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WHEN YOU TRAVEL

Being Prepared Can Prevent TripsFrom Going Nowhere

Breathing Easier

Jeff and Mary Sutton of Omaha, Neb., spent months poring over the

details of their February 2003 wedding and honeymoon. But something

unexpected still disrupted their week-long trip to Orlando, Fla. Instead

of soaking up the sun and racing between theme parks, the Suttons

took an unscheduled ambulance ride to an emergency room.

by Gregory Alford

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Jeff Sutton, 32, suffers from mild allergies and asth-ma but had not experienced a severe attack in morethan a decade. “It started pretty fast,” he recalls, “Ibegan to feel congested and tight in my chest within acouple of hours of getting off the plane. I used myemergency inhaler (which was the only asthma med-ication he used at the time), but it wasn’t as effectiveas it normally is. I didn’t think much about it at thetime. I was too excited about getting married and hav-ing a week alone with Mary.”

Before checking into their hotel room, the couplemade a quick stop at a drug store to purchase an over-the-counter allergy medication. Jeff thought the aller-gy medication would ease his symptoms. The lastthing he wanted to do was let an allergy put a damperon his and Mary’s honeymoon. This was the first timeeither had been to Florida, and the warm weather wasa welcome escape from the frigid February tempera-tures in Nebraska.

During that evening, Jeff ’s chest tightness turnedinto wheezing, and he was getting short of breath,though he continued to use his rescue inhaler. “I did-n’t panic because I had had asthma attacks when I wasyounger and I thought I knew what was going on,” hesays. “I thought it would pass.”

Jeff woke up at about 2 AM in the grip of a severeasthma attack. Far away from home and in a city nei-ther knew well, Mary had to sort through her optionsand decide what to do. She says this was the firstmajor asthma attack she had ever witnessed, and shewas rattled.

“I tried not to panic,” says Mary, but she acknowl-edges that she did panic. “I decided to call 911because I had no idea where to take him. When theoperator asked me for the hotel address, I nearly lostit—I had no clue. I was tearing apart the room look-ing for stationery with the hotel’s address. I felt prettyhelpless.”

Prepare, Prepare, PrepareBruce Bender, MD, head of the Pediatric

Behavioral Health division at National Jewish Medicaland Research Center in Denver, Colo., says beforegoing on a vacation, anyone with asthma or allergiesshould make sure they pack plenty of medications ofall types.

“Also,” warns Dr. Bender, “don’t ignore the early signsof an asthma attack because you are having too muchfun to stop. That can lead to a medical emergency. It isalways better to recognize and respond to the early warn-ing signs, even if it means a temporary halt to the fun.”

The American College of Allergy, Asthma andImmunology and the American Academy of Allergy,Asthma and Immunology recommend that asthma

and allergy sufferers prepare for a vacation by doingthe following:

• Find out in advance where the nearest emergencyroom is located and how to get there.

• If you use a nebulizer, obtain a portable unit thatplugs into the car cigarette lighter or works off aportable battery pack.

• When traveling by air, take an antihistamine beforethe flight. Notify the airline ahead of time if youhave food allergies, and drink plenty of fluids tostay hydrated.

• Pack all medications in carry-on luggage so they arehandy even if your luggage is lost or delayed.

• Make sure you bring more than enough medica-tion, and store it in the original containers, whichwill include instructions on how to take the med-ication and how to obtain refills.

• Carry a peak flow meter, an asthma control plan,and a copy of your physician’s phone number. Keepany emergency medications you need, such as anti-histamines, bronchodilators, self-injectable epineph-rine or a short course of corticosteroids, on hand.

In addition, check on pollen and mold-spore countsas well as air pollution before setting vacation plans instone. This simple step can help prevent allergy-inducedasthma attacks. Detailed allergy information can befound on many Web sites, including www.aaaai.org./nab/ and www.weather.com.

“Individuals may have symptoms with pollen countsof 20 to 100 grains per cubic meter,” says Christopher

If you use a nebulizer, obtain a

portable unit that plugs into the car

cigarette lighter or works off a

portable battery pack.

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C. Randolph, MD, a board-certified allergist and anassociate professor of allergy and immunology at Yale

University School of Medicine. “Symptoms may beaffected by recent exposure to other allergens, the inten-

ipsTFORTraveling with Allergies and Asthma

Seasonal travel: Climate and the season affect allergen exposure. In tropical and damp climates, expectmore allergens such as mites, airborne molds, and specific pollens. In cold or damp climates, there is moreexposure to house dust mites and indoor molds. Cold, dry air can also be an irritant for those with asthma.

Air travel: When traveling in an airplane, you are in close quarters with many people and there is limitedfresh air. This puts you at risk for exposure to asthma triggers such as pet dander on a neighbor’s clothing orher perfume. Be sure to bring asthma medications on board with you so you can have access to them inflight. If you have food allergies, be extremely cautious when eating airline food. It is safest to bring foodfrom home or purchase food that has not caused a reaction in the past.

Cruise ships: Ask for the qualifications of medical personnel and the type of care available while onboard. Check what medical services are available in ports of call and under what conditions your insurancewill cover treatment. If you have food allergies, bring injectable epinephrine in case of a severe allergicreaction.

Something new: If you are participating in a new or strenuous sport, make sure you are comfortablewith your level of activity, and monitor your breathing.

Avoid these activities: As a general rule, asthmatics should avoid strenuous activities at altitudes above5,000 feet, where the available oxygen decreases. In addition, avoid scuba diving unless you have discussedit with your physician and received his or her approval. It can be a particular hazard for asthmatics. Instead,try snorkeling.

Time zones: When crossing several time zones, compensate for the change in time to keep medicationschedules constant.

Leaving the country: Before taking a vacation outside the United States, obtain the name of an AAAAIallergist/immunologist located in your destination city from the American Academy of Allergy, Asthma, andImmunology’s Physician Referral and Information line (800-822-2762) or the Physician Referral System, whichis found on the AAAAI’s Web site (www.aaaai.org).

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sity of pollen exposure, and individual sensitivity.”

Before Checking InPotential problems can lurk inside as well. Hotel

rooms house the same asthma-inducing dust mites,mildew, mold, and pet dander that lurk at home.When making a reservation, ask for an allergy-proofroom if the hotel makes these available. Although rel-atively few hotels have what are often referred to asgreen rooms (allergy-free rooms), the number is grow-ing. A simple Web search using any of the majorsearch engines can help vacationers pinpoint allergy-free hotels and bed and breakfasts.

At a minimum, experts advise staying in a smoke-freeroom at a hotel that enforces a pet-free policy. Sincecarpets and drapes harbor dust mites, inquire aboutbooking a room with blinds or shades and a wood floorrather than carpeting. If mold is a problem, request aroom that is located far away from indoor pools.

Try packing dust-proof, zippered covers for pillowsand mattresses or personal bedding if dust mites are aconcern. In addition, sprays that kill the mold andremove the dust in the air conditioning systems areavailable in most home stores.

An Ambulance RideAfter calling 911, Mary Sutton made the front desk

staff aware of the situation. “I couldn’t believe what was

happening to me,” says Jeff. “It felt like there was noroom for air in my lungs. I just wanted to get somehelp—fast.”

Help arrived in about 15 minutes, and the coupleshared an anxiety-filled ride in the back of an ambu-lance to a nearby emergency room. During the next 4hours, doctors ordered several nebulizer treatments andthe first dose of a course of the oral corticosteroid, pred-nisone. The medications eventually relaxed his airwaysand reduced the inflammation in Jeff ’s lungs. He saysthe emergency room doctors told him the attack wasprobably a reaction to mold spores common in the trop-ics but not in Omaha.

The corticosteroids staved off additional asthmaattacks during the trip, and the Suttons did make it tothe Magic Kingdom. Although they still enjoyed theirhoneymoon, it was not the carefree trip they had imag-ined it would be.

“We were totally unprepared to handle this,” saysMary, adding emphatically, “but, now, you better believewe do everything we can to make sure Jeff never scaresme like that again.”

Gregory Alford is a freelance writer and health columnistfor several newspapers in Illinois.

Reprint requests: Elsevier, Inc., 11830 Westline Industrial Dr.,

St. Louis, MO 63146-3318; phone 314-453-4350.doi:10.1016/j.asthmamag.2005.04.012

Before taking a vacation outside the

United States, obtain the name of an

AAAAI allergist/immunologist located

in your destination.