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Old 02-27-07, 12:51 PM   #1
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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

Thanks, Karen.
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Old 02-27-07, 01:35 PM   #2
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Legal doping. Bleh.
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Old 02-27-07, 01:52 PM   #3
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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.

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Old 02-27-07, 02:22 PM   #4
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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.
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Old 02-27-07, 03:33 PM   #5
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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

Last edited by Al.canoe; 02-27-07 at 03:42 PM.
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Old 02-27-07, 03:35 PM   #6
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Originally Posted by JPradun
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.
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Old 02-27-07, 04:18 PM   #7
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Originally Posted by Al.canoe
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?

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Old 02-27-07, 04:29 PM   #8
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Originally Posted by !!Comatoa$ted
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

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Old 02-27-07, 04:35 PM   #9
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Originally Posted by slowandsteady
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
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Old 02-27-07, 04:40 PM   #10
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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.
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Old 02-27-07, 04:46 PM   #11
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Quote:
Originally Posted by slowandsteady
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.
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Old 02-27-07, 05:08 PM   #12
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Originally Posted by Al.canoe
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.

Quote:
Originally Posted by Al.canoe
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?
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Old 02-27-07, 06:50 PM   #13
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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
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Old 02-27-07, 07:34 PM   #14
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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
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?
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Old 02-27-07, 07:59 PM   #15
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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.
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Old 02-27-07, 08:47 PM   #16
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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.
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Old 02-27-07, 09:00 PM   #17
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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.
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Old 02-27-07, 09:18 PM   #18
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Originally Posted by Machka
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?
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Old 02-27-07, 10:13 PM   #19
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Originally Posted by Al.canoe
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.
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Old 02-27-07, 10:53 PM   #20
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Originally Posted by !!Comatoa$ted
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.
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Old 02-27-07, 11:06 PM   #21
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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.
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Old 02-27-07, 11:11 PM   #22
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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.
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Old 02-27-07, 11:13 PM   #23
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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.
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Old 02-27-07, 11:23 PM   #24
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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.
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Old 02-28-07, 06:50 AM   #25
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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.
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