Asthma and travel

[Beefull8]

I just got diagnosed with asthma and lung disease last year. I had to cancel my trip then and finally took the trip this year. I’m on a bunch of preventative meds including inhalers and montelukast, but I still struggled on the plane. I had trouble concentrating on reading or watching anything because I had to focus on my breath. I didn’t even think of taking my rescue inhaler but the next morning i felt terrible. My chest and back hurt and felt exhausted like breathing was tiring. I checked my peak flow and it was lower than normal so I took my rescue for the first time since last year. I’m just wondering what to do next. Will I feel back to normal after this so I can enjoy my trip? How do I know whether to go to the hospital or take prednisone pack? Thank you! I used to love traveling and now I wonder if I’ll ever want to travel again.

[d2read]

Hi! I hope you are feeling better by now, but I’ve just seen your note.

First of all, where are you? Are you in the US or a foreign country? Are you a US citizen with private insurance (with preferential in-network pricing) or public insurance (Medicare)?

These are critically important pieces of information to always have with you. (For example, if you are a US citizen and traveling in another country, your insurance may not cover any of your expenses! Do you have travel insurance and emergency medical insurance?)

When you were diagnosed, didn’t your physician go over an asthma action plan with you? At the LEAST, you need to call your asthma doctor at home about your symptoms. S/he may tell you to see a local physician who specializes in asthma/lung diseases NOW. You also need your rescue inhaler — why didn’t you have it with you? You should ALWAYS have it with you!

Rescue inhaler is your first defense. Remember that planes vibrate a great deal, and that can also trigger additional discomfort in your chest/back the next day.

(Do you take and chart your peak flows? I would strongly recommend you do so every morning before taking any medication or drinking anything - whether you feel fine or are sick. It will help you and your doctor learn how your lungs normally function and how they change as you are getting sick, and then when you are sick.)

It sounds as if your doctor probably gave you an Asthma Action Plan (ASP), along with the peak flow meter and prednisone dose pack. What does it say about when you should begin the steroids? If you don’t have an AAP or forgot to bring it, call/email your doctor and give him/her your peak flow readings, other symptoms and concerns and ask if you should start the pred now.

If nothing else, ask at your hotel for the name of a doctor who speaks English (if you are somewhere it’s not the primary language), and the hotel’s recommendation for a hospital or emergency clinic. (An English-speaking doctor making a call to a hotel at night may charge a fairly high fee in cash, but a hospital may take a credit card and also permit you to pay a rate more in line with their national fee - almost anywhere in the world will be cheaper than the US.)

I know it can be scary to have asthma when you are away from home, especially away from familiar doctors and treatment.

But I worked all over the world with severe asthma and only ever had bad problems in the US (although I had attacks in other countries, I was able to successfully treat them). I also was trained by my doctors to monitor my situation carefully, contact them if necessary, and travel with all the medications I was likely to need. I only stopped traveling when I developed dangerous complications a few years ago and now that my condition is improving, I desperately want to get strong enough to be able to travel again. (Note this was all LONG before email, when even fax machines weren’t terribly common or left on all day and night in a doctor’s office.)

Also, like anyone with a chronic illness, I would always check with my doctors before leaving for any vaccinations/special precautions. I also charged my air tickets on a certain card that offered emergency medical insurance/evacuation if necessary, and had a supplemental insurance policy (not the kind they try to sell you when you are buying your airline tickets or at the airport). These are more expensive policies, but well worth it. I never had to use the insurance, but it was worth the peace of mind.

Your problems on the plane could have been caused by something like a reaction to another passenger’s perfume, insecticide sprayed in the cabin if the plane flies in areas with disease-carrying insects (like mosquitos), or even a reaction to something you ate or drank before getting on the plane.

I would suggest, subject to your doctor’s approval, that in addition to your rescue inhaler you always carry Benadryl and, if warranted, an Epi-pen set (two pens - 1 may not be enough). All your meds should always be with you, not in an overhead or checked bag. Put them in a clearly marked Medical bag (or with a large red cross), so in an emergency a flight attendant can find it and administer what you need (which means a copy of your Asthma Action Plan, too).

Also, at home do you use nebulizer treatments? I have a fabulous new nebulizer that works on regular batteries, is about the size of my iPhone, is almost completely silent and can be used just about anywhere - called a Flyp. It would have made life even easier for me traveling if I’d had access to my nebs, even on a plane. You can pull it out, put your dose in and use it at your seat without anyone being inconvenienced. I’m not trying to sell you one, I just wish mine had been available 30 years ago ...

Stay calm (fear is normal, but it alone can trigger asthma, so meditate or whatever to stay calm). Enjoy your trip, but I’d suggest you be careful not to overdo the tourist stuff. If you’re tired, sit in a cafe instead of walking miles through museums. Stay away from smokers and any triggers.

Please let us know how you are.

Debbie

[Beefull8 in reply to d2read]

Thank you for all these great resources! I flew from Hawaii to California and got in touch with an online doc who recommended I just increase the dose of my preventative inhaler and take rescue when I need it. I’ve been monitoring my peak flow and it’s getting back to normal just not as high as when I use the rescue. I’m starting to feel better so I’m going to skip the prednisone and will definitely call my doctor when they’re open tomorrow. I just don’t want to go through this again on the plane. I was in denial o have asthma because I hate having this illness. I already have a few and worrying about another is overwhelming. Thank you again for your help!

[d2read in reply to Beefull8]

Everyone goes through a similar reaction - yours was denial, mine (since I’d had severe asthma from birth) was rebellion (“well, okay, if that’s how I’m gonna die then I’ll just cut out all the crap meds and do whatever I want” - yeah, I was a fun teenager to raise😂).

Just remember the more you know, the more options you have. The more options, the easier to get the result you want with fewer drugs/acute episodes.

That said, steroids may be necessary to save your life - they’ve saved mine many times.

Enjoy your trip!

[Beefull8 in reply to d2read]

Thank you! I will. The one question I still have is this. When falling asleep I keep waking up like someone throw cold water on my face. I’m wondering if this is related to my asthma?

[d2read in reply to Beefull8]

Hi, It sounds to me like you might have apnea. Sleep apnea is very common among asthmatics - and it is potentially very dangerous. Call your pulmonologist and get evaluated. S/he may schedule you for a sleep study (no worries, let me know, I’ve got lots of tips on those, too😁).

But first - how often do you wash your pillow and thoroughly dry it and how old is it? I replace my pillows every year, and launder with hot water and dry thoroughly in a hot dryer every month. I launder the dust-mite protective cover each week.

I’ve found that my sleep and issues around it can be surprisingly clear warning signals. I get very vivid troubling dreams when the mold and pollen levels are extremely high (even if I haven’t been outside and have kept my filters clean). Similar kinds of early warning signals to sleep apneas to yours (but mine involved falls from my bed, breaking my nose twice and making me look like I’d been mugged).

All Hilary’s advice is spot on (great minds😂). Two other trip tips - travel with your own clean pillow/dust-mite cover & pillowcase - whether you’ll be in hotels or with family/friends. Never know about dust mites other places and pillows give you an important barrier.

Many international hotel chains in the US & Europe have rooms for the disabled where they will use special anti-allergic cleaning products and processes (no carpet, no chemicals/insecticides/air deodorizers etc). When you get a chance, check with your fav chains, make notes, request in advance and tip/lavish praise on travel ratings blogs.

Ciao!

[Beefull8 in reply to d2read]

Thank you! I should have thought of bringing my pillows! The hotel smelled like chemicals and I’ve been sleeping on the couch. My allergist rang in and said it’s prednisone for me. I’ve never been on it so hoping for least side effects.

[d2read in reply to Beefull8]

It’s smart. You’ll probably get the steroid rush - something some of us no longer get. In a couple of days you’ll have more energy and feel like you can leap small buildings. You can’t of course, so don’t overdo😊. But the steroids will give your body jet fuel for a bit. Just also remember that they actually make you heal more slowly, get sick easier (temporarily compromises your immune system).

Also of you have other side effects from the Prednisone, like inability to sleep, you can take all of the day’s dose at one time in the morning (discuss with your dr, but it’s common for most of us who have problems with the side effects).

Take care. Let us know how it goes! Debbie

[Beefull8 in reply to d2read]

i did do a sleep study but they said everything was normal. It was a home sleep study and I think one of the parts wasn’t working. It seems like since my asthma has been acting up, I’ve been waking up more with that adrenaline rush and then a deep breath. Will it go away once my asthma is stable?

[d2read in reply to Beefull8]

I don't know. We've spent the past three years trying to get to the bottom of my sleep problem (it's complicated like most of my medical stuff). Couple of things I'd say to consider and urge you to make notes about to discuss with your doctors:

1. When precisely are you taking you're evening/bedtime meds and what are they? What time do you go to bed? Do you eat or drink anything whatsoever besides a few sips of water with pills between dinner and bedtime? What specifically? (sometimes things like wine can cause you to relax and fall asleep easily and then suddenly wake).

2. Try and keep a really detailed daily journal about the time you go to sleep, how long before you fall asleep, how often you wake, what time you get up, do you get sleepy during the day/when you get home. Precise timing of meds, foods and beverages, exercise, even entertainment (if you are going to a movie theatre that's dusty, maybe that's a trigger). Anyway, the more detail and the longer you do it, the more likely you are to find the answer.

3. Drug interactions. Sometimes the strangest things seem to interact for me. [ I actually got to the point where I take my bedtime pills at 11 pm, try to sleep (not always successful by midnight), then get up at 4 am to take my thyroid medication (necessary because of interactions with other medications otherwise). Then back to sleep until 7, morning meds, etc.]

I suggest you would try when you get home to make certain about the pillows etc, then try the notebooks for a few weeks. Then see your pulmonologist and allergist about their thoughts. I've heard that home sleep studies are not as accurate as the ones in a center (but take your own pillow!).

Sure hope y'all get to the bottom of it. I'll ask around and see if anyone I know has any bright ideas about it -- but I'm thinking you'll find the answer in the journaling or sleep study.

Fingers crossed!

[hilary39 in reply to d2read]

Debbie said everything I was going to say!! that was a great very thorough post-

I travel a lot and it is non-negotiable with me because it is one of my favorite things in the world. I’ve had a lot of flare ups while traveling but have learned from them.

I agree with Debbie’s points have a few additions:

1) make an asthma plan (if you google ‘asthma plan template’ there is a standard one most doctors use—you can fill that out with your doctor at your next appointment and travel with it) 2) always keep with you a prescription for your meds (in case you need refills unexpectedly, I recently did!), your rescue inhaler, a course of prednisone, and a travel nebulizer 3) keep your meds in your carry on in case your luggage gets lost 4) be super careful to book hotels with pet free rooms if that’s trigger for you; I find chain hotels easier as small inns can be dusty or have pets etc. 5) avoid cities with a lot of pollution—you can check the air quality index (AQI) online; anything above 100+ can be hard for sensitive people like us 6) totally agree about all of her insurance recommendations

Good luck and I hope you find new ways to feel like your asthma is manageable so you can enjoy your life and vacation time!! I have severe asthma and have traveled the world, I’ve just learned to be super cautious every step of the way.

[Beefull8 in reply to hilary39]

Thank you so much! This gives me hope. Maybe when I get better at figuring out my triggers and knowing when to take prednisone I will feel more confident.