Two years ago I wrote an article for Running Journal titled, "Breathe Better: Understanding Asthma." That article, as with all my writings, talked about getting to the root of asthmatic symptoms and how certain medications provide clues to the cause of any asthma. What I soon realized after that article was written was that there is very little information regarding asthma, (and EIA), other than how to get by with a prescription drug. The lack of information is something that I am continuously reminded of as I still receive [weekly] emails from across the US, Canada, and even Europe, just from that one article. So after a long hiatus from contributing to RJ, here is my comeback article, with a revisit to the non-information, (if that is even a word), and mis-information regarding asthma and EIA. (For simplicity, I will use the word asthma rather than distinguish between EIA and asthma.) Take a puff of that inhaler and read on.

The number one reason for asthma is an adrenal related issue. This is because the majority of bronchodilators are adrenergic and/or steroid medications. Asthma is most commonly a classic case of a lung symptom resulting from a hormonal issue. Like most things treated today, this is similar to putting a muzzle on a barking dog so you can continue to step on his tail. The common names for adrenergic medications are Albuterol, proventil, ventolin, airet, and volmax. These drugs stimulate the adrenal medulla, which is where adrenalin and noradrenalin are made. Therefore, if one of these medications "work" for you, then investigating what is driving (or actually not driving) the adrenal glands to do this themselves is something to look at. Additionally, many times there is something irritating the lungs and the adrenal glands simply cannot muster up the strength to deal with the irritation on their own. Common irritants to the lungs are poor air quality, other medications, food and environmental allergies, and chemical intolerances and sensitivities - such as caffeine and chemicals called aldehydes. Aldehydes are the main chemicals in perfumes, carpets, paints, and other similar items which many people are sensitive to.

The adrenal corticosteroids are another popular group of meds. These drugs include Aerobid, Flovent, Azmacort, and others. These affect the adrenal cortex which is where hormones such as cortisol and aldosterone are made. Cortisol is your major hormone secreted as a result of stress. It is an anti-inflammatory hormone and it is partly responsible for blood sugar control. Aldosterone is the major hormone that helps regulate your electrolytes, primarily sodium and potassium. When aldosterone levels are low you'll lose a lot of sodium in your sweat and urine leaving you dehydrated and fatigued. Many people have an adrenal cortical problem. Saliva tests available today are extremely accurate in measuring the circadian rhythm of cortisol to pinpoint any potential problem.

Adrenal gland issues many times also reveal themselves through some ache or injury in the body. Most commonly, there is an injury to the knee, ankle, or low back. Plantar fasciitis, shin splints, and ITB frictional syndrome are three very common injuries that almost always have an adrenal component to them. It is not just a coincidence that an injury like that pops in a person who also has an asthma problem, or EIA occurs after an injury.

The adrenal glands and the pancreas work together to maintain a balanced blood sugar. So if the adrenal glands are off, then usually blood sugar is off too. Signs of an intolerance to carbohydrates, termed insulin resistance, include symptoms such as craving sugar, getting sleepy after eating, hypoglycemia, and irritability, just to name a few.

So when an adrenal based medication helps your asthma think about your adrenal glands, not your lungs. Evaluate what may be causing your adrenal glands to not function properly. Are you training too hard - (overtrained)? Is your diet bad - containing excess sugars, caffeine, and hydrogenated fats? Are you under too much stress?

Other medications combat allergic reactions and inflammation. Mast cells in the body secrete histamine in response to an allergy. Mast cell histamine and leukotriene blocker medications are Intal, Tilade, and Singulair. These do two things: they act as an antihistamine and they block leukotrienes, which are inflammatory hormones. So if this works for you then you need to figure out why you are making histamine and/or leukotrienes; that's what makes sense to me.

Histamines are produced in response to, most commonly, an allergy. Although the allergy can be environmental such as pollen, grasses, or weeds, I can safely say from clinical experience that there is almost never someone who has an environmental allergy that does not have a food allergy. They usually just don't know about the food allergy. Some estimates note that over 55% of people are allergic to something, and a vast majority of those individuals are allergic to a food that they don't know is bothering them. This is because the majority (80%) of food allergies are of a slow onset type, not the anaphylactic type most are aware of where you flare up with a rash from eating a peanut or shellfish. The most common food allergens with respect to asthma are [cow's] dairy, wheat, soy, corn, and egg. So histamine levels are already high and when an extra stressor such as pollen comes around, it's too much for the person's immune system to handle. These are the same people who need to take Claritin, Zyrtec, Allegra, or any other antihistamine to get through the change of season.

Leukotrienes are often made in response to a fatty acid imbalance problem. They can also occur from taking NSAIDs. Yes, those very same medications such as ibuprofen, aspirin, Vioxx, or other anti-inflammatory drugs, can really be messing things up. A diet that contains hydrogenated fats is also a big culprit to this problem. Considering the fact that the half-life of a hydrogenated "trans" fat is 51 days, eating a food with this stuff in it as little as once a week can be enough to cause problems. A diet high in saturated fats such as red meat, dairy, and shellfish can also cause this chemical reaction. Nutrients such as magnesium, vitamin B6, zinc, and the powerful bioflavonoid quercetin tend to help with leukotriene and histamine problems. Other leukotriene modifying drugs (not antihistamines) are Zafirlukast and Zileuton.

Atrovent, another adrenal-based asthma med, is in the anticholinergic category. This has to do with a sympathetic/parasympathetic imbalance which basically means that the nervous system is out of whack. Most commonly, the nervous system is too stressed, too "hyped-up". Correlating symptoms include sleep problems and a short temper. Interestingly, most multi-vitamins and B-complex supplements contain choline in them, many times in high quantities. Taking choline at the same time as taking Atrovent, (in this instance), would not be a wise idea.

So what does this all mean? It means that there is a reason for asthma - it just doesn't pop up one day. Some people are born with sub-optimal lung function from an underdevelopment during fetal life. For many people unresolved stress and an overload of the nervous and hormonal systems leads to asthma. If you "need" a medication, or should I say, "do better with a medication", then take a step back and ask yourself why. If a physician tells you to take a certain drug, ask him or her why it will benefit you and what is the medication trying to accomplish. Remember, the inhalers and other meds don't fix anything; they just get you by. So resolving the asthma will not only take a load off your chest (ha ha) but your overall health will improve and that will mean improved performance - in fitness and life.