Need to start making some changes to help my asthma

[Ash123445]

Hi all, hope you are well. At the moment I'm really bad with taking my steroid inhaler, pretty overweight and I smoke. So I need to start helping myself. I'm going to the gym but I do very little cardio as I mainly lift weights. Any tips and advice would be great, I'm still waiting on my GP to help with the smoking and that's frustrating

[Bevvy]

So main thoughts are as you say, you need to help yourself. Why don’t you arrange with gym to see an instructor? They could set a programme with you to include more cardio. Also why are you waiting for gp help with stopping smoking? You could go to chemist and discuss various programmes/medications that may help you to stop. With regards inhaler. Only you can do something about that. You could set an alarm on your phone. Or place it near your toothbrush to remind you to take it but ultimately it is up to you.

[Troilus]

Hi Ash,I find protein drink useful when I need to lose weight. Asda do some palatable ones; I prefer the vanilla to which I add a little bit of dried milk. I use those because it helps to ensure that you are at least getting some of your essential nutrients and they are easy and quick to prepare. (I also have a sweet tooth, so they get rid of sugar cravings)

As for stopping smoking, I did it without aids. I started by watching how much and when I smoked. Then I started just cutting down a bit. I smoked about 20 ish, so I cut to 18, then 15 until I got to 6 and then I stopped completely.

I found a useful website called Why Quit, which has a detailed timeline. So each day I would check. It tells you when all of the poisons will have left your body, when the cravings will stop etc so it was really helpful in keeping me going when I was tempted to ‘just have one.’

Wishing you the best of success 😁

[Poobah]

I tried exercise without tackling my diet and it just doesn't work. Diet is 80% and exercise 20% of the answer to better health. No matter how much you exercise you can't change what food (or smoking) does to your body.

Excess body weight = fat, and fat does all manner of damage and stores itself in a variety of ways. It even produces hormones when it reaches a certain stage and they can be very unhelpful to asthmatics in addition to the restriction that a chest cavity stuffed with hard, unyielding fat provides for the lungs.

Fat packs itself into the liver and a non-alcoholic fatty liver has taken over as the main cause of cirrhosis of the liver today. In the past it was alcohol. Then fat surrounds the organs and that puts stress on how our organs work. People can be TOFI (thin outside, fat inside) but no one can be FOTI (fat outside, thin inside). So in addition to a fatty liver, fat packed organs, we're carrying around excess weight that also puts huge pressure on our organs and whole system.

This sounds harsh, but it's the exact same lesson I had to absorb before I was ready to ditch all the rubbish I used to consume. And what is presented as food and drink today, to a great extent, is absolutely toxic rubbish for our bodies. If you're not convinced that the food industry is doing us damage, then watch the 3 part documentary made for the BBC in 2014, entitled *The Men Who Made Us Fat. It explains how our diets have changed over the recent decades and why those changes were made, leading to increasing amounts of obesity and sickness (type 2 diabetes numbers have steadily increased over the years and now the preventable disease is appearing in the population at a far younger age than ever before. 4.7 million T2D cases in the UK today - totally preventable).

I think we're fooled as tobacco products are covered in clear messaging that informs consumers of the known damage that the product can have - there's little room for doubt. However, highly processed food and drink comes packaged with a traffic light system and I believe that's still voluntary. "Low fat" is sold as somehow a healthy choice despite a product being full of sugar and palm oil. It's barmy.

I've been very lucky in having a brilliant asthma nurse who referred me to a NHS health coach last year. While I was waiting for my appointment (huge waiting list) I started intermittent fasting (2 meals a day, 6 hours apart). After 4 weeks I introduced keto (low carbs). I eventually got my first appointment with the health coach and I was dreading a lecture on how low calorie diets are the only way (been there, doesn't work for me). I was so surprised that the HC recommends intermittent fasting and low carbs for patients struggling with disease and weight. I've never stuck to any eating plan for this length of time and never has one been so easy. Because I felt so much better so quickly it really is worth ditching sugary and carb foods. Wish I had done this years ago.

After 12 weeks I was able to come off my LAMA inhaler. I've been able to reduce my Fostair by 25%. My goal is to reduce Fostair by 50% in total and come off my blood pressure tablets. My BP started to reduce in the first week. Fortunately I wasn't diabetic. I'm also hoping that my glaucoma (diagnosed last May at the start of my IF adventure) has reversed as it's a side effect of the LAMA inhaler. I have to stress that ALL my goals are health based and this is not about losing weight as some kind of vanity project.

This one short video probably explains IF better than I can, if you're still not convinced by the health benefits. youtu.be/A6Dkt7zyImk(Not working as expected?)

*still available online via Dailymotion.

[Singinglouder in reply to Poobah]

Poobah: just as it is wrong to say that asthma can be cured (which you rightly objected to on another post), it’s also not true to say that Type 2 diabetes is totally avoidable. Not everyone who develops T2D is obese or even overweight; there can be a strong genetic element; women with PCOS develop insulin resistance, which frequently leads to T2D; I knew someone whose T2D turned out to be due to pancreatic cancer; I myself have an extremely rare condition which has caused hard to control diabetes and completely messed up my body’s ability to process fat; and of course there is such a thing as steroid induced diabetes, which can be reversible, but can combine with a genetic tendency to cause permanent T2D. I’m sure there are other causes, that’s off the top of my head!

It’s extremely frustrating to be told I could have avoided diabetes by eating healthily, especially as I have eaten a wholefood diet since my late teens, so very little processed food, and until other things kicked in in recent years have also been very active.

Please, don’t make the jump from ‘may be’ or even ‘often’ to ‘totally’ avoidable. Thank you.

[Poobah in reply to Singinglouder]

Singsinglouder, many apologies for my horrible error and thank you for sharing your experience. I learn so much from this forum. I think I got carried away, but that's no excuse. I should know better as my grandfather had diabetes and his life was ruled by a very restrictive diet, insulin not being commonly available at that time. All the best.

[Kekememe1 in reply to Singinglouder]

I got type 2 diabetes from medication. I have to take prednisone.

[Singinglouder in reply to Kekememe1]

It’s frustrating when meds for one thing cause another - sorry it happened to you. How do you treat the diabetes?

[Keisha192001 in reply to Poobah]

This whole post is very uneducated. Sure if your looking to lose weight then diet is 80%. But you can improve lung health without losing weight. Excess body weight also just doesn’t always equal fat. This FOTI BS is absolute rubbish. The most obvious example being sumo wrestlers. They are no more at risk than a skinny healthy person as the way fat is stored is different.

Intermittent fasting and keto (if not medically necessary for seizure management etc.) is honestly just disordered eating under the guise of health.

As well as everything people have said below about your t2d comments.

I would hope on a forum like this people would post educated replies.

[Poobah in reply to Keisha192001]

Unfortunately I learned most of what my post contained from my NHS health coach. The NHS is promoting the low carb diet for patients with long term health problems and intermittent fasting too. The Freshwell app supprting keto was put together by NHS GPs for patients (available through Google playstore). And more about NHS health coaches here: england.nhs.uk/personalised...

I definitely misunderstood the T2D issue, but I've apologised for that. The fact that if a asthma nurse, doctor or specialist says a patient should lose weight as it will improve their asthma (or T2D), cannot be argued with. And most patients know that already, they just need support in doing so.

I would also recommend Dr Moseley's current series on obesity and the problems in getting a co-ordinated policy funded by government thanks the huge food industry lobbying against restrictions on what they produce and advertise. In the first episode he talks to a specialist who was seeing record breaking number of children with non-alcoholic fatty liver disease and it was directly linked to diet and being overweight.

Being overweight isn't healthy and we shouldn't be afraid to say so, neither should our healthcare professionals. They're not fat shaming, they're just trying to improve the health of the patients.

[Lysistrata Administrator Community Ambassador in reply to Poobah]

Hmm, I don't want to get into this can of worms but I would say it is quite a complex issue and can't necessarily be reduced to anything as simple as 'overweight bad, not overweight good'. Being overweight does not automatically make you unhealthy in itself, though there are of course associations between increased body fat and less desirable/more unhealthy metabolic profiles. It's still entirely possible however to be overweight while also being fit and healthy (or normal/underweight and not fit or healthy). And as I'm sure you're aware, there seems to be a difference based on where you store your fat (eg waist vs hips).

This applies especially when people use BMI as a measure of what is or is not overweight - I'm not saying you did but it absolutely is still used by many healthcare professionals. As far as I am aware it was not intended to be used on an individual level and it is a pretty blunt instrument for individual health which does not look at body composition or fat distribution. For example, there has been research (cited in European cardiovascular guidelines) that middle-aged women with a BMI classed as overweight appear to have a lower cardiovascular risk as a population than women in the same age range with a BMI in the 'normal' range.

I'm not disputing that you and indeed others may have found diet change and weight loss have helped your asthma, but asthma is also a complex area and it's not necessarily going to be the case for everyone that their weight/diet is closely associated with their asthma control, nor should doctors be assuming that this is the case. Steroids also complicate things - you can look at someone who is obese/overweight and say their asthma is bad, but if they're on high dose oral steroids because their asthma is bad, it's likely that's made them put on weight and find it hard to lose (and it's not just about increased appetite, which isn't even a given on steroids. I never got cravings with them and I still put on weight and lost it once I was off them).

I'm also glad that your healthcare professionals don't fat shame, but that sadly doesn't go for all of them. There are plenty of examples out there of doctors and other professionals not looking beyond the weight and just advising weight loss instead of addressing the problem, even when the weight gain itself is a sign (eg someone with thyroid problems or PCOS where treating the problem would help with the weight gain a lot more than vice versa.) Also encountered myself at times totally pointless advice to lose weight without any attempt to either actually help with the problem or give useful, non-judgemental weight advice which doesn't stigmatise people or ignore mental health aspects. (In my case I was advised to lose weight to help with a shoulder problem. I wasn't even overweight at the time.)

In relation to asthma specifically, if someone is overweight from steroids (and indeed other reasons) they are usually very much aware as you have said. But I have absolutely had friends tell me they were told they were fat and just needed to lose weight when they were unstable on high dose steroids and made to feel awful about it. This was instead of doctors trying to actually help their asthma and enable them to reduce their oral steroids, which would actually help them lose weight (as well as deal with the immediate problem of the life-threatening asthma attacks they keep having).

It's also pretty difficult to lose weight by yourself if you're dealing with constant severe chronic illness flares, in and out of hospital and limited energy to actually cook properly. I'm not saying it's impossible but it makes things a lot harder and I definitely feel that this is often not appreciated by healthcare professionals. (This isn't me at the moment and I definitely know people worse than me, but I also know how hard it is when you're in limbo or in and out of hospital to summon the mental and physical energy for things like healthy shopping and cooking - and anyone with limited finances and/or trying to keep working will probably find it even harder.)

[Poobah in reply to Lysistrata]

Thanks Lysistrata for you measured and thoughtful response. You put it all much better than I can. A lifetime of regular Prednisolone and antibiotics courses can really impact one's control on metabolism and struggle to keep on the healthy side of weight control. Too little money is spent on this side of things and it's important to highlight services that are available that can support patients in the health and well-being side of things. But how long money will be available, who knows?

I remember a nurse of the children's ward (another admission with an asthma attack) telling me I had to go on a diet, I was 10yo. I had never heard of the word and had no idea what it meant and when I realised I couldn't eat the nice things I wasn't happy. But it was a result of steroid weight gain and my parents were given my dietplan and we were left to get on with it, which we did (I wasn't given a choice). It's been a struggle ever since, with my heart sinking every time I was prescribed steroids. As you say, it's overwhelming to try and lose weight or give up smoking or get fit, when daily life is a struggle just with one's asthma or arthritis or cardiac challenges etc.

With the NHS health and well-being coaches available it shouldn't be a secret and we should let more people know about it - it's not a service that's advertised on my GP surgery's website and the noticeboards at the surgery are no help either. I'm not one for Weight Watchers, Slimming World etc ( that's just me as I don't think the health of the customer is their primary motivation) but I'm very excited seeing that the NHS are taking onboard patient well-being and the H&WB coach's approach is for the long term. Importantly, they're in a unique position, working for the NHS, and understanding each patient's health challenges and health history.

This service would be great for Ash, the original poster, as Ash has several challenges to cope with and doing it with support and with their health in mind. Making changes should be tailored to the individual and their health goals, in this case losing weight, giving up smoking and increasing exercise safely. And if the patient is one who has lots of hospital admissions, the H&WB coach is well placed in being able to discuss their side of things with the specialists involved in the asthma care of the patient (or other specialist depending on the disease).

[Lysistrata Administrator Community Ambassador in reply to Poobah]

I definitely hope it would be helpful for Ash, who is obviously motivated to lose weight, and I hope they're able to access support (as others have said, maybe a pharmacist and see the links below). I am definitely one with the view that support for these things is helpful and that most people can't successfully go cold turkey. Ash - maybe these pages would help, though the exercise AUK one may be more tailored to severe asthma:

nhs.uk/better-health/

asthma.org.uk/advice/severe...

asthma.org.uk/advice/inhale...

nhs.uk/better-health/quit-s...

My cynical self says that since I get absolutely no useful help from my asthma specialists these days, I can't think they'd be any use if I wanted them to help me with exercise or weight loss either in the context of my asthma. They prefer to tell me all my asthma symptoms are probably unfitness (they aren't, for various reasons I won't go into here) but have never provided any referral to services that would improve that. (I find it very frustrating how much exercise advice with asthma assumes you can achieve asthma control, when it often can be difficult even for people who are able to achieve control? Ash - I would definitely try to optimise your preventer taking to help with exercise, as well as quitting smoking).

I did try to sign up for a gym programme with my local leisure centre (Better Health, in case that's useful as I know some people do find it helpful) but on the basis of BMI they made me go to advice classes I didn't find useful at all - maybe they are for some, I opted out.

I certainly think it would be nice if the NHS could provide specialised health coaching for more people, like you have found useful now and like Ash would also find useful from the sound of it, if done right. I also think more accessible respiratory physio would be good.

I will say I was a little horrified with the 10-year-old you being forced onto a diet in the way you describe. I hope with knowledge now that would be approached very differently, especially with increasing realisation that strict diets don't tend to help long-term and can cause other problems. I definitely hope we can learn from a very sad case of a 13-year-old who died of asthma a few years ago due to multiple care failures, one of which was her paediatric specialist's decision to obsess over her weight and focus on it to the point of denying her steroids she needed for her asthma. (I'm not saying this to say weight loss shouldn't be discussed even in severe asthma, but definite need for balance, and the NHS does seem to struggle with communication).

[Keisha192001 in reply to Poobah]

Nope. The fact that their is a fat bias in healthcare is the issue. Intermittent fasting is just the start of disordered eating. And it’s unfortunate that doctors are pushing people towards this as a ‘solution to their problems’. This is more complexed than you are suggesting. They wouldn’t dream of telling me to lose weight for my asthma because they know I’m probably fitter than they are. And when I’ve lost weight my asthma has been worse than it ever has. So no you may think you understand everything there is to it but you’re definitely surface level right now. Finding HAES doctors may help you to understand the bias and the more specific nuance that’s required for full understanding

[Poobah in reply to Keisha192001]

But that's your experience and I agree that one size doesn't fit all (bad pun, unintended). However, the unfortunate truth is that time and again calorie controlled diets don't work for life long changes, otherwise Weight Watchers, Slimming World etc would go out of business. I've lost count of the number of diets that the people around me have repeated over the years, the weight goes straight back on when the diet ends, plus a wee bit more each time.

Doctors and healthcare professionals are increasingly worried at the increase of obesity related illnesses they are seeing. If you're unaffected, health wise, then good for you. Those who are affected though need long term support and encouragement to live as healthily as possible, in terms of food/drink consumed, exercise and other lifestyle choices. Support is poorly funded, especially when compared to the amount the food industry spends on advertising. As for the money spent on lobbying against government health policies targeting food consumption - the sky's the limit. As someone recently said, the PR we're now hearing from the food industry, where health is concerned, is akin to the PR we used to see from the tobacco industry. The assertion being that sugar has not been proven to cause obesity (just one example).

Right now, after ten months of intermittent fasting and low carbs, I can't recall the last time I felt so well. Ditching a LAMA inhaler that was causing glaucoma and my blood pressure down 25 points is definitely a huge improvement. I've no idea how much weight I've lost as my goals are solely health driven and so I'm extremely pleased that my health is improving. I used to rely on daily doses of Ventolin, but rarely need it now. After a lifetime of systemic steroids, my health is paramount and finding a way to correct the accumulated effects of Prednisolone is important. Giving up on processed foods is not exactly a fad or unhealthy choice. My intention is to carry on as the benefits are too important to me.

If Ash wants to tackle their fitness, weight and smoking for health purposes, then I really hope they get support from the currently available services provided by the NHS, as these will take into account their history of health and any specific areas that need careful attention.

[rachelmi]

Great advice 👌. Congratulations 👏 on your amazing journey. Fantastic 💪🏋️‍♀️👌🤗

[fraid]

You know it’s up to you,I too had to make a conscious decision to stop smoking after I saw my dad die in agony from throat cancer.I just cut it down by one cig a day then went onto menthol when I got to two I realised I was being ridiculous,I didn’t need to smoke atall! Especially as I kept getting sore throats,that was a warning of what I was heading for.Now I can’t even abide the smell.Swap your craving for something else,keep busy with your hands,when you want a cig have a pint of water first!Tried vaping?Fact is only way to lose weight is stop eating so much!I lost 3 stones in 6 months -I lost appetite re nausea from meds & now my weight stable.Being active will stop you smoking & get you fitter.

Make that decision!Good luck! X

[Itswonderful]

Any change is difficult. Sometimes it takes a few attempts to get there. Help is all around you. There is a free NHS diabetes prevention course run by Reed. It’s 9 months long and the sessions go to once a month after the first few to bed you in. You have to commit to it though because it’s not fair to take a place then not show up. Someone else could have had your spot and it’s not cheap for the NHS to pay for it. If you have a BMI that is overweight or above you qualify. There are also weight watchers and slimming world in person or on line. There’s also the new on line program called Noom which takes a different approach to weight loss. There is a two week free trial to be had. But as everyone else has said the common denominator in using your prescription inhaler as you should, stopping smoking and loosing weight is you. People can suggest and support but nothing will change (and may deteriorate) unless you take charge of you. As someone else said, why wait for GP to help you with smoking cessation when there are so many other ways to access it? Are you waiting to be prescribed patches or other things to get you off the fags? Or are you going to take control of the situation yourself and go to your local pharmacist? A journey of a thousand steps depends on you taking the first step. Then one more and one more. It really is one step at a time but no one can take those steps for you so take the first one and you will start to feel stronger. Just Do It! 👍

[Gareth57]

I used patches to give up smoking keeping a couple of real smokes for emergencies but only too 1or2 drags if I lit one. After 2-3 weeks I was able to stop the patches but the thing is you have to really want to stop, you have to find smoking a bit disgusting. As for fitness, get a bike. I find it clears your lungs when you work hard and my asthma is better controlled when I ride regularly. Hope some of that is useful and good luck!

[Poobah]

If you want to explore the NHS health coach services to support your lifestyle changes, then you can find out more here: nhselect.nhs.uk/Bespoke-Ser...

Once you start, there will be opportunities, through the health coach, to get together regularly with others who are also on a similar journey to you, if you wish. They will even arrange a shared WhatsApp group as a way to support each other.

The hardest step is the first one, but you don't have to do it all alone. Give it a go, it's definitely worth it. Good luck.

[Catsncrochet]

Hi Ash, My husband bet me something I really wanted if I didn’t smoke for a year. It worked and I haven’t smoked since (31years). I hope that could work for you. We’re more at risk from covid being overweight. You’re better than me at exercising. I was advised to reduce portion size so that a plate of meat or other protein, potatoes and veg would look like a T shape; a little blob of meat and potatoes and, down the middle, all the veg. It’s helped.

Take care.

[Mandevilla]

Set an alarm to remind you to use your inhaler if you can't remember any other way. I have mine sitting by my bed, so it's the first thing I see when I wake up and when I go to bed - makes it really easy to remember! You might find that if you take it more regularly, it helps with your weight loss. I put on 3 stone in the two years between starting to get bad asthma symptoms and getting a diagnosis. My asthma has been under control for the past two months and I've already started to lose weight and I'm not even trying - it's just that I'm able to be more active because I'm not struggling to breathe all the time!

The pharmacy should be your first stop for getting help giving up smoking. I don't smoke myself, but I have friends who have given up successfully without ever seeing their GP - just with pharmacy help and some willpower. One of them saw something she would love to have but couldn't afford - she then realised that if she gave up smoking for a month, she would have saved enough money to buy it. Once she'd saved that much, she picked another savings goal - she said it really helped, as every time she wanted a smoke, she'd ask herself if she wanted it as much as the item she was saving for!

[Tree20862]

I walked off 12 lbs without changing my intake. Then I started tracking what I ate with a weight loss program. Being accountable for what I ate really helped me.

More fruits and vegetables, smaller portions of carbs, 3 dairy, and conservative portions of meat.

I still eat pizza and fried chicken but not as often.