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Old 02-16-05, 09:11 PM   #1
Machka 
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Exercise Induced Asthma

This morning I had a pulmonary test to check me for asthma, because I experience asthma-like symptoms when I exercise (i.e. cycle) and especially when I exercise in the cold.

Thank goodness for students! They're so excited about learning to perform all these tests that they tell you many of the results right there and then.

RESULTS:
1. I do not have asthma.
2. My lung capacity is 131% of what is considered "normal" for someone my size and age.

Back to the asthma thing again for a minute ... I asked about exercise-induced asthma, because that's when I have the symptoms. When I'm sitting quietly in a chair in a warm room, I'm fine ... when I'm exercising, I'm not.

One of the students told me that they don't diagnose anyone over the age of 18 with exercise-induced asthma. Once you reach 18, you either have asthma, or you don't. That sounded a little odd to me ... and she couldn't explain why I would have asthma-like symptoms when exercising, when I don't have asthma.

I'll be consulting with my Dr again in a week or so, but have any of you been diagnosed with exercise-induced asthma, or have you done some study on that subject. It just seems strange to me that when a person reaches the magic age of 18, all of a sudden that person can no longer have exercise-induced asthma.
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Old 02-16-05, 09:24 PM   #2
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Strange. I've met at least two folks who developed exercise induced asthma, and they were WAY past 18.

Good that you went to the doctor. Good luck on that.

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Old 02-16-05, 09:35 PM   #3
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I've got it.

I don't know how long i've had it since I moved here from Miami, Florida three years ago and it's near impossible to exercise in cold weather there.

My doctor didn't do much testing. I got the feeling that the inhaler doesn't have many bad side effects and he just prescribed it without much thought.
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Old 02-16-05, 10:07 PM   #4
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Are you 18, Lord Opie (I don't think you are... ).

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Old 02-16-05, 10:34 PM   #5
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Oh! I got it!

Never realized it - I just thought that's what everyone felt when they exercised. I was probably about 35 when I was diagnosed. I needed to get medical clearance to take a scuba-diving class, and they asked if I had more trouble breathing when I exercised in cold weather compared to warm. When I said yes, they immediately made me stop diving until I got a doctor to approve me. The doctor wouldn't do it - the end of my career as Jacques Costeau's groupie! I still tend to forget that I have it. I was hiking in the Grand Canyon over New Years and was huffing and puffing, and couldn't catch my breath - that's all I get - I don't really get the wheezing. My boyfriend asked if I was having an attack, and that's when I though - oh, yeah, I am! Two puffs later (actually, about two minutes) I was fine. I very rarely use the puffer, and whenever I do, I always think that it's amazing to breath like normal people do.
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Old 02-17-05, 02:17 AM   #6
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Exercise-induced asthma is a well-known and relatively common problem in both children and adults. Like regular asthma, it's more common in children, but is also seen in adults. It's usually worse when breathing cold air. In some people, physical exertion causes inflammation on a cellular level, which causes a partial obstruction of the small airways in the lungs. Since the airways are smaller in children than adults, asthma in general is more common in children. As the airways grow with the child, many children will outgrow asthma as they get older since the same level of inflammation cannot block the larger airways of the adult. Cold air can produce the same inflammatory effect in some people, which magnifies the effect.

Typically, exercise-induced asthma feels like normal asthma while the attack lasts. If you pay attention to it, you don't actually have trouble breathing in, you have trouble breathing out, which is when the characteristic wheezes are generally heard. A typical asthmatic attack looks like somebody taking quick breaths in and struggling over a much longer period to breath out.

Exercise-induced asthma is generally treated first with cromolyn sodium inhalers, which are generally pretty effective. It also helps if the patient ceases exercise and removes themselves from a cold environment.

Having had a couple episodes of exercise-induced asthma, I can attest to the fact that it's a pretty unpleasant experience. Thankfully, I don't have asthma in general, because I wouldn't want to live with that sensation hanging over me all the time.
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Old 02-17-05, 03:39 AM   #7
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Shoot, I thought everyone was that way. As long as it doesn't start making me pass out, I don't mind it. I just got done with a training ride for the tour I'm about to take. I've got my fully loaded(35 pound dog included!) bike and trailer, plus a 50 pound sack of gravel on my trailer, over a course of these lovely Tennessee hills! Needless to say, my EIA is kickin' right now!
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Old 02-17-05, 03:40 AM   #8
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I am 47 years old and have had exercised-induced asthma for about 15 years. I ususally control it by slowing down or limiting the exercise when breathing becomes difficult. The last 4 years cold weather has been a trigger. I had 2 terrible episodes last winter, once while coasting on the bicycle and the other while walking slowly in the cold. I only carry my inhaler when I am in a spinning class - where I push myself and when I cycle in unfamilar territory, otherwise I regulate my activities to control breathing.
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Old 02-17-05, 08:00 AM   #9
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I don't have problems during the ride. However, after we're back to the cars and I'm driving home, I have wheezing and coughing. Usually lasts until I take a nice hot shower. I don't have any problems in warm weather. I'm 45 BTW....
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Old 02-17-05, 09:00 AM   #10
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I've had exercise + cold + allergy induced Asthma since age 5; or at least that's when I was diagnosed with Asthma. The best drug out there for my Asthma is Serevent. It allows me to operate pretty well down into the lower 30's. I had a good ride starting out at 31 degrees just a few weeks ago. I always take a puff of Albuterol about 15 minutes before riding. Asthma is aggravated by sinus problems. I use Claritin to keep that under control.

Most Asthmatics need to avoid sulphites (wine, dried fruits) and many of us are allergic to Aspirin; one now and then are OK, but taking them for a few days will bring on the Asthma.

Miami is pretty pollen free. My parents moved there when I was 11 and I had the fewest attacks there than other places in Florida, the North E and the South E. The Gulf Coast where I live now is probably one of the worst places.

I've always refused to regulate my activities to control the Asthma. It's far better to push through it by warming up slowly and charging ahead aided by medication. The more fit you are, the less of a problem Asthma becomes. I've followed that regime since age 26 when the drugs were not nearly as good as they are today.

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Old 02-17-05, 10:12 AM   #11
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Exercise induced asthma is more common is childhood/adolescence but can present at older ages.

A good test is a methacoline/histamine challenge - bronchoprovocation where we try to elicit a 20% drop in airflow. If we can't provoke that, you don't have current asthma. If you don't have asthma, you don't have exercise induced asthma. A positive test doesn't prove asthma, a negative test excludes it. Easier than an exercise challenge, though sometimes those are also done. If you're well insured you can even talk yourself into a free V02 Max cardiopulmonary test .

A trial of medication can be useful if testing not done. EIA (exercise induced asthma) almost always improves with the use of a bronchodilator (e.g. Ventolin) pre-exercise, if symptoms don't it's probably not EIA.

Bronchodilators pre-exercise work well, especially long-acting ones if you exercise beyond a couple of hours (e.g. Serevent, Oxexe). Anti-leukotriene drugs e.g Singulair also work well esp if you need something regular. If asthma symptoms present at other times also (which is often the case even if not recognized initially) then inhaled steroid meds or combinations are usually indicated (e.g. Flovent, Pulmicort, Advair, Symbicort).

Cheers

General comments only, not personal medical advice.
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Old 02-17-05, 12:20 PM   #12
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For a number of years now, my symptoms have been that while I'm out cycling (or doing other exercise) in the cold, I'm fine, but shortly after I stop exercising and go in where it is warm, I hack up a lung and continue to do so for hours after. In some cases, even days. However, I could deal with that and I never had it checked.

Then last year I developed a new symptom: hyperventilation. I'd be on a cool/cold ride, exerting myself a little more than usual and breathing hard. I would develop the rasping and wheezing while still on the bicycle and if I continued to push, I would suddenly start hyperventilating so badly that I would have to stop cycling right then and there, and really focus on calming my breathing down. That worried me a bit, but I still didn't have it checked.

The final straw was my Great Southern Randonnee - 1200 kms in 90 hours . . . and I spent most of that time hacking up a lung, struggling to breathe, and hyperventilating. Now apparently the Black Wattle was in bloom then and it causes hay fever and allergic reactions in many people, so that could be a contributing factor. And it probably also didn't help that I have a very, very mild allergy to eucalyptus, and 90% of the trees in Australia are eucalyptus. Add to that exertion in cold temps ... and I was in trouble.

Now I'm having it checked. I'd like to be able to ride AND breathe.
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Old 02-17-05, 01:40 PM   #13
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Quote:
Originally Posted by lungdoc
Exercise induced asthma is more common is childhood/adolescence but can present at older ages.

If you don't have asthma, you don't have exercise induced asthma. A positive test doesn't prove asthma, a negative test excludes it. Easier than an exercise challenge, though sometimes those are also done. If you're well insured you can even talk yourself into a free V02 Max cardiopulmonary test .

Cheers

General comments only, not personal medical advice.

Thanks for clearing that up. It appears that many believe that exercise induce Asthma is somehow an independent affliction from Asthma.

I once got a cheap version of that V02 Max cardiopulmonary test . It was during my first interview with a new GP/family doctor about 35 years ago. After he read from my record about the asthma, he lit a match and asked me to blow it out without pursing my lips. I couldn't do it. He said "you have Asthma all right, a normal person can do that easily". That was the first time I realized that I was handicapped somewhat when I was not having an attack.

Al
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Old 02-17-05, 02:17 PM   #14
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I'm a life long asthmatic, and it doesn't slow me down at all.
Well, Ok, I visit my allergist yearly and he keeps me perfect.
I have two small daily pills and another inhaler for running during peak allergy season.
Asthmas doesn't have to block you from doing what you want, I'm free now and loving it.
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Old 02-17-05, 02:23 PM   #15
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EIA can be controlled and lessened. EIA is not solely as a result of an exposure to cold weather. It is more accurately described as sudden exposure to temperature CHANGE. Asthmatics, as people with migraines can be characterized as having a vascular disease.
When it is cold out, the veins constrict to conserve your heat. The skin has a lot of blood flow, so this is why we become pasty white in the wintertime. Conversely, in the heat we can become flush, or red. This is a result of the dilation, as the body moves to cool itself.

During sudden temperature shifts, sometimes the body spasms during this 'transition' period. This can bring on an asthma-like symptom.

To minimize this, make sure that you are well hydrated BEFORE the ride. Even a little dehydration can bring on vasocontriction. (we get 15% of the water in our system from our respiration, so if you don't run a humidifier you might be 15% deficient as you wake up in the morning)

Another way is to be exposed to the cold for about 10-15 minutes prior to exercise (just standing in the colder air, to get used to it could help)

I do know that if your first episode occurs in the 1st 15-20 minutes, once you let the worst of it pass and don't push it, you could minimize the attack and proceed to your harder workout.

then there is all the allergen's and pollution that contributes to it. The chicago area recently had very bad air quality. all the soot and pollution that had been kept in the snow for the last month had been released into the air when it all melted and there was no wind, so everything was sitting there.
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Old 02-17-05, 03:12 PM   #16
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A trial of medication can be useful if testing not done. EIA (exercise induced asthma) almost always improves with the use of a bronchodilator (e.g. Ventolin) pre-exercise, if symptoms don't it's probably not EIA.
A lot better than a lot of expensive tests.
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Old 02-17-05, 05:44 PM   #17
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*** FEWER than 10% of all people actually have true EIA, even if they have symptoms during exercise. Most people just have UNDERdiagnosed chronic asthma that is exaccerbated with exercise.
Asthma is an inflammation of the airways, causing a narrowing and ultimately a spasm in severe instances.
EIA does not involve this inflammation. It is caused by decreased water flow and other psychologic changes.

hope some of this helps.

Now if you have allergies that worsen the problem, then this is simple.
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Old 02-17-05, 06:14 PM   #18
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Quote:
Originally Posted by RiPHRaPH
*** FEWER than 10% of all people actually have true EIA, even if they have symptoms during exercise. Most people just have UNDERdiagnosed chronic asthma that is exaccerbated with exercise.
Asthma is an inflammation of the airways, causing a narrowing and ultimately a spasm in severe instances.
EIA does not involve this inflammation. It is caused by decreased water flow and other psychologic changes.
Has the exact mechanism of EIA ever been clearly pinned down? What I've read is that the evaporative loss due to increased ventilation of dry and/or cold air causes increased osmolality in mucosal cells. This increased osmolality is supposed to cause bronchial smooth muscle contraction (spasm), but also activates mast cells to trigger the vasodilation and inflammatory cascade you see with normal asthma.
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Old 02-17-05, 06:25 PM   #19
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Quote:
Originally Posted by RiPHRaPH
EIA can be controlled and lessened. EIA is not solely as a result of an exposure to cold weather. It is more accurately described as sudden exposure to temperature CHANGE. Asthmatics, as people with migraines can be characterized as having a vascular disease.
When it is cold out, the veins constrict to conserve your heat. The skin has a lot of blood flow, so this is why we become pasty white in the wintertime. Conversely, in the heat we can become flush, or red. This is a result of the dilation, as the body moves to cool itself.

During sudden temperature shifts, sometimes the body spasms during this 'transition' period. This can bring on an asthma-like symptom.

.
Powerful concept, however, I've backpacked for days at a time between 20 and 35 degrees. I never had a sudden temperature change and still had the Asthma. Though I was living in relatively constant temperature, each time we would start to hike with the packs, I had to go through an Asthma attack just like when I went from a warm house to the cold outside. There was negligible difference.

I've never been told by a specialist/GP that Asthma was a vascular disease. Nor have I come across that description in any of my books. Must be a new theory or something.

By the way, in case you didn't read the post, the good doctor has already stated that if you don't have asthma, you don't have EIA. I've had Asthma for 60 years.

Al
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Old 02-17-05, 07:17 PM   #20
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I should clarify for the more specific aspects of the discussion that you can have EIA without other asthma manifestations (although it is correctly stated as being the definite exception). EIA is still a form of asthma, just a specific uncommon manifestation. You can't to my knowledge have current EIA without bronchial reactivity, therfore negative methacholine excludes asthma and therefore also excludes EIA. The above description by Sessamoid is correct to my understanding.

Cheers
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Old 02-18-05, 07:49 AM   #21
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Originally Posted by lungdoc
I should clarify for the more specific aspects of the discussion that you can have EIA without other asthma manifestations (although it is correctly stated as being the definite exception). EIA is still a form of asthma, just a specific uncommon manifestation. You can't to my knowledge have current EIA without bronchial reactivity, therfore negative methacholine excludes asthma and therefore also excludes EIA. The above description by Sessamoid is correct to my understanding.

Cheers
That's interesting. I'll have to do a Google search (key words?). Is the vascular/temperature change affect a known factor in the more "normal" Asthma episode? It doesn't appear to be or rather, I've not noticed it.

Al
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Old 02-18-05, 09:13 AM   #22
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Wow - there are a lot of people here tossing about some really big words! Bringing it back to layman's terms...

As I mentioned, I was diagnosed about 10 years ago with EIA. I don't get the wheezing, but I just experience difficulty catching my breath. After reading some of your comments, it doesn't sound like I truly have asthma. But, I do know that after I take a puff of atrovent or albuterol, I feel great and can breath normally, while doing the same level of exercise. In other words, doing the same amount of exertion, I'm no longer huffing and puffing. Was I mis-diagnosed?
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Old 02-18-05, 09:46 AM   #23
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I was diagnosed with EIA when I was 24 and have been dealing with various manifestations of it over the past 10 years. When I lived on the east coast I would have severe attacks in the hot, humid climates and I relied on an inhaler for any cycling or running. When I moved to the PNW I found I could control the EIA much better in this stable, maritime climate, and was eventually able to ditch the inhaler. I was never fond of the inhaler anyway because it would give me the shakes.

Then when I was 31 it came back something fierce and my doc said, "Well here's an inhaler, that's your life again." I knew there had to be a better solution than bowing down to the drug companies so I went to see my friend's naturopath and through a simple food elimination diet (great way to lose 10 lbs) I found out that my asthma was triggered by WHEAT and DAIRY. Once I eliminated these from my diet I literally got my life back and was stronger than ever and had NO asthma attacks. This was during my mountain climbing phase and it doesn't get much more strenuous than breathing at 14k with 40# on your back.

I've come to find my limitations and now know that I don't have to eliminate wheat and dairy 100% of the time, but if I want peak performance then I do have to be strict about it.

So I wouldn't rely on just drugs to solve EIA issues, look at systemic reasons also. I'm not a hippy freak, I just know that I've had a slew of health issues and this has worked miracles for me. Food sensitivities are a much overlooked segment of health care.
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Old 02-18-05, 10:38 AM   #24
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Quote:
Originally Posted by Machka
Thank goodness for students! They're so excited about learning to perform all these tests that they tell you many of the results right there and then.
Well, I guess they are enthousiastic and well intentioned students but may still have a lot to learn. The "you have asthma or you don't" does not inspire me either. Asthma really needs to be left to the experts.

For the last ten years or so, I have been followed by doctors specialized in pulmonary diseases and have been very happy with their advices. In fact most wil tell you that a lot needs to be discovered about asthma as it affects a lot of people in many different ways, appears, disappears and reappears without always real known reasons. No known cures but a lot of progress has been done to help asthmatics controlling asthma and lead normal lives.

I don't have EIA but used to as a child, and strange as it may sound nowadays I never experience any asthma while riding or exercising (unless there is high pollen count, hay dust or stuff like that in the air, but that is not EIA). One thing I also remember from my childhood EIA is that I was able to control an attack by slowing down the pace (from running to walking slowly, or riding slow using an easier gear) instead of stopping all together, then could continue without any problem. I guess such is the uniqueness of each individual's disease.

I have always heard also that cold weather is particularly dangerous for asthmatics, and this is another reason to talk to a specialized physician.
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Old 02-18-05, 04:33 PM   #25
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Quote:
Originally Posted by lungdoc
A good test is a methacoline/histamine challenge - bronchoprovocation where we try to elicit a 20% drop in airflow. If we can't provoke that, you don't have current asthma. If you don't have asthma, you don't have exercise induced asthma. A positive test doesn't prove asthma, a negative test excludes it. Easier than an exercise challenge, though sometimes those are also done. If you're well insured you can even talk yourself into a free V02 Max cardiopulmonary test .
Lungdoc, thanks for the input. So when you talk about a 20% drop in airflow during the challenge, which pulmonary variable do you measure for that drop? I always learned that a 10% fall in FEV1 post-exercise/challenge may be indicative of EIA...not proving that you have EIA, but just may indicate that it's a possibility in that person. Are there other measures that you can look at as well? Does that percentage (10%, 20%) vary with geographic location at all? I think your profile said you live in Canada and I thought that maybe there was a difference because I learned about all of this in the States.
Thanks!
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