I have historically had some issues with asthma, mostly in cold weather. It was usually manageable with a long warmup. Moving to Florida helped a lot for a while since here in Tallahassee we have fewer subfreezing mornings and only very few mornings in the teens, but lately I have had issues on warmer mornings. I figured they were triggered by allergies. They seem to have gotten more frequent and worse since I had covid a little over a year ago.

Anyway my GP suggested I might try an inhaler (Albuterol). I had one that the urgent care doc prescribed when I had covid that I hadn't used, so I started using it. The GP said to use it when I could sense the triggers coming on early in the ride, but avoid using it anywhere approacning daily. I have been struggling a little with managing the frequency of use. I ha​​​ve been using it only when I have pretty bad symptoms early in the ride (only a couple times a week), but feel like I would benefit from using it much more frequently. If I use it anytime I feel symptoms early in the ride I'd head off most or all of the problem, but would be using the inhaler daily at least for some portion of the year. I am not sure if it would wind up being just a seasonal thing or not.

I am curious how others manage the decisions of when/how often to use the inhaler.

After decades of having to use an inhaler frequently (sometimes twice a day), my sensitivity gradually subsided to the point where I haven't used one for maybe six months or more. That said, here are some observations, in no particular order:

Albuterol is a "rescue" medication. When I told my GP that I was using my inhaler up to twice a day, he suggested going on a regimen of injections. Didn't like the idea (expensive and inconvenient), so I looked for alternatives.

When I began using an inhaler many years ago, Primatene Mist was what was available. Then it was off the market for quite a while, presumably for safety-related reasons. But it's back now (Walgreen's, CVS, etc.). Much cheaper than albuterol, and evidently with fewer safety concerns, since you can buy it over the counter (for around 30 bucks).

Sleeping with asthma symptoms was always the biggest problem. Running a high-quality air cleaner in my bedroom helped a lot.

One other suggestion: Loratadine is the active ingredient in some over-the-counter hay fever medications. The label says nothing about asthma, but after reading a journal article that reported that it often relieves asthma symptoms, I started taking a pill a day.

Don't know whether it would help you as it helped me, but that's when I went from daily use of my inhaler to using it only once in a while.

Loratadine tablets are available under several brand names. I used Amazon's version, labeled simply "Allergy Relief."

I'll keep that in mind for future reference.

I generally cut back on or cut out antihistamines due to a problem with dry eyes. I try to use them very sparingly if at all. Something to keep in mind though.

Along the lines of what Trakhak suggested…perhaps there’s an oral tablet/capsule you could use (OTC or prescription). I had significant asthma as a kid, but eventually grew out of it in my 20s. But my doc back then had me on an “as needed” oral prescription. Generally, I had to medicate prior to any run or ride.

Dan

As a life long asthmatic, I have tried all sorts of medications. One early learning experience was to avoid Primatene Mist, since it was (still?) epinephrine, which has all sorts of side effects best avoided. Not just my opinion but pounded into me by multiple physicians since I was a kid. I strongly suggest seeing an allergist. Once I saw one, it was night and day with treatment.

All the allergists I have seen made clear that daily use of albuterol was a sign that asthma was not controlled. However, pre-exercise use was encouraged and I found it very helpful. It did take some trialling to find the combination that works for me. My current treatment is an inhaled corticosteroid+others mix (Breztri), oral Singulair, and monthly injections of Xolair. For me, all are covered by insurance and pharma discounts. Still not inexpensive, but cheaper than a hospital stay. Initially I was hesitant to use an inhaled steroid, given past experience with oral prednisone for asthma flare ups. Most of the studies I read show it stays in the lungs. Side effects are non existent for me — much better than asthma attacks. This regimen has worked so well for me that I cannot remember the last time I used a rescue inhaler outside of pre-ride. Still keep one at the ready.

To be fair, I have been off my bike for several months due to (hopefully) unrelated heart issues, but prior to this had minimal asthma issues with the above medications. I would use albuterol before rides in the Memphis heat, but there were plenty of times I forgot to take a puff or two and had no issues. I can only think of few times I needed albuterol mid ride, and was clearly allergen related.

If you find yourself needing the albuterol frequently, you may benefit from an inhaled steroid like Fluticasone or Advair. These stabilize the lung lining to reduce the irritation that triggers asthma attacks. As they are an inhaled steroid, they do not have the adverse side effects from long-term use associated with systemic steroids.

Understood.

That said: of the treatments I've used, the loratadine tablets have been by far the most benign. If the choice were between an asthma attack and dry eyes, I'd take dry eyes every time. Annoying, but you don't feel on the verge of death.

You probably already know, but for others reading this thread: there are over-the-counter solutions for treating dry eyes.

By the way, I found half-tablets of loratadine worked just as well for me as the full tablets, with less in the way of the dry-eye effect.

I think my use would probably be considered pre-exercise. I typically evaluate the need after a short hop to the MTB trails on the road. At that point I can typically tell if it is a bad trigger day and decide if I need a couple puffs before proceeding or not.

I do use Fluticasone and find it helpful.

For years I had exertion related asthma, especially in cold weather and heavy allergy conditions -- wheezing, hacking, gasping for breath. Here are a few things that worked for me...

First, I use albuterol daily as a preventive. It's not a true rescue inhaler. I get arguments about that, but having worked in emergency medicine I cannot consider an inhaler that takes 15-30 minutes to be effective a "rescue" inhaler. By that time a person with a serious asthma attack may be passed out and unable to help themselves.

Primatene Mist is a true rescue inhaler. It works well. But it's very harsh and irritates the hell out of my trachea and sinuses. I've used it only two or three times in the past five years, always on max effort high intensity running and cycling sessions due to cold dry air or heavy allergy days in warm weather. So far I've never had a serious asthma attack without exertion, just moderate asthma problems.

Primatene tablets, or generic oral ephedrine, also work well for near-rescue situations. But it can raise blood pressure, heart rate and cause other problems. Use it sparingly, only when absolutely necessary. Same with Sudafed or generic pseudoephedrine.

Oral montelukast tablets have worked really well for me as a preventive. I could probably get by without my daily dose of albuterol inhaler, although I'd still huff albuterol just before heading outdoors for a ride, jog or long walk. I've read that some folks had negative experiences with montelukast but I've had no problems.

Nasal inhalers: fluticasone has been moderately effective, but azelastine has been very effective. Azelastine is pricey but worth it. Fortunately my insurance covers it.


I rotate various OTC antihistamines -- generic Allegra, Claritin, Zyrtec and Xyzal. Allegra works best for me, but I've found that no OTC antihistamine is effective in long-term daily use. I need to switch them around every week or so to be effective.

Use your inhaler when you need it. Using it more often won't make you need it more; there is not a rebound effect.
If you are using it a lot, tell your doctor as you may need additional or different treatment, as mentioned by several others above.

After some experimenting I have changed up and found a routine that is working well for now with what I think is minimal use of my inhaler. I switched the Fluticasone from one spray in each side from before bed to first thing in the AM and taking one puff of Albuterol before my morning ride. I think that in other less allergy prone times of they year I may be able to skip the Albuterol altogether and there may be other times when I need two puffs.

Sounds like a plan.

One final thought: my use of inhalers dwindled over the last few years to almost nothing. Part of it might be explained by some change in my sensitivity to allergens, but I think another reason is my having bought a fairly expensive air cleaner.

When I see how much dust collects on the outermost of the two filter layers over the course of just a month or so, I'm happy to have spent the money.

My wife had terrible asthma when I met her, 53 years ago. She'd been living with a smoker and she's allergic to the smoke. The smoker was gone, but not the asthma, still has it. Yes, absolutely do NOT wait until you have symptoms. Take a hit off the Albuterol every time before you do something which might trigger the asthma. Ideally, you never want to feel "tight". Toughing it out is exactly the wrong thing to do. Do it before you have symptoms. Put it in your helmet or bike shoe. You doctor doesn't know crap about it. He's dead wrong. Albuterol is harmless, asthma is not.

My wife has chronic asthma, meaning she'd have problems with it even if she didn't encounter an agonist, thus she'd have trouble all the time if she didn't take medication. She has to use a fluticasone/salmeterol inhaler daily as well as the albuterol before aerobic activity. She's been doing this for 50 years with no adverse effects, nor has her asthma gotten worse, if anything it's better.

Personally, I'd change doctors. Wrong about one thing, maybe wrong about many things.

I also have asthma. Fortunately it is relatively well controlled, I use alvesco every night as my maintenance inhaler. I’m down from using it twice a day. Since starting to use it I have not had to use albuterol at all…I do keep an inhaler with me though where ever we go. I don’t tolerate smoke or strong fragrances well at all. (I also take an allergy shot once a month…that’s down from 3 a month.) Altitude is also a major player for me as well…and I used to live in Colorado Springs. Florida works well for me…