When it comes to asthma and appetite, doctors and dietitians worry most about patients who eat too much, shun exercise for fear of becoming breathless, and end up being overweight.
But in a small minority of patients, poorly controlled asthma can leave them too breathless and fatigued to eat properly. Furthermore, a few asthma medications can cause upset stomachs or thrush infections in the mouth, leading to poor appetite.
By Jan. 1, 2009, millions of Americans with asthma and those with chronic obstructive pulmonary disease will have to make the switch from CFC-propelled inhalers to HFA-propelled inhalers, if they haven't already.
The change comes as a result of a federal ban on CFC (chlorofluorocarbons) albuterol inhalers that goes into effect Dec. 31, 2008.
For some asthma patients, like 35-year-old Shelby Rothrock of Silver Spring, Md., the new inhalers are a big improvement. She says she prefers the feel of...
“As a group, asthmatics are overweight,” says Karen McCoy, MD, chief of the division of pulmonary medicine at Nationwide Children’s Hospital in Columbus, Ohio.
Parents of children with asthma often excuse them from physical activity if they complain of shortness of breath, she says. Although most asthma drugs, including inhaled steroids, typically don’t affect appetite, oral steroids can make some children eat more than double their usual amount, she says.
Carrie Gleeksman, MS, RD, works with many adult asthma patients who are on long-term oral steroids such as prednisone at National Jewish Health, a respiratory hospital and research center based in Denver, She has seen long-term use of these asthma drugs have dramatic effects on patients.
“Prednisone has a number of side effects that impact their nutritional status,” Gleeksman says. “The biggest one is significant weight gain, partly due to an increase in appetite from the prednisone, partly due to the way the medication works and slows down the metabolism and leads to fluid retention.”
“Weight loss in that population is no different than weight loss in any other population: balanced diet, increased activity, decreased calories -- basically, the same thing that everybody knows,” Gleeksman says.
Asthma May Also Cause Poor Appetite
Although it’s much less common, some asthma patients have poor appetite.
Loss of appetite “is usually a signal that the asthma is not well controlled, not adequately treated,” McCoy says. If patients are not breathing well, their lungs can become hyper-inflated, she says. “They get full faster since their diaphragms under the lungs are pushing down on the stomach and it may not feel comfortable to their breathing to over-fill themselves.”
Some patients with uncontrolled and under-treated asthma are so breathless that they have a hard time eating their meals. “The best thing to do for that is small, frequent meals,” Gleeksman says. “If it just takes that much energy to eat -- and for some people, it really does -- the best thing they can do is to eat smaller amounts throughout the day.”
Asthma can also leave some people too fatigued to cook, Gleeksman says. “They know the energy that it’s going to take them, not only to eat, but to prepare food. It almost ends up being a negative feedback mechanism, where they know how exhausted they’re going to be from thinking about getting out, preparing, cooking and then eating food. They don’t want to do it at all.”
Although long-term oral steroids can cause increased appetite and weight gain, asthma drugs can also cause stomach upset or mouth lesions, making eating more difficult. For example, higher doses of inhaled steroid doses to control asthma can cause fungal thrush infections in the mouth. But using a spacer or holding chamber with the inhaler can lessen the amount of medicine deposited in the mouth or throat, according to the Asthma and Allergy Foundation of America. Rinsing the mouth with water after each inhaler use also helps to prevent thrush.