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-   -   Exercise Induced Asthma (EIA) (http://www.bikeforums.net/general-cycling-discussion/930621-exercise-induced-asthma-eia.html)

HIPCHIP 01-20-14 09:50 AM

Exercise Induced Asthma (EIA)
 
I was born and raised in So Cal, so anything under 70 degrees we were searching for a jacket. Even with all the smog, I never had any breathing problems. Moved to Northern California to do my Grad work. The area was cold and moist most of the year, so I ended up getting bronchitis, which cleared up. Later I moved to Sacramento area where the allergens overwhelmed my system, so even though I don't have allergies, I still got a stuffy nose. I don't know if this has any impact on the following, but just throwing out the info.

Some time ago I was riding and turned into the wind, which was cold. Felt a sharp pain in the middle of my chest and was afraid I was having a heart attack, but when I turned my head so I wasn't getting the cold air forced down my throat the pain went away. Saw a doctor and he said it was Exercise Induced Asthma (EIA). It's not much of a problem when it's warm, but now that the air temp is in the 30's and 40's, especially when it's breezy, my chest, throat, neck, shoulders, and arms hurt, and I'm completely winded, even when it's only a good cross-wind. I wear a balaclava and even put a folded up bandana over my mouth so that I have 5 layers I'm breathing through. I wear a thermal jersey, regular jersey, jacket, and wind vest, but when the cold air comes through it's like I just sprinted 100 yards and I'm all winded. I take a pill for asthma and have a rescue inhaler, but on bad days nothing works.

Just wondering if there's anybody else out there who suffers through this who has any info I should look into? I went from being a front to mid-pack rider to being the Tail End Charley, so while I'm still able to ride, I feel bad about making the group wait for me again (they don't mind, but I do.).

Thanks in advance for any help.

RPK79 01-20-14 09:55 AM

I have issues riding in temps near or below 50 degrees. If I do ride in those temps (which is rare) I make sure to warm up slowly and that seems to help. Otherwise I just resign myself to the trainer during the colder months.

HIPCHIP 01-20-14 08:32 PM

Quote:

Originally Posted by RPK79 (Post 16425715)
I have issues riding in temps near or below 50 degrees. If I do ride in those temps (which is rare) I make sure to warm up slowly and that seems to help. Otherwise I just resign myself to the trainer during the colder months.

A cold winter day here is probably spring weather where you are! (LOL). Did a 54 miler today (longest ride ever at this point) and was at the back again, but at least I was able to complete it. Just hoping there's something I don't know that I can try. So far it a drag. I'll keep bugging my Doc and see if they have any other ideas.
Thanks for the info.

Dahon.Steve 01-20-14 09:04 PM

I have exercise induced asthma and there is no cure. I don't have all the pain you have which is stange to me. When the condition appears, it feels like I'm breathing through a straw but no pain in my neck, shoulder and arms. It sounds like the lack of oxygen is giving you into a mini heart attack! I would be careful in your condition. Here's what I do.

In the first 2 miles, you have to stop and take a 10 minute break until the condition subsides. After that, you can travel about 3-4 miles before making another 10 minute break. After that, you can travel about 3-5 miles before taking a break and so on.

RPK79 01-21-14 08:13 AM

Quote:

Originally Posted by HIPCHIP (Post 16427522)
A cold winter day here is probably spring weather where you are! (LOL). Did a 54 miler today (longest ride ever at this point) and was at the back again, but at least I was able to complete it. Just hoping there's something I don't know that I can try. So far it a drag. I'll keep bugging my Doc and see if they have any other ideas.
Thanks for the info.

If winters were like spring here I would just spend the winter doing Long Steady Distance with some intervals on the trainer a few times a week.

HIPCHIP 01-21-14 09:14 AM

Quote:

Originally Posted by Dahon.Steve (Post 16427608)
I have exercise induced asthma and there is no cure. I don't have all the pain you have which is stange to me. When the condition appears, it feels like I'm breathing through a straw but no pain in my neck, shoulder and arms. It sounds like the lack of oxygen is giving you into a mini heart attack! I would be careful in your condition. Here's what I do.

In the first 2 miles, you have to stop and take a 10 minute break until the condition subsides. After that, you can travel about 3-4 miles before making another 10 minute break. After that, you can travel about 3-5 miles before taking a break and so on.

My doctor says it's like an "Ice Cream Headache" where the cold is just overwhelming my nerves so they don't know what to do, so they hurt. The pain causes the muscles to tighten up, or cramp, which then works it's way up from the lungs into my neck and shoulders, so no heart attack, just a bad cramp. I do stop when it starts bugging me, but as soon as I start back up it flares up again. Once I get in better shape I hope that it will subside some more.

demoncyclist 01-21-14 10:53 AM

Anything you can do to increase your aerobic capacity is a good start. Also, try to breathe through your nose as much as possible. Mouth breathing is colder and drier. You can also wear something to keep the warm air in- a buff or bandana over your nose and mouth can be helpful. Are you on any meds? My asthma isn't exercise induced, and if you have only seen a GP about this, he may be incorrect in his assessment. Go see a good Pulmonologist and be tested to get the full picture about how good or bad your breathing is and get any meds you need to keep the inflammation in your lungs under control. I take Singulair and Claritin daily as controllers and always have an Albuterol inhaler within arm's reach.

HIPCHIP 01-21-14 12:40 PM

Quote:

Originally Posted by demoncyclist (Post 16428700)
Anything you can do to increase your aerobic capacity is a good start. Also, try to breathe through your nose as much as possible. Mouth breathing is colder and drier. You can also wear something to keep the warm air in- a buff or bandana over your nose and mouth can be helpful. Are you on any meds? My asthma isn't exercise induced, and if you have only seen a GP about this, he may be incorrect in his assessment. Go see a good Pulmonologist and be tested to get the full picture about how good or bad your breathing is and get any meds you need to keep the inflammation in your lungs under control. I take Singulair and Claritin daily as controllers and always have an Albuterol inhaler within arm's reach.

I am seeing my Doc this next week, so will ask about seeing a pulmonologist/respiratory therapist, etc. I am using a balaclava with a bandana inside it so I have 5 layers of cloth and my nose and mouth are covered. It helps, but when the wind kicks up it still bothers me. I was taking Singulair but my insurance won't pay for it, so they put me on another med that is in the same class. I don't know if there is something else. I have a couple of inhalers too, but again, when the wind is blowing not much seems to help. :(

Little Darwin 01-21-14 12:46 PM

It is my understandoing that some asthma is also strictly cold induced, regardless of exertion based on what I was told concerning my son years ago.

And just to add a different twist to demoncyclist's advice concerning a pulmonologist... If you have any additional symptoms, you may want to see an allergist. :)

I developed Cold Urticaria, which is an allergy to cold. http://www.coldurticaria.info/ There are other symptoms along with breathing... I first discovered mine in August when I was holding a can of Pepsi for several minutes and my hand started itching severely. When I looked online to see possible causes (since it had never happened to me before) I realized that I had experienced a couple of other symptoms, but had ignored them.

I use Singulair daily, Zyrtec twice a day, and keep Albuterol and an EpiPen close by just in case... especially when it is cold. So far I haven't needed the emergency measures even though I regularly go for walks, regardless of temp, a couple of times a week. The allergist insists that I don't go on the walks alone, but that works for me since I am always with at least one other person.

CharlyAlfaRomeo 01-21-14 01:19 PM

Hi HIPCHIP.

Do you have any food allergies? I have a hyper-sensitivity (my skin gets itchy and rashy) type of allergy to a few different food items. I mostly ignored it and ate what I wanted until it got more severe and the itching was too bothersome.

When I stopped eating those foods my EIA all but disappeared. I don't need my inhaler before playing hockey or running and biking. I'm in Canada so the temps are likely a fair bit colder than what you're dealing with!

If that has no bearing on your situation I'd suggest using your inhaler 20-30 minutes before riding. Prior to my asthma improving that's what I did and I could run, bike or skate at -20 C with no problem. Using the inhaler after the asthma started helped but didn't make it go away if I continued to exercise. I also sometimes got symptoms like yours with the tightness, especially between my shoulder blades. Two puffs before exercise did the trick every time.

HIPCHIP 01-21-14 01:31 PM

I have been tested multiple times by different Allergists and they all came away saying I had no allergies, but Sacramento, Ca. is known for being terrible for allergies and even if you don't have allergies the allergens can overwhelm the system and you'll have allergy symptoms. I live right next to farm and open land, so lots of dust and pollens here.

I also have some type of a cold allergy. If I go in the ocean and the water is cool, I'll get a rash, like a heat rash, only it's from the cold. Bumps and all itchy, etc. I don't know if that has anything to do with the EIA, but I never had any asthma when I lived in a warmer climate. Of course I was younger, healthier, and thinner too. The EIA is definitely only being caused by the cold air. I'm trying to exercise and get my aerobic activity level up, but when you have a hard time breathing it's kind of hard. For now I just plug along and do the miles, and drop some weight, but it sure would be nice not to be in pain just when I'm trying to do a hill with a cold headwind! I did 54 miles yesterday, with some hill work and a headwind. I was dead last the whole ride but once it warmed up I felt OK, but by then I was pretty tired from huffing and puffing. I just hope the EIA goes away as I get in better condition.

CharlyAlfaRomeo 01-21-14 02:58 PM

Mine only bothered me in the cold too, thankfully not any more.

Have you tried using your inhaler prior to riding?

demoncyclist 01-21-14 03:20 PM

If you are taking Montelukast, it is the generic form of Singulair. Hopefully, your GP and a good respiratory/pulmonary specialist can get this sorted. I generally use the albuterol (ProAir HFA) before a ride, and periodically during. It seems to keep the inflammation at bay.

Little Darwin 01-21-14 03:36 PM

Quote:

Originally Posted by HIPCHIP (Post 16429146)
I also have some type of a cold allergy. If I go in the ocean and the water is cool, I'll get a rash, like a heat rash, only it's from the cold. Bumps and all itchy, etc. I don't know if that has anything to do with the EIA, but I never had any asthma when I lived in a warmer climate.

This sounds like it could definitely be cold urtiicaria... I would definitely see an allergist, and if you are in a normally warm environment, you may have to help educate him/her, since it is not very common (check online at various sites for info). Check out the link from my earlier post as one source. If you have a severe enough situation/reaction, it can lead to anaphylaxis... that is why my allergist has me carry an epipen.

FYI - In short, cold urticaria has no known cause, no known cure, but the symptoms can be treated (as with any allergy). At 30 degrees when I wasn't on anti-histamines I got hives (bumps and itching) shoveling snow in my driveway for 45 minutes... at 5 degrees, I did justr fine snowshoeing for over an hour with anti-histamines. I need to be careful, and monitor myself for symptoms, and be sure that I am not alone in cold situations. You should probably take precautions as well.

My allergist has me taking Zyrtec (actually the generic equivalent), as his experience is that it is most effective for most people for this particular condition. It is over the counter, but he has me taking it more than indicated on the label, and may reduce me to once a day when I see him for a follow-up appointment. You may want to try it in the standard dosage (once a day) to see if it does the job for you.

HIPCHIP 01-21-14 04:19 PM

I have Zyrtec now as I think the allergist recommended that. I'll try taking one before my ride to see if it helps. I use the inhaler twice before rides. My GP said to take it, then again in about 20 min. so I do that before I head out the door. I haven't taken the inhaler on the ride as it doesn't seem to do anything as I have ridden out the door and immediately gotten a pain in my chest from the wind (just after the 2nd inhale), but as soon as I get to the LBS to start the ride, and I am stopped, it goes away. It even stops if I am drafting and getting enough of a wind break, but as soon as I'm back in the wind, even a good cross wind, back comes the feeling of being out of breath. It's only if I keep pushing with the out of breath feeling that it goes into the spasm and into my chest/neck/shoulders/arms. When that happens I turn my head sideways so I'm not getting the direct wind and that helps a lot, but not exactly a safe way to ride.

Hopefully my GP will send me to the asthma guys and maybe they'll refer me to the allergist and I'll get this all figured out. Of course knowing Murphy's Law, it will happen just when the weather warms up so we won't know if it was the meds or the change in weather! D'OH!

Just looked up the Cold urticarial. It sounds like what may be happening with me occasionally. Only problem is, I constantly ice my legs and arms after workouts with no problems, so it's intermittent with me. That just me, nothing works normal on me. I even herniated several discs in my back, and they herniated on the opposite side so my symptoms were backwards. Nobody could figure it out for months. Fortunately, I can ride a road bike because they went the opposite direction, but I can't MTB...go figure! (LOL)

wrigleycub 01-23-14 09:31 PM

HIPCHIP- this may sound a bit strange, try reading a book called the art and science of living low carb. These doctors and scientist explain the science they have found concerning allergies to gluten and carbohydrate that typically get misdiagnosed as "athletic induced asthma". These allergies do not test positive on allergies screens and they persistently get worse with age. You may find something useful! Maybe not!

HIPCHIP 01-24-14 12:25 AM

Quote:

Originally Posted by wrigleycub (Post 16436293)
HIPCHIP- this may sound a bit strange, try reading a book called the art and science of living low carb. These doctors and scientist explain the science they have found concerning allergies to gluten and carbohydrate that typically get misdiagnosed as "athletic induced asthma". These allergies do not test positive on allergies screens and they persistently get worse with age. You may find something useful! Maybe not!

I'll check it out. I'm pretty low carb now as I'm dieting, and I was checked for gluten and it was all negative. I have a Masters' in Kinesiology so this is kind of up my alley, but there's always something new to learn. With as weird as my body is, nothing would surprise me.

smahler 02-06-14 02:51 PM

My girlfriend has EIA and just makes sure she takes her inhaler when we go out for long rides. She doesn't do cold weather but can cycle for 2 + hours in 90 degree heat/humidity.

HIPCHIP 02-06-14 06:03 PM

Quote:

Originally Posted by smahler (Post 16473579)
My girlfriend has EIA and just makes sure she takes her inhaler when we go out for long rides. She doesn't do cold weather but can cycle for 2 + hours in 90 degree heat/humidity.

Thanks for the info. Warm weather is actually good for me, even when it's hot, as I don't have the EIA problem. So far wearing the face covering and taking Zyrtec seems to be helping. GO FIGURE! As long as it works. Did 4+ hours yesterday in the COLD with no problem, only had a problem at the very end when the wind kicked up, but not too bad. Can't wait for March/April.

eja_ bottecchia 02-06-14 06:29 PM

Quote:

Originally Posted by Dahon.Steve (Post 16427608)
I have exercise induced asthma and there is no cure. I don't have all the pain you have which is stange to me. When the condition appears, it feels like I'm breathing through a straw but no pain in my neck, shoulder and arms. It sounds like the lack of oxygen is giving you into a mini heart attack! I would be careful in your condition. Here's what I do.

In the first 2 miles, you have to stop and take a 10 minute break until the condition subsides. After that, you can travel about 3-4 miles before making another 10 minute break. After that, you can travel about 3-5 miles before taking a break and so on.

I have been an asthmatic all my life. I am also a regular rider and, for about 97% of the times, asthma does not affect my riding.

As Steve pointed out, your other symptoms (the pain that you are experiencing) do not seem to be asthma related. Cold temperatures cause your arteries (including your coronary arteries) to constrict and reduce blood flow to the heart. The asthma makes the condition worse because you are now also dealing with restricted air flow into the lungs.

You have not mentioned your age, height, weight and level of fitness. Those are factors to take into consideration when evaluating your symptoms.

If you can afford it, please go and see another doctor, preferably one with experience dealing with exercise induced asthma. You may want to ask him for a treadmill test, just to make sure that everything is working OK with you.

As far as medications are concerned what, if any, are you taking?

The Advair disk (taking one puff twice a day) seems to work well as a preventive measure for most asthmatics. You may also want to carry a rescue inhaler, like Proventil, to help you when you get an attack in the middle of a ride.

Asthma can be a PITA to deal with, but the sports world is full of athletes who competed, at the highest levels, while also dealing with asthma. Having asthma should not keep you from enjoying your passion...just be sure that you see a competent doctor.

Good luck.

smahler 02-06-14 06:31 PM

Quote:

Originally Posted by HIPCHIP (Post 16474093)
Thanks for the info. Warm weather is actually good for me, even when it's hot, as I don't have the EIA problem. So far wearing the face covering and taking Zyrtec seems to be helping. GO FIGURE! As long as it works. Did 4+ hours yesterday in the COLD with no problem, only had a problem at the very end when the wind kicked up, but not too bad. Can't wait for March/April.

Good deal, man. It gets hot and really humid here (Eastern Shore of Maryland) in the summer, but I would take that right now - been a cold and snowy (not as bad as our brothers to the north) winter. It was -2 one morning last week - never gets that cold. We bought a trainer in November and it's been a great investment. However, I'm itching to get out on the actual road again!

HIPCHIP 02-06-14 07:58 PM

Quote:

Originally Posted by eja_ bottecchia (Post 16474163)
I have been an asthmatic all my life. I am also a regular rider and, for about 97% of the times, asthma does not affect my riding.

As Steve pointed out, your other symptoms (the pain that you are experiencing) do not seem to be asthma related. Cold temperatures cause your arteries (including your coronary arteries) to constrict and reduce blood flow to the heart. The asthma makes the condition worse because you are now also dealing with restricted air flow into the lungs.

You have not mentioned your age, height, weight and level of fitness. Those are factors to take into consideration when evaluating your symptoms.

If you can afford it, please go and see another doctor, preferably one with experience dealing with exercise induced asthma. You may want to ask him for a treadmill test, just to make sure that everything is working OK with you.

As far as medications are concerned what, if any, are you taking?

The Advair disk (taking one puff twice a day) seems to work well as a preventive measure for most asthmatics. You may also want to carry a rescue inhaler, like Proventil, to help you when you get an attack in the middle of a ride.

Asthma can be a PITA to deal with, but the sports world is full of athletes who competed, at the highest levels, while also dealing with asthma. Having asthma should not keep you from enjoying your passion...just be sure that you see a competent doctor.

Good luck.

I've had all the tests and everything was negative. My doc said it was like an "ice cream headache" where the cold fired off the nerves, so no cardiac problems. I've been checked by respiratory therapists and everything was fine, just my weird symptoms. On warm days I am absolutely fine, and since I started taking the allergy medicine, Zyrtec, the EIA has almost completely disappeared, so I'm just goofy.

I'll be 58 in March, 5'8" and 208 lbs, so have a lot of fitness I need to gain, but I do 40-50 miles regularly and average 13-18 MPH, so while not Cat 1 conditioning, still not bad for an old fat guy. I hope to be down to 165 by this time next year, and Bicycling magazine just had a big article on air quality problems and asthma, so I hope that pushing it a little harder and losing the weight will cure the EIA.

Thanks for all the info.

berner 02-07-14 12:47 PM

It has, evidently, been known for some time that during periods of stagnant air caused by weather conditions, people begin to suffer respiratory ailments from pollutants in the air not being flushed out. This does not mean that during normal weather pollutants are not present. It means that there are less pollutants. The net result is that those pollutants that are present in normal weather have a cumulative effect because they are present 24/7, day in and day out, doing damage. I one lived down wind of a coal fired power plant on the Mississippi Gulf Coast. While that plant did not spew out black smoke, after washing my car there would be a black substance on the surface. Of course, there was also a string of refineries to the West in Louisiana and Texas which likely contributed to poor air quality. My solution was to move. I should add that I not have asthma again after an absence of 65 years.

overbyte 02-07-14 01:16 PM

I also get exercise-induced asthma. Had it all my 69-years-life. What I've done for many years (under doctor's advice of course) is I take 1-2 puffs of an inhaled steroid (Qvar) in the morning and sometimes at night if allergy is acting up. Just before doing a bike ride, I take 1 puff of my bronchodilator (albuterol) rescue inhaler. The steroid is the long-term treatment to cut down on the inflammation of the bronchial tubes in the lungs. The bronchodilator opens the airway through the bronchial tubes but only for a few hours. Doing this, I have no trouble on rides even in cold weather.


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