When I came back from India in late November, I returned with that familiar feeling in my chest. I have been starting to feel it as of my last couple of trips from India. It's that tight, coughy feeling - that shortness of breath. There's a feeling you get when you breathe in too deeply. You can't go all the way. A number of times I had a difficult time in the rickshaws breathing in the soot from other rickshaws. It's a long way of saying...the asthma is back.
It's a sad feeling - been over 25 years since I last felt symptoms. The memory never goes away, but I really thought I beat it. Well this time when I went to see my doctor, he listened to me describe my symptoms and prescribed Advair - inhaled corticosteroids with a long acting bronchodialator. Usually I despise medication, but I took it as I felt a great deal of chest tightness. There was some impact within days but it's still there. I know that a low dose of Advair takes a while to have impact.
The story twists here... Well I went over to the Apieron office this weekend to measure my exhaled nitric oxide (eNO) levels. As many of you know, Bhairavi and I started Apieron. We are building a device that measure exhaled nitric oxide or eNO at the parts per billion level. eNO is indicative of inflammation of the airways. High inflammation leads to symptoms. If you can catch and control inflammation early, you are much less likely to feel symptoms. In my case, I've been typically measured at in the low 30s over the years. Today, I was at 46 ppb - this is after 3 days of Advair. Much much higher than normal. While there is no established protocol for treatment in conjunction with eNO measurement, it's clear that lowering eNO and inflammation is the way to go.
I was happy about one thing - eNO works. My measured level is much higher than normal. As a mild asthmatic, my normal level is higher than non-asthmatics. To see it this high really hit home. It is one thing to hear presentations on studies that have been conducted. It's quite another to feel it directly. The measurement works - our device has value.
Every week, I plan to go back in to see the decline. When it gets low enough, I plan to see if I can switch to a pure inhaled corticosteroid vs. Advair.
In one way, this stinks. In another way, it's heartening that our collective hard work can truly help the world.