Training & Nutrition - Exercise Induced Asthma questions...

Hi all,

I have been having trouble breathing when it’s cold outside and finally went to the doctor yesterday. I have exercise induced asthma and it’s brought on mainly by cold, dry air. I got a prescrip for albuterol and doc said to use it 30 minutes prior to exercise and to make sure that I warm up sufficiently.

My question: how does one warm up? Do I start my rides 30 minutes early and just do really easy spinning? If my group ride starts at say, 10AM, do I arrive 30-45min early and go for a ride before my ride? This is all new to me, so bear with me.

I used the inhaler today, about 20min before my lunch time ride, but as I was riding during my lunch hour, I don’t really have a chance to do any sort of warm up and get a good ride in too. I noticed about 10min into the ride, that I was feeling a little congested and had some wheezing :( and, I’m still coughing a little bit now. I realize that I prolly didn’t get a “proper” warm-up, but somebody tell me what to do or what works for them. Haul my trainer to the ride start and do a warm-up on it??? I’m sure to get WTF looks if I do that :rolleyes:

Thanks, Karen.

Legal doping. Bleh.

I've had bad chronic asthma for decades, when living in cold places I never left the house in winter w/o a scarf. It's never been considered 'exercise induced' per se for me, just temp shock has always been a trigger.

You could try arranging a scarf around/in front of your neck/head (not wrapped tight around your face) so that the air you are breathing is warmed up/humidified by your in/ex-halations by the time you breathe it in. Create a warmer/humider microclimate around your nose/mouth.

The warming up pre-exercise doesn't ring any bells for me. Nor the proactive rescue-inhaler use. What I would do instead is wait for pulmonary tightness (which was always around the corner for me) and then use the albuterol reactively. 2 inhalations at a time, wait for improvement. (edit: that is specifically 'what I would do', not my recommendation for what I think you should do, you need to do some learning about how your body reacts to the combination of triggers, medicines, etc... you throw at it; I do think you should try the scarf/bandanna thing, though).

After finally giving up on ever hoping for any qualitative change in the asthma, I'm almost a week away from the last time I took any asthma medicine at all, I would never have thought that would happen.

There are some studies that suggest that untreated asthma leads to emphysema later in life. So, you should try to prevent an attack.

I use a buff to warm the air when it's cold outside. I'm on a bunch of different drugs, which seem to help my overall lung capacity, but I'll still have an attack when it's really cold/dry out. Singulair, QVar, Foradil and Nasonex.. Seems to help.

You'll have to experiment on the warm-up. Everybody is different. I've had exercise, cold induced and allergy induced asthma for about 63 years and I've had to experiment and devlop processes for different times of the year. You'll have to learn what works for you.

For normal people, it takes about 10 minutes for their aerobics system to kick-in to adapt to a major increase in effort. So gradually increase your effort for say 30 minutes as a starter. It will be temperature dependent and will vary day to day for unknown reasons.

Take a puff of Albuterol maybe 20 minutes before you exercise.

If you do have cronic Asthma, suggest you look into Serevent which is a timed release version of a Bata Agonist. Albuterol is also a Beta Agonist of some type. One puff of Serevent lasts 12 hours. Two puffs a day has been the best treatment for me, making the Asthma rarely a problem which is a big improvement of Albuterol or any medication prior.

I'm good to mountain bike even in the North Georgia mountains with Serevent to below 30 deg temperatures. Not possible with Albuterol or anything else.

The sinuses are often involved, so things like Claritin might be usefull at certain times of the year. You'll have to figure all that out.

By the way, you can exercise through an attack. It'll get real bad, but it'll ease up as you continue the exertion. I did it for decades before they had decent medication. The more you do it, the less severe the attack you have to punch through. You might wheeze and have trouble breating the whole exercise period or not. It didn't matter to me, I had to jog/backpack/canoe trip/ride so I toughed it out when I had to. My overall health and enjoyment benefited.

Al

Legal doping. Bleh.


Oh, yeah, because those with EIA are just blowing away the competition with their albuterol inhalers. It is legit, and I used to get it while running. Some albuterol before and I didn't cough or wheeze. I didn't run any faster, it just kept me from having an asthma attack afterword.

By the way, you can exercise through an attack. It'll get real bad, but it'll ease up as you continue the exertion. I did it for decades before they had decent medication. The more you do it, the less severe the attack you have to punch through. You might wheeze and have trouble breating the whole exercise period or not. It didn't matter to me, I had to jog/backpack/canoe trip/ride so I toughed it out when I had to. My overall health and enjoyment benefited.

Al


Are you sure that everyone that has exercised induced asthma will experience it in the same way you do?

Are you sure that everyone that has exercised induced asthma will experience it in the same way you do?

Did I not say everybody is different? Did I not say you have to experimment? Did I actually say i was sure about anything? I am sure I know what works for me. That said, it's worth a try to see how you do experience it.

Al

Oh, yeah, because those with EIA are just blowing away the competition with their albuterol inhalers. It is legit, and I used to get it while running. Some albuterol before and I didn't cough or wheeze. I didn't run any faster, it just kept me from having an asthma attack afterword.


One of my past doctors claimed that Albuterol will make anybody breath better.

Interesting that you get your Asthma only after. From my own experience, it could be post nasal drip inducing the attack. I follow a schedule of decongestants starting three or four hors before I do strenuous exercise. That reduces my post exercise mostly minor coughing/wheezing to zero.

Al

I used to have a mild case of this in the past, but since I started riding regularly a couple of years ago, I don't experience any problems at all, not even starting to ride hard with no warmup in 15°F temps.

Oh, yeah, because those with EIA are just blowing away the competition with their albuterol inhalers. It is legit, and I used to get it while running. Some albuterol before and I didn't cough or wheeze. I didn't run any faster, it just kept me from having an asthma attack afterword.

Abuse of medical exemptions is becoming a real problem in professional sports. How does one define “exercise induced” and is treating exercise related conditions in competition ethical?

Imagine a person who really has moderate exercise induced asthma and normally takes one puff of an inhaler as a prophylactic before exercise. If that person enters a race and then thinks “hey today I better take two puffs” Did they cheat? After all they used a higher dosage than normal / prescribed. What about people who have very mild symptoms that do not warrant medication; should doctors over diagnose to be fair?

The situation gets even worse when you bring in training induced alterations. If I do a very hard training block and develop mild anemia and hypotestosteronism should I get some EPO and a shot of steroids? Of course not, because it’s self inflicted, not dangerous and will resolve without treatment.

A majority of the time discomfort related to training and exercise should just be tolerated or prevented, not masked with drugs.

Did I not say everybody is different? Did I not say you have to experimment? Did I actually say i was sure about anything? I am sure I know what works for me. That said, it's worth a try to see how you do experience it. Al

No need to get upset, the reference was made to the following line.


By the way, you can exercise through an attack. It'll get real bad, but it'll ease up as you continue the exertion. Al


Did you find when you started eating better your asthma got better?

No need to get upset, the reference was made to the following line.


Did you find when you started eating better your asthma got better?

Now I'm upset? You appear not to read correctly. Each line is not an independent isolated thought, but related to the other thoughts in the post.

As far as eating better, I found little or no correlation with the actual food items except for those few that exacerbated the Asthma which I avoided anyhow. Asthma is always present at a reduced level of impairment in-between the obvious attacks. Meaning you are always impaired to a degree, at least with chronic Asthma. That's apparently the case for most Asthmatics according to an ex doctor of mine. So you seem get fast feedback when you eat stuff that doesn't agree.

The food connection seemed to be indirect and relatively minor compared with the exercise/fitness connection. However, since Asthma is often an allergic reaction, I can imagine some getting a large improvement by eliminating certain foods.

The less animal products I ate (over about three decades) the higher my energy level was, the more exercise I could tolerate, the quicker I would recover and the fitter I was. The fitter I was, the more I could be active before I had an attack.

All this was counter to the prevailing medical opinion of the time which had one living like a couch potato. That was my first break with the medical profession. The second was when I tore up a doctors prescription for high blood pressure medication, gave it back to him and cured it myself in three months by jogging. That was about 40 years ago.

The state of the medical art has not changed much in all that time except for the drugs, surgical procedures, scanners/immagers and the cost of treatments. It's the drugs that have led to improved lifestyle for Asthmatics and not the doctors.

Al

Now I'm upset? You appear not to read correctly. Each line is not an independent isolated thought, but related to the other thoughts in the post.

As far as eating better, I found little or no correlation with the actual food items except for those few that exacerbated the Asthma which I avoided anyhow. Asthma is always present at a reduced level of impairment in-between the obvious attacks. Meaning you are always impaired to a degree, at least with chronic Asthma. That's apparently the case for most Asthmatics according to an ex doctor of mine. So you seem get fast feedback when you eat stuff that doesn't agree.

The food connection seemed to be indirect and relatively minor compared with the exercise/fitness connection. However, since Asthma is often an allergic reaction, I can imagine some getting a large improvement by eliminating certain foods.

The less animal products I ate (over about three decades) the higher my energy level was, the more exercise I could tolerate, the quicker I would recover and the fitter I was. The fitter I was, the more I could be active before I had an attack.

All this was counter to the prevailing medical opinion of the time which had one living like a couch potato. That was my first break with the medical profession. The second was when I tore up a doctors prescription for high blood pressure medication, gave it back to him and cured it myself in three months by jogging. That was about 40 years ago.

The state of the medical art has not changed much in all that time except for the drugs, surgical procedures, scanners/immagers and the cost of treatments. It's the drugs that have led to improved lifestyle for Asthmatics and not the doctors.

Al

:cry: Someone needs a hug


So you have had success in treating it yourself by getting fitter because you started eating better, it is nice how that all fits together.

I read a non-fiction novel about a canoe trip from Winnipeg to the Amazon where one of the people had asthma that required frequent use of medicine for it. Part way into the trip he did not need to use his medicine anymore, and they were also eating mostly plants and other stuff they foraged for parts of the trip.

It's funny that you mention tearing up prescriptions, because it has been a long time since medicine is actually cured anything, they sure make some nifty drugs though.

About the drugs that have led to improved lifestyle for Asthmatics and not the doctors.. Aren't medical doctors involved in the making of the drugs, you know, for research and the like?

Warm ups, light calisthenics such as jumping jacks, jog in place. Exercise the joints and do some stretching to warm up the joints and ligaments. It also helps to increase blood flow to the lungs and joints and can help prevents cramps and sore joints later on.

FYI, I'm diagnosed COPD and take Serevent and Pulmicort daily. I take Albeutrol before rides and then carry it with me just in case.

First a comment on the "legal doping" comment ....... not all of us are or want to race. Some of us, and I'd venture a guess that it is actually most of us, just want to ride. And those of us who just want to ride want to ride comfortably, without passing out on the road. If that is a problem for you, then I hope you develop EIA as badly as I have it. Enjoy the feeling like you are cycling under water.

Secondly, about EIA. I was officially diagnosed with it just about exactly two years ago, but suspected I had it for years before that. I didn't think it was a huge problem until about 2.5 years ago, when it suddenly became significantly worse. With me, it isn't just a little congestion and wheezing, although it started like that, now it has developed to the point where any stress (public speaking, cycling, running) but especially stress in adverse weather conditions (coolish, damp air) can set me hyperventilating to the point where I cannot breathe ... I feel like my lungs are collapsing or are full of water, and I start to be come faint and dizzy.

I have been given two inhalers. One is a fast acting, but short-lived one for emergency conditions when I need it RIGHT NOW. The other is slower to act (I have to take it at least 30 minutes before I go out on the bicycle), but it last for up to about 12 hours. I use it on my long rides.

As for warming up, it never seemed to help me. In fact the "warmer" I got, the less I could breathe. Getting fitter hasn't seemed to have helped either. I've been getting fitter and fitter as the years go by, by my EIA has been getting worse. However, the inhalers help. I've gone from feeling the fear and panic of not being able to breathe on just about every strenuous ride to being able to do all my rides fairly comfortably. It's nice. :)

Luckily my experience with EIA was more like Al's than Machka's. I was diagnosed when I first started exercising in a cardiac rehab class. My case was mild but troublesome, with wheezing, coughing, congestion and shortness of breath. It started soon into exercise and didn't let up for an hour more afterward. Like Al's my case got better as I exercised more. I still have mild symptoms on rare occasions, but I haven't used the Albuterol for more than 5 years now.

I have been given two inhalers. One is a fast acting, but short-lived one for emergency conditions when I need it RIGHT NOW. The other is slower to act (I have to take it at least 30 minutes before I go out on the bicycle), but it last for up to about 12 hours. I use it on my long rides.

As for warming up, it never seemed to help me. In fact the "warmer" I got, the less I could breathe. Getting fitter hasn't seemed to have helped either. I've been getting fitter and fitter as the years go by, by my EIA has been getting worse. However, the inhalers help. I've gone from feeling the fear and panic of not being able to breathe on just about every strenuous ride to being able to do all my rides fairly comfortably. It's nice. :)


Do you use a peak flow meter to help alert you to changes related to your asthma? I have heard that these work very well in forming an action plan to deal with exacerbations before they become serious.

I remember that you mentioned in another thread that you have a high heart rate to start out with on longer rides. I was wondering if the asthma medication would raise the heart rate as well, because I have heard that some long acting beta 2 agonists may speed up the heart?

One of my past doctors claimed that Albuterol will make anybody breath better.



Al

Actually, I believe it's the exact opposite. That's one of the tests they use to diagnose asthma. People without it will not have any improvement with Albuterol, and only asthmatics will show improvement. Asthma medications do not make you breathe better than people without it, they just prevent asthma systems.

Do you use a peak flow meter to help alert you to changes related to your asthma? I have heard that these work very well in forming an action plan to deal with exacerbations before they become serious.

I remember that you mentioned in another thread that you have a high heart rate to start out with on longer rides. I was wondering if the asthma medication would raise the heart rate as well, because I have heard that some long acting beta 2 agonists may speed up the heart?

I haven't been using a peak flow meter ... but I can feel the changes coming on. It usually starts with me taking a breath and it feeling just a tiny bit constricted, and I know I'd better slow up and/or get my inhaler out ... or I start to rasp and cough a little bit on climbs or when I'm pushing myself.

And yes, the asthma medication does raise my heart rate. The fast/short acting one raises it quite a bit, and quickly. I can take it, and within a few minutes, even if I'm just sitting in a chair, my heart is racing. I don't use it while riding if I can help it because it feels weird. I have to weigh the pros and cons with that one. I'm sure the other one also raises my heart rate, but not as dramatically as the first one. I can use it while riding and not feel like my heart is about to leap out of my chest.

Do any of you use a spacer with your Albuterol? Without a spacer you get about 30-40% of the medicine in your lungs the rest goes to your stomach and does no good. With a spacer you get about 95% of your medicine in your lungs. The proper way of taking Albuterol for EIA is one puff 15 minutes before exercise repeated by another puff 5 minutes later. I'm going to show this thread to my wife, she has worked with the American Lung Association for 18 years in asthma education. You can also contact her free of charge: Sharon Borradori, 661-847-4700 office or 661-319-2098 cell. All her services are provided free of charge, to make this possible she does a three day bike ride fund raiser on the Central Coast of California. All proceeds go to help people with asthma and COPD. Please follow the link in my signature below.

Machka, you must not be using a spacer. One of the side effects of taking Albuterol without a spacer, as I mentioned above, is that it goes to your stomach and causes the heart race and jerkys.

Machka, you must not be using a spacer. One of the side effects of taking Albuterol without a spacer, as I mentioned above, is that it goes to your stomach and causes the heart race and jerkys.

I'm not on Albuterol. I'm on a type of Ventilin (for emergency use), and Seravent for longer use.

But no one has ever mentioned a spacer to me.

Ventilin is a brand of Albuterol. One of the biggest things my wife fights is that doctors never mention anything about a spacer. Please give my wife a call, she loves helping people with their asthma problems. You can also e-mail her at sharon@kernlung.org.

wow guys, lots of information.

i've always, or at least when i've been exercising, had problems breathing well in cold, dry air. when i started running several yrs ago, the same problem existed but the doctor gave me advair, which didn't do anything to help. i pretty much had to quite running during march/april and some of may due to pollen and the problems i had trying to breathe.

i'm still somewhat congested today from yesterdays ride. but, today, i'm gonna try riding w/something covering my mouth to help warm the air up. the first 5min of my ride is slightly downhill, but then hits some hills. i had trouble yesterday on these hills cuz i didn't feel like i could get enough air in, like sucking through a straw. so, we'll see how today goes.

i did have a lung function test several yrs ago, but i was well above normal because i hadn't exercised before hand. also have a peak flow meter, but it also shows normal values (or it did). maybe i should bring that with me sometime just to see the effects this really has on me.

i don't have a spacer with mine. how do you go about getting one? how does it help? i hope to only have to use this during the colder months, as i haven't really noticed any problems when it's warmer. maybe as i get fitter, there will be less incidents of EIA.

food allergies?? how would i go about determining whether something i'm eating is part of the problem? i eat pretty well as it is. hardly any red meat, mostly chicken or lean pork, some eggs, whole wheat bread, not much dairy (tho i should eat more), veggies (just about any kind) & fruit.

thanks for the responses. it helps to know others are having or have had the same problems and that i'm not alone. my riding partner tells me i just need to get acclimated to the cold....no, i can't freakin' breathe and acclimation has nothing to do with it. people don't really know or understand how we are feeling unless they too experience it.

Do any of you use a spacer with your Albuterol? Without a spacer you get about 30-40% of the medicine in your lungs the rest goes to your stomach and does no good. With a spacer you get about 95% of your medicine in your lungs. The proper way of taking Albuterol for EIA is one puff 15 minutes before exercise repeated by another puff 5 minutes later. .


Never have used a spacer, nor has any of my doctors over the years recommended one. I'll check it out with Google to see if I'm interested.

Never have had an increase in pulse rate (as mentioned in another post). My resting is typically around 58 and no impact on blood pressure (typically 110-120/70 to 75). The only difficulty is telling when the container is empty enough to discard.

I only need Albuterol a few times a month now that I'm Serevent and the Claritin generic. Again, Serevent is the same type of medication as Albuterol, it's just time release. That, surprisingly makes a huge difference.

My theory on why is that it's working on the breathing impairment that continually affects the victim, but is not apparent like an attack. Therefore, when you start exercising, your breathing efficiency is starting out at a much higher level.

Since your continually being medicated with Serevent, your breathing is more normal and you are far less prone to stessing your cardio-vascular/oxygen system and inducing an attack. At least that"s what I think is going on.

I really have to be having a bad day to notice my Asthma when exercising with Serevent. And, that doesn't happen often. Riding single track, I maintain my herat rate around 130 (120 to 140+ typically, once in a great while near 170 which is my measured max) for severall hours and the breathing is fine.

Al

wow guys, lots of information.

i've always, or at least when i've been exercising, had problems breathing well in cold, dry air. when i started running several yrs ago, the same problem existed but the doctor gave me advair, which didn't do anything to help. i pretty much had to quite running during march/april and some of may due to pollen and the problems i had trying to breathe.

i'm still somewhat congested today from yesterdays ride. but, today, i'm gonna try riding w/something covering my mouth to help warm the air up. the first 5min of my ride is slightly downhill, but then hits some hills. i had trouble yesterday on these hills cuz i didn't feel like i could get enough air in, like sucking through a straw. so, we'll see how today goes.

i did have a lung function test several yrs ago, but i was well above normal because i hadn't exercised before hand. also have a peak flow meter, but it also shows normal values (or it did). maybe i should bring that with me sometime just to see the effects this really has on me.

i don't have a spacer with mine. how do you go about getting one? how does it help? i hope to only have to use this during the colder months, as i haven't really noticed any problems when it's warmer. maybe as i get fitter, there will be less incidents of EIA.

food allergies?? how would i go about determining whether something i'm eating is part of the problem? i eat pretty well as it is. hardly any red meat, mostly chicken or lean pork, some eggs, whole wheat bread, not much dairy (tho i should eat more), veggies (just about any kind) & fruit.

thanks for the responses. it helps to know others are having or have had the same problems and that i'm not alone. my riding partner tells me i just need to get acclimated to the cold....no, i can't freakin' breathe and acclimation has nothing to do with it. people don't really know or understand how we are feeling unless they too experience it.


You can probably get a spacer from your pharmacy. It is odd that the doctor did not tell you how to use a spacer, and your medication properly.

Here (http://www.on.lung.ca/yourlungs/asthma_inhalers.html) is a good websight that has a lot of good info on how to use asthma medication. If you are using an inhaled corticosteroid, make sure to rinse out your mouth later to avoid thrush infections, and dysphonia (voice changes)

Actually, I believe it's the exact opposite. That's one of the tests they use to diagnose asthma. People without it will not have any improvement with Albuterol, and only asthmatics will show improvement. Asthma medications do not make you breathe better than people without it, they just prevent asthma systems.


That's good to know, especially for the athletes who are competing with the Albuterol users.

One check for Asthma used on me by a new doctor years back was to get me to try to blow out a lighted match with my mouth wide open, lips wide apart. Well, I couldn't do it. He explained that normal folks can blow it out that way. That's when it hit me that I was continually impaired. Just never thought about it before

Even with Serevent I'm still slightly impaired. If I breath out hard as I can, I can hear/feel the wheezing.

Al

Here (http://www.on.lung.ca/yourlungs/asthma_inhalers.html) is a good websight that has a lot of good info on how to use asthma medication. If you are using an inhaled corticosteroid, make sure to rinse out your mouth later to avoid thrush infections, and dysphonia (voice changes)

Reading the article, I gather that the spacer seems to be for those who have problems. I don't have problems, so I'll not use one.

Over the years I've been off and on with the corticosteroid thing. Corticosteroids have had zero noticeable effects on me and I quit after about 5 years under my doctor's protest. Stayed off of them for about 5 until a new doctor (the previous one died) brow beat me into getting on them again under the old argument that it prevents long term lung damage. Well, that doctor leaves town, so I quit again after about three years.

My rationale was that since Serevent maintains such good control, I'm at zero risk of further lung damage. I do have some damage (so they tell me) from the many years where there was no effective medications, but since I can physically outperform many much younger cyclist and about every canoe paddler I've ever paddled with, it can't be much.

Well, I read this article that verifies my rationale. Six months ago, my replacement doctor (of about three years) brings up corticosteroids again.

He says he knows my position, but has to bring it up again because a new study has shown that those taking corticosteroids have a lower chance of death due to Beta Agonists (Albuterol, Serevent, etc). Now that's attention getting.

My decision was/is to still forgo the corticosteroids. I've got decade's of experience with these Beta Agonist medications and my fitness level probably provides an order of magnitude less chance of succumbing than the normal couch-potato Asthmatic who is just hanging-on (relatively speaking) to begin with.

Al

Reading the article, I gather that the spacer seems to be for those who have problems. I don't have problems, so I'll not use one.

Over the years I've been off and on with the corticosteroid thing. Corticosteroids have had zero noticeable effects on me and I quit after about 5 years under my doctor's protest. Stayed off of them for about 5 until a new doctor (the previous one died) brow beat me into getting on them again under the old argument that it prevents long term lung damage. Well, that doctor leaves town, so I quit again after about three years.

My rationale was that since Serevent maintains such good control, I'm at zero risk of further lung damage. I do have some damage from the many years where there was no effective medications, but since I can physically outperform many much younger cyclist and about every canoe paddler I've ever paddled with, it can't be much.

Well, I read this article that verifies my rationale. Six months ago, my replacement doctor (of about three years) brings up corticosteroids again.

He says he knows my position, but has to bring it up again because a new study has shown that those taking corticosteroids have a lower chance of death due to Beta Agonists (Albuterol, Serevent, etc). Now that's attention getting.

My decision was/is to still forgo the corticosteroids. I've got decade's of experience with these Beta Agonist medications and my fitness level probably provides an order of magnitude less chance of succumbing than the normal couch-potato Asthmatic who is just hanging-on (relatively speaking) to begin with.

Al



What you say proves that you know yourself better than a Dr.

The respiratory therapist who showed us how to teach asthmatics how to take their puffers said, the spacer delivers more medication to the lungs, and the spacer will indicate if you inhale too hard because it makes a honking noise when you do. Without the spacer The RT said that a greater portion would hit the back of your throat, and not make it to your lungs.

What you say proves that you know yourself better than a Dr.

The respiratory therapist who showed us how to teach asthmatics how to take their puffers said, the spacer delivers more medication to the lungs, and the spacer will indicate if you inhale too hard because it makes a honking noise when you do. Without the spacer The RT said that a greater portion would hit the back of your throat, and not make it to your lungs.


Now that's hard to argue against. The Serevent disc might be superior as it deosn't squirt the medication out under pressure like Albuterol. It used to be, but they switched to the disc some years back.

Al

so, it's possible that i'm not getting all the medication to my lungs. i thought i read somewhere that you could just hold the inhaler 2-3cm away from your mouth when you use it and that this would be somewhat more effective in delivering the meds to your lungs.

any of you guys have experience doing it this way as opposed to actually having the inhaler in your mouth?

Karen.

Now that's hard to argue against. The Serevent disc might be superior as it deosn't squirt the medication out under pressure like Albuterol. It used to be, but they switched to the disc some years back.

Al

I have been told that there are no spacers that can be used with the disk inhalers, but suposedly the disks don't have the problems associated with the other puffers that require a spacer.

so, it's possible that i'm not getting all the medication to my lungs. i thought i read somewhere that you could just hold the inhaler 2-3cm away from your mouth when you use it and that this would be somewhat more effective in delivering the meds to your lungs.

any of you guys have experience doing it this way as opposed to actually having the inhaler in your mouth?

Karen.


Holding the puffer in you mouth is said to shoot most of the medication against the back of your throat, whereas holding a few cm away is better, but it requires precise timing. This is where the spacer comes in, you do not have to co-ordinate the spraying and inhaling, you can spray the medicine into the spacer then inhale it, and if you are in acute distress you can take a few short inhales if you can't get it all in one.

Occasionally I had issues spraying my tongue with the inhaler. It does take some coordination.

One of my past doctors claimed that Albuterol will make anybody breath better.

Interesting that you get your Asthma only after. From my own experience, it could be post nasal drip inducing the attack. I follow a schedule of decongestants starting three or four hors before I do strenuous exercise. That reduces my post exercise mostly minor coughing/wheezing to zero.

Al


I am sure albuterol would make anyone breathe better. But is it enough to make a significant difference in healthy individuals, I doubt it. It isn't so uncommon for EIA to occur after the event. In fact it is the coughing that occurs afterward. Only occasionally would I get an attack during a hard effort. My brother had the same thing. He never had an attack, but would have horrible fits of coughing for hours after riding. Albuterol 30 minutes before prevented the coughing.

No post nasal drip and decongestants do nothing for me unless I actually have a cold. I don't really have any sinus problems or allergies. I could be coated in pollen and would feel perfectly fine.

I must say as pretty much a life long asthmatic, I am always amaxed to hear what some doctors are teling people about how to treat themselves. If you truly have asthma, you should be taking a preventative medication like Advair to help strengthen your airways. Further, if it is allergy induced, you should be using an allergy medicine like Flonase, or Claritin. Both of these treatments can help to reduce the amount of attacks you get as well as the severity. I have both allergy induced and exercise induced asthma and it's not fun. The good news is that aerobic activity will help to strengthen the lungs. When I was highly active and competing in various sports, I used to use my Albuterol before the activity and it did help. Find a good Pulmonary Specialist to prescribe a proper treatment for you.

Abuse of medical exemptions is becoming a real problem in professional sports. How does one define “exercise induced” and is treating exercise related conditions in competition ethical?

Imagine a person who really has moderate exercise induced asthma and normally takes one puff of an inhaler as a prophylactic before exercise. If that person enters a race and then thinks “hey today I better take two puffs” Did they cheat? After all they used a higher dosage than normal / prescribed. What about people who have very mild symptoms that do not warrant medication; should doctors over diagnose to be fair?

The situation gets even worse when you bring in training induced alterations. If I do a very hard training block and develop mild anemia and hypotestosteronism should I get some EPO and a shot of steroids? Of course not, because it’s self inflicted, not dangerous and will resolve without treatment.

A majority of the time discomfort related to training and exercise should just be tolerated or prevented, not masked with drugs.

SPOKEN LIKE SOMEONE WHO DOES NOT KNOW WHAT IT FEELS LIKE TO SUFFOCATE

My wife has chronic asthma. She once spent 3 days in the hospital after a bad attack. The new meds have made all the difference for her. I have EIA. The opinion of our physicians is that an asthmatic should never (or almost never) have to use their Albuterol (rescue) sprayer. We concur with that belief. If you're using Albuterol, that means that you are having a breathing impairment. Every time you have a breathing impairment, your lung function is also impaired, even if very slightly. Enough of that and you get COPD.

Asthma is one of those popular diseases that everyone, including the wealthy get, so Big Pharma has been putting lots of money into drugs for it. If you're a sufferer, a pulmonologist will be your best resource for treatment. Research is moving pretty fast for the average doc to keep up with it.

My wife uses Advair, which is the cat's meow for chronic asthmas sufferers. Those of you who live in These Benighted States better have a good prescription health benefit or a good income if you want to try it. I use Flovent, which contains only the corticosteroid component of Advair, once every day. That pretty well controls it for me. Before rides that I know will be hard multi-hour rides with HRs at and above LT, I'll also take Serevent, which contains the second component of Advair. I almost never have to use my Albuterol, though I carry it with me.

What I say above about Albuterol is only for chronic sufferers: those who will suffer asthma again and again. If your doctor prescribes Albuterol to help your lung function in the lingering stages of a cold, flu, or lung infection, that's totally appropriate. Like the posters above say, you'll have to see when it works best for you.

For more information about Flovent and Advair, see:
http://www.gw-flovent.com/
For Serevent, see:
http://www.serevent.com/

I use my peak flow meter every morning at the same time in my schedule. I chart the results in my training software. This allows me to spot potential asthma problems before they effect my riding. My EIA changes with the seasons and what's pollinating. The flow meter is a big help.

The spacer is a good idea. My wife keeps hers by the bed, just in case she has a problem in the night, but neither of us carry the spacer with us. It's just too much of a hassle. It does work, however.

wow guys, lots of information.

thanks for the responses. it helps to know others are having or have had the same problems and that i'm not alone. my riding partner tells me i just need to get acclimated to the cold....no, i can't freakin' breathe and acclimation has nothing to do with it. people don't really know or understand how we are feeling unless they too experience it.

Wolfpack, I’ve got a great demo for your friends that don’t what it is like to have an asthma attack. Get some of those little red cocktail straws, have your friends put one of them in their mouth, have them pinch their nose shut and breath thought it (just the straw). Some of them will have trouble, now have them run in place. I think somewhere around 0% of them can handle this, they will be dropping like flies. It will be amazing how quick they can get the straw out of their mouth.

If you are using your rescue inhaler more than twice a week your asthma is out of control. It seems be the responses here that a lot of you have rescue medicine but don’t take any controller medicine. Albuterol/Ventolin is a quick relief medicine. It is designed to be used as needed. The use of Albuterol more than two times a week indicates that your asthma is out of control. Proper asthma management requires the use of a controller medicine everyday, even if you feel well, and the use of Albuterol as needed only. The use of a controller medicine will greatly reduce or eliminate bronchospasms, therefore limiting the need for Albuterol. You need to take a controller medicine to stop the inflammation. The use of meter dose inhalers (MDI) without a spacer will get a very limited amount of the medicine to the lungs where it is needed. When the medicine is released from the MDI it comes out at approximately 55mph. Now try sticking your head the window of your car and catch a bug with your mouth at 55mph, it’s almost impossible. With the use of a spacer or holding camber the medicine is suspended in the camber and your breath it in to the lungs where it is needed. By taking one puff of your inhaler 15 minutes before exercise this allows the medicine to start opening the bronchotubes, the next puff 5 minutes later will go deeper into the lungs and open them wider. This technique is much more effective then just taking two puffs at one time.

Please check with your doctor before starting or stopping any asthma treatment. Also, check with your local ALA for information on adult asthma classes and information. I forwarded your problems to my wife, Sharon, who has worked with the ALA doing asthma management for 18 years. If you would like more information about asthma management and/or consulting please call her: Sharon Borradori, 661-847-4700 office and 661-319-2098 cell. All the information and classes from her are free, also check with her about a spacer. To help fund this free information and classes she puts on a three day fund raiser bike ride on the Central California Coast, please follow the link in my signature below. All the funds are used to help people with asthma and COPD.

my personal wonder-drug for chronic asthma was advair, which had an amazing night/day effect on me. Considering I had been taking serevent and flovent together before I switched (they are the 2 components of advair), I have to assume the delivery system was the difference, advair where you just suck powder out of a cracked capsule vs the other 2 where the aerosolized powder is blasted down your throat w/ a propellant. I speculated that the propellant systems would just blast the medicine off the back of my throat and it would bounce wherever, rather than get sucked straight down into my lungs. That could be an argument for a spacer, but a spacer never did anything for me either (I liked the fancy one w/ the harmonica built in to tell you if you're inhaling too fast, but the difference between serevent/flovent + spacer and advair tells me the spacer alone didn't compensate for whatever other differences there are between those products).

I don't understand the rationale for taking albuterol/salmeterol (serevent) w/ no accompanying steroid (flovent). I guess I can see albuterol by itself if you just periodically need 'rescuing', but salmeterol/serevent implies an amount of forethought and awareness of a deeper-underlying condiiton that I just don't get why it wouldn't also be addressed w/ a steroid.

well, i have been feeling slightly congested today. not sure whether it's lingering effects from yesterday's ride or if i'm possibly coming down with a chest cold. otherwise, i feel fine. with the congestion and feeling a little constricted today, i took 1 puff about 40 min before riding and 1 more 5 minutes later. both of these, i held the inhaler away from my mouth. i could definitely tell that i had taken it this time. i felt a little jittery afterwards, towards ride time.

this ride, i brought something to wear over my mouth, but i just wanted to try and not use that. so, i breathed through my nose only for the first 10-18 minutes and i could definitely tell a difference on the ride today. on the same route, the hills weren't nearly as bad, i could breathe going up them, no wheezing or feeling of constriction. i'm still slow up hills, but at least this time i could breathe. whoo-hoo! maybe this will help me....

so, danteB - my doctor told me to use this whenever i exercise in cold, dry air, which could be several days per week. your last post seems to indicate that i should be using something else besides the albuterol every day?? since i seem to have EIA, and i don't feel bad on days where i don't exercise (not too often), is it beneficial to use something similar to Advair everyday and the Albuterol just before exercising?? if you only have EIA, do you or should a person be using a controlling medication everyday?

thanks, karen.

so, danteB - my doctor told me to use this whenever i exercise in cold, dry air, which could be several days per week. your last post seems to indicate that i should be using something else besides the albuterol every day?? since i seem to have EIA, and i don't feel bad on days where i don't exercise (not too often), is it beneficial to use something similar to Advair everyday and the Albuterol just before exercising?? if you only have EIA, do you or should a person be using a controlling medication everyday?I'm not danteB, but I posted just above him. Yes, it's so frustrating! Either doctors simply aren't aware of current medication practices, or they are actively trying to keep the costs down for their HMO. I was a member of Group Death in the PNW for a long time and definitely saw the latter happening. As danteB said, if you are using your Albuterol more than twice a week you have a problem. See my post for possible solutions AND call as indicated by danteB. And, you might consider changing doctors. . .

well, don't want to change dr's, as other than this, he's pretty good. he told me to not worry about the "if you use it more than 2x week" thing since i was exercising. i don't really seem to have any problem 'cept with the cold/dry air and pollen. i can go to the gym and run on the treadmill with no problems what-so-ever, so i'm not convinced i have anything other than just EIA caused from the outside environment. i can see where i would use it, prolly, at least 4-5x week from now till sometime in May, when the pollen in this area goes away. is there really anything wrong with that??

prolly, from May-October, i won't have any trouble with breathing - i didn't last year. but, i suppose if i do start to have problems during this time, that i might need to look into other medications. i guess i'll just go with this for right now...

Wolfpack, try the albuterol again and see if it provides any relief. It didn't work for my exercise induced asthma. Neither did advair, singulair, or any of the nasal sprays or other normal allergy meds used in conjuction with the albuterol, but some combination of them may work for you---see your Dr.

For me, it took months before I found something that worked, so don't give up. My Dr. finally prescribed Spiriva, which is for emphasyema, but in my case, is the only thing that worked and let me ride completely free from any asthma symptoms.

HDWound - it seemed to work today. With that and the nose breathing, I didn't have any problems in the area where I was wheezing before. Granted, hills are still hard for me, but I could breathe up them this time. Yesterday, I couldn't (don't think I used the Albuterol correctly or much didn't reach my lungs). I had Advair before, just didn't see ANY results with that. It was just like a placebo for me....

Hopefully, I should know whether this works in a coupla weeks I suppose....

Karen.

Did you see a regular doctor/internist or a pulmonary specialist? My wifes family all have asthma and until recently never saw a specialist. They were getting bad advise and puffing on albuterol all day long. I am 58 and got an onset of exercised induced asthma about 10 years ago. I was getting extremely out of breath all of a sudden when exercising. According to the specialist I saw he said it is not that unusual to get EIA in midlife. As mentioned earlier in this thread, using a rescue inhaler more than a few times a week is dangerous, not good for you. He put me on Pulmicort, one puff per day which was the minimum dose. After a couple of weeks the symptoms went away when exercising. When I asked him, "isn't taking a steroid inhaler every day worse than Albuterol a few times a week" and he said definitely not. Because of changes in medical plans I had to change specialists and the 2nd kept me on the same medicine and said the same thing about Albuterol. It is necessary to have but try not to use it.Gradually over the last 10 years I am up to 3 puffs per day which is working. I have only had one "attack" in the past 3 or 4 years. We had a tough hilly ride last fall and mid way up a steep hill I had trouble breathing. I had trouble catching my breath. It took me 20 minutes to stop huffing and puffing. I had to hold up the whole group. Since I hadn't had an attack in years I didn't have the Albuterol with me. Now I bring it with me on rides for so far haven't needed to use it.

A quick note on the food allergy bit-
Dairy is a major allergen for many people. It's also a mucus producing food, so even if you're not allergic, it can make breathing more difficult. I noticed a huge improvement in myself when I elliminated dairy. Unfortunately, I love all dairy products, so it's hard for me to stay off it. Usually I'll eliminate it when my asthma's getting worse, I'll get better, and then I'll start eating it again, which makes my asthma comes back. Arrgh!

Another thing to think about elliminating is cold beverages. An ice cold drink, especially in winter, can "shock" your lungs and make breathing difficult. I always have my water at room tempurature, and try to stick with hot beverages in the winter.

I'm not danteB, but I posted just above him. Yes, it's so frustrating! Either doctors simply aren't aware of current medication practices, or they are actively trying to keep the costs down for their HMO. I was a member of Group Death in the PNW for a long time and definitely saw the latter happening. As danteB said, if you are using your Albuterol more than twice a week you have a problem. See my post for possible solutions AND call as indicated by danteB. And, you might consider changing doctors. . .

Carbonfiberboy, you’re right most doctors about the docs. Most of them get their info from the drug representatives, I’m going to step on some toes. They tell them this is the latest and greatest drug to help asthma. Somewhere along the line the proper delivery never get included with the drug. The docs rely on the pharmacists to tell you how to take the drug. A spacer needs to be prescribed by the doc when he fills out the prescription. Most of them don’t do it, not because they don’t think you need it, because they don’t know the proper method of delivery (the drug reps never told them or they weren’t listening). My wife puts on continuing education for docs, it’s very hard to get them there. Some of them show and sleep through the class.

I’m not saying you need to change docs, as mentioned above in another post, but some of the people need to find a good pulmonologist who has a good understanding of asthma. Please check with your doctor before starting or stopping any asthma treatment. Also, check with your local American Lung Association (ALA) for information on adult asthma classes and information. I forwarded your problems to my wife, Sharon, who has worked with the ALA doing asthma management for 18 years. If you would like more information about asthma management and/or consulting please call her: Sharon Borradori, 661-847-4700 office and 661-319-2098 cell. If all of you call my wife she is going to be busy, it sounds like there are a lot of riders with asthma who want to fell better. All the information and classes from her are free, also check with her about a spacer. To help fund this free information and classes she puts on a three day fund raiser bike ride on the Central California Coast, please follow the link in my signature below. All the funds are used to help people with asthma and COPD.