterday stopped the running down my throat business instantly so I'm taking some with me.

Bresky I'm on the same Symbicort strength as you but it's used as a preventive in my case and my doctor has me on 1 or 2 (my choice) puffs twice a day,much less than yours. Finding out Symbicort can be used as a rescue inhaler explains why it works so quickly on me as well as long term. I have not been to the hospital since going onto it and I think I should count my blessings as we live in a clean air area (wilderness). If I lived say in Toronto, or any big city, I am sure I'd be in much worse shape. I know if I visit a big city for a week or more and there is smog/dirty air it really affects me and my heart goes out to all of you living in dirtier air than me.

Again thank you so very much, all of you, for your very interesting, informative and caring answers. I really appreciate it!
 
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amcate replied to TinselPixie's response:
Your welcome. I wish my response had been more relevant to your specific situation.

For future reference, in place of a netti pot, one doctor once told me you can also use distilled water (48 onces), 2 teaspoons of pickling salt, 2 teaspoons of baking soda and mixed them together. You can then use an ear bulb syringe thing to put it in your nose to pull out congestion in the sinuses. It can also be used every day to clean out sinuses to prevent allergy or infection related issues. If the solution causes irritation, you use 1 teaspoon of pickling salt instead of 2. The doctor was a specialist in Ear, Nose, and Throat.

In the United States, where I live, they have urgent care centers. The emergency rooms here are overloaded, and so sometimes the wait times are long and they make mistakes in determining how immediate a problem is (in their triage). In urgent care centers, you go in and are seen within 20 minutes normally, and there is typically one or two people in the waiting room. The doctor normally is certified in emergency medicine, but sometimes will be a family practice doctor with some training in emergency medicine, but not certified. They normally can give asthmatics scripts to fill at the pharmacy or give shots of anti inflammatory stuff....but they are not attached to a hospital like emergency rooms are. They also cost more, which is why there is not a big wait....about 200-300 dollars. I didn't know if Canada had some type of walk in center like that, but you all have a different health care system, so I don't know.

Anyway, glad you found your answer. Here in the USA, they don't use one drug for both a controller and rescue medicine. They put you normally on something like Advair, which has an antiinflammatory and long acting bronchodialator to take every day to prevent problems, and then a separate drugs like albuterol that acts within 20 minutes to address attacks. So, I learned something as well.

Have a good trip, and glad you found your answer.