Exercise-induced asthma

[THE LONG RANGER]

Hey everyone -

This weekend on the Vapor Trail, I succumbed to a bad case of exercise-induced asthma. The first half of the race went really well! Felt strong, hitting my goals and all that. The second half was when I found myself slowing to literally a crawl. Kind of crazy, knowing you're in good form, and then looking at a small rise and not knowing how the hell you can get over it. Having asthma seemed to have a domino effect, as my muscles started to seize up from going anaerobic, when I should have been still going aerobic.

This is the second time this has happened to me this summer - the first time was day #3 of the CTR - I didn't know what the heck was going on. I had to stop a few hours earlier than I want, and then sleep longing than I had planned. The next day felt better - not great, but salvagable.

Was just wondering what others have done to prevent and treat this.

For me, it seems it takes a good, eight hours of pretty intense moving to start feeling the effects. I'm guessing that having an inhaler handy may help things - I was actually given an inhaler by an aid, which I hit hard, but it didn't seem to make much of a difference - perhaps I don't know how to use it correctly, or it was just too late for it to make a difference? I starting inhaling it around 2-3 hours after the first symptoms seem to show up. Caffeine also seem to have little to no affect.

Some ideas I've had, were perhaps learn to breathe through my nose more, rather than my mouth, and perhaps start thinking of restricting some foods (milk? wheat?) from my diet, to keep the mucus buildup down. I'm guessing that the asthma gets triggered when I totally overexert myself as well. Not sure what to do about that except... don't (ha!) or wear a HR monitor to see when I'm totally going overboard.

[mjr5house]

Have the same problem bro it gets real bad in the cold. When its cold I ride with a buff over my mouth to warm the air and that helps a lot. However I have yet to sort it out on the hot days. One thing I have noticed is the longer I take to warm up the longer I can go before it happens. What really sucks is its hard to tell if it's the asthma or I'm just bonking from lack of calories or poor digestion. cause they kinda end with the same effects.

[juanesunpescado]

I suffered from asthma for 5 years until I cut out wheat. Symptoms were gone in 3 days and have only returned when I succumbed to a plate of pasta. The occasional doughnut or beer does not seem to hurt. I suggest you give it a try. Especially if you are blood type O. Good luck!

[wahday]

I have had asthma for the last 25 years and I run and bike regularly. It is manageable!

For me, it is usually brought on during bad allergy season and in cold or very dry weather (which is great since live in the desert...) Apparently "cold weather" asthma is less about temperature than the dryness of the air. This is one reason the scarf over the mouth helps. Warming up slowly is also commonly recommended and definitely helps me.

Dietary issues are a good place to start. For me, I never could identify a culprit so easily. So I take a pulmicort inhaler twice a day and have found it to be great. Prior to about two years ago I used an albuterol inhaler about 20 mins before exercising. That was ok but the pulmicort you take every day regardless of exercise and has improved my lung capacity and performance in general. It's a mild and localized steroid. Both it and the albuterol are both via prescription. I definitely do not recommend any over the counter inhalers like primatine mist. That stuff's nasty!!

I do carry my albuterol for emergencies but very rarely need it. Good luck! Asthma has not slowed me down at all but finding good medication took some time. If you can identify a dietary contributor, even better.

[Done]

Sounds like it's time to visit your doctor or an allergist. Different types of asthma require different treatments. Web forums might not be the best place to figure out what will work best for you.

I've had asthma for 20 years. Damn near died a couple of times before getting proper care for it. The good news is that once I got a treatment regiment figured out, I've been fine ever since.

[aschuhmann]

I second the allergy piece. I have terrible asthma in June when the pines are pollinating. At least you can figure out how to manage it, or if it's allergies at all.

[THE LONG RANGER]

Thanks for all the feedback, ladies and gents.

* I'm a little skeptical it being a true allergy for me personally, as it's not something that happens when I immediately enter an environment: I mean, it takes > 8 hours to start having any sort of asthmatic symptoms - my training for this thing was 8-15 hour rides (including the course itself) and 6+ hour trail runs.

I think it's just: dust (which COULD though, be made up in part from all the pine pollen in the air), coupled with all the other stresses on my body, over time. (I also have no other known allergies, save penicillin).

I'd love to go to a doctor to test these theories of mine, but that may have to wait. I may start just starting a ad-hock eating diary to see if anything like that seems conclusive.

[shakes]

Thanks for all the feedback, ladies and gents.

* I'm a little skeptical it being a true allergy for me personally, as it's not something that happens when I immediately enter an environment: I mean, it takes > 8 hours to start having any sort of asthmatic symptoms - my training for this thing was 8-15 hour rides (including the course itself) and 6+ hour trail runs.

I think it's just: dust (which COULD though, be made up in part from all the pine pollen in the air), coupled with all the other stresses on my body, over time. (I also have no other known allergies, save penicillin).

I'd love to go to a doctor to test these theories of mine, but that may have to wait. I may start just starting a ad-hock eating diary to see if anything like that seems conclusive.

Having asthma all my life and done a little research on it there is alot of triggers out there for alot of people.

 - Sudden change in air temps, especially to cold.
 - dry cold air
 - extreme humidity
 - dust mites/pollen/airborne allergens in general
 - pickled foods
 - gluten (not wheat)
 - stressing your lungs, ie prolonged exercise or a sudden increase in intensity of excercise.
 - stress/anxiety/exhaustion
 - a heap of other random things
 - change of seasons

Lucky me fits into most of those boxes. Often if it's just one of them it stays ok, if multiples guaranteed I need to use ventolin.
Lots of info out there, lots of outdated info that wont be of much help either. Google is handy but take alot of it with a grain of salt.

http://en.wikipedia.org/wiki/Asthma reads pretty spot on from my understandings.

Always carry a puffer with you, regardless of if you think you need it as it WILL kill you if it come one hard enough

[Done]

Always carry a puffer with you, regardless of if you think you need it as it WILL kill you if it come one hard enough

Excellent advice!

While it's always good to understand personal triggers, and then to avoid them whenever possible, an asthmatic should never be without immediate access to a rescue inhaler (albuterol/salbutamol). According to the Asthma and Allergy Foundation of America, 25% of emergency-room visits are the result of asthma. And asthma causes about 3000 deaths per year--almost all of which could be avoided with proper treatment.

[THE LONG RANGER]

While it's always good to understand personal triggers, and then to avoid them whenever possible, an asthmatic should never be without immediate access to a rescue inhaler (albuterol/salbutamol). According to the Asthma and Allergy Foundation of America, 25% of emergency-room visits are the result of asthma. And asthma causes about 3000 deaths per year--almost all of which could be avoided with proper treatment.

When I was using someone else's albuterol inhaler on the trail, it seemed to have little effect, which was puzzling to me. I thought maybe I either didn't know how to use it correctly, or it was just too far into having the episode for it to work, "instantly"

So, I took about a week off, after the race (pretty easy to do, with all our raining/flooding) and took an, "easy" spin.  Seems as if, whatever's there, is still happening, whenever I need to breath hard. Ugh. I'm gonna cut out milk/wheat  out of my diet for a while, see if that helps. Of those two, my guess is the milk may be causing problems. I'm sort of leaning on the idea that this also may be a seasonal allergy from whatever is in the air from Late July till now, that I didn't know about.

Fun!

[Done]

When I was using someone else's albuterol inhaler on the trail, it seemed to have little effect, which was puzzling to me. I thought maybe I either didn't know how to use it correctly, or it was just too far into having the episode for it to work, "instantly"

So, I took about a week off, after the race (pretty easy to do, with all our raining/flooding) and took an, "easy" spin.  Seems as if, whatever's there, is still happening, whenever I need to breath hard. Ugh. I'm gonna cut out milk/wheat  out of my diet for a while, see if that helps. Of those two, my guess is the milk may be causing problems. I'm sort of leaning on the idea that this also may be a seasonal allergy from whatever is in the air from Late July till now, that I didn't know about.

Fun!

Yes, if you are have a severe attack, albuterol will have less of an effect. That's one reason why asthmatics die--they use their rescue inhalers too late. The hospital has a more effective delivery system, but even it isn't 100% effective if things are too far out of hand.

But albuterol is just one tool in a doctor's bag of tricks. Preventing attacks is generally the best approach. There are a bunch of different inhaled steroids that do wonders for allergy-induced asthma. There are also desensitization shots, antihistamines, bronchodilators, mast-cell stabilizers, leukotriene modifiers, etc. Diet modification, dust masks, and even nasal washes can also be beneficial. But, again, the right combination of drugs and/or lifestyle changes isn't something that you can probably pull out of a hat. A good doctor that specializes in asthma can get you back on your feet with a solution that works for you and your needs. I highly recommend National Jewish Hospital in Denver--it's a world-class facility that gives Colorado residents priority. If I hadn't gone there, I might have died. Instead, I take a minimal amount of medication and a make few lifestyle changes during certain times of the year, and life is good. While asthma sucks, it rarely slows me down these days. The same is true of my mother, brother, and son.

I will now get off of my soapbox!  

[THE LONG RANGER]

Def. happy to receive your input, Toby! Thanks again,

[Done]

Def. happy to receive your input, Toby! Thanks again,

Glad to help, Justin. I hope that you get your lungs sorted out soon. Not being able to breathe really sucks. The physical side is bad enough--but the mental impact is probably tougher. Fear combined with low O2 blood saturation can make for some crazy thought patterns. I feel your pain, perhaps a little too acutely!

[wahday]

Just to reiterate Toby's excellent synopsis, albuterol is a preventative medication that is most effective taken prior to exercise and before symptoms. As you experienced, it is not very effective once an attack has begun. If you do find yourself in that situation, I find it works best if I let my body cool down before taking it (which can be hard if you are short of breath). I then need to chill out for about 20 minutes before riding again. That usually does the trick, but with my newer medication (pulmicort inhaler) I have not had this issue in a while. Still, I keep it in my pack just in case...

[boglenn]

To add a few more cents to the great discussion. . . I never had asthma until I went through a particularly stressful time, drank too much coffee, too much beer and gained too much weight.  Often I would eat and drink without regard to when I was going to sleep.  I developed exercise induced asthma.  My Dr. diagnosed it as caused by acid reflux.  When I lay down at night, some acidic contents in my stomach would come up and leak into the airway causing an inflammatory response.  He put me on an acid blocker (Protonix), asthma medication (Singulair) and an emergency Abuterol inhaler. Also, he had me raise the head of my bed 4 inches, stop drinking or eating 3 hours before bedtime and stop eating things that increased my indigestion.  It took some time for it all to settle down, but I have been symptom free for several years except when I rode the higher passes in Colorado where I had a return of symptoms.  While I had asthma, I would use the inhaler 20 minutes before races and it worked fine even though the race would include a swim in cold water.  (Having an asthma attack in the middle of the lake was no fun). 

I would do some more exploring on the cause of your onset of EIA.  It may be you can stop the process that makes you susceptible rather than just treating the symptoms. Good luck!

   

[THE LONG RANGER]

Here's a followup, describing some of the things I've been trying:

After the Vapor Trail, I took a solid week off, in an attempt to clear out things, and give my body some recovery time - the Vapor Trail COULD be called Colorado Trail Race Lite if you wanted to go that far.  Great ride, that all the Absolute peeps put on.

After a week, I did my usual 30 mile road ride here in Denver and was surprised and exceptionally aggravated that I felt a similar asthma-like feeling in my lungs - what?! That's not something that's ever happened (I think?) unless I'm really gunning it, for a while. Surely, not on the easing into things again road loop.

That night, I decided to really be serious and go without milk and wheat. I'm a glutton for food, so I wasn't even sure how this was going to happen. I live, literally, 2 blocks from pizza places and was hitting up them, say, at least once a day (what can I say?). Ice cream was also a every-other-day affair. My activity level seems to demand quite the caloric intake.

But, I went for it. I'm not perfect, but it's certainly not impossible to do in Denver. I've saved quite a bit of money not eating out all the time - but most importantly, it seems to have made a big impact on my problem.

The next time I took that same road ride, it was literally night and day: no asthma-like symptoms, and my average speed was around 3 miles/hour faster, for a 30 mile stretch. Here's a small segment, with just 3 days sans milk/wheat:

9/17
http://app.strava.com/activities/83787249#1713418502

9/20
http://app.strava.com/activities/83787250#1713416593

(this is on a 27lb CrossCheck, with Schwalbe Marathon 28mm tires - not exactly a rocket!)

It was very encouraging. I def. have WAY less stuffiness in my nose, and it seems I've gained half a lung somewhere along the way. I can tell I've been breathing through my nose a whole lot more, which I think is helping stop the domino effect of breathing through my mouth and annoying my lungs w/unfiltered air (and then, causing the asthma)

It's only been a few weeks since then, but I haven't had a asthma-like symptom since. I can't say I've done any Vapor-Trail like rides since (ha!), but my last 15 mile "hike" up and down and around Mt. Elbert seemed almost easy, with endless, boundless energy - whenever you get >14,000 feet and the altitude doesn't really make you slow way down is a good day! Especially, since this is a spit away form the places I've experienced these problems.

Had an unrelated problem with my piriformis muscle (there's always SOMETHING, isn't there?!), but getting to the summit was an exercise of passing everyone else on the trail, and I hobbled back to the tailhead with the help of some ibuprofin

I'm gonna stick to the no milk/wheat for the time being and see what happens on my next Big Something-Or-Other. I'm pretty hopefully that this may help manage things. I have been losing a few pounds of weight, just as there's no way I can take in as much calories as I have been doing, without eating ice cream and pizza all the time

That kinda gets me to another topic: sometimes on these really long races (Tour Divide, Colorado Trail), you can slip into this mode of eating just junk, because sometimes junk is the easiest thing to find. When you finish these things, it's easy enough to forget to reset your dietary habits to something a bit more realistic, and NOT continue to eat junk. It's also easy to think that since you ate all this junk during this race, this sort of food is 100% fine to eat more often when you're not doing these races. Probably not the case.