Possible Asthma?
 

I'm a bit concerned that I may be experiencing a mild form of Asthma after intense cycling efforts. This first occurred last year during and after my first Criteriums, it feels like I have to carefully breath in or I will suffer a bought of dry, painful, coughing. When experiencing this, my airway generally feels tighter, and it is much harder to get full, deep breaths. I don't really start wheezing but end up coughing a lot, for many hours.

I hadn't thought too much about it because normally this is a very rare occurrence for me during indoor rides, but when I'm outside, in the currently cold dry air, simply riding along at 200 watts for more than an hour induces this, and quite badly, the same symptoms seem to occur for many hours (up to a day afterwards).

So, my main concern is I have 4-5 Criteriums scheduled for April, would an OTC bronchodilator like epinephrine be effective? Is it UCI race legal?

If I were to go to my doctor, would it be a difficult, lengthy, and expensive process to have any kind of diagnoses and treatment for this? My concern is the symptoms only seem to appear after prolonged moderately intense aerobic exercise outside or extraordinarily intense intense indoor exercise, and even then, it does not occur 100% of the time.

Does anyone else have experience with something like this and may have some general advice they would like to share?

Go seek medical advice from a doctor instead of armchair doctor advice from a cycling forum.

Jeesh...

Bleeeh, people are asking about concussions, DVT, heart attacks, etc. I'm bored at work and want some anecdotal advice from some people who may have experienced something similar.

Short and sweet answer, your symptoms are exactly what I suffered before christmas, I'm now on a prescribed brown "preventer inhaler" two puffs in the morning and two at night and the problem is gone, completely.
That "trying to take a deep breath but can't" is pretty terrifying isn't it!
Go see your doctors, it's really worth it!

I had similar symptoms and my primary care doctor prescribed an albuterol inhaler just based on my description of the symptoms, no tests or anything. I picked up the inhaler at the pharmacy later that day. I have used it a few times, but mostly I just avoid the intense efforts that cause the coughing fits. That probably won't work if you're racing.

Great, some advice from people with similar/same experiences, I'll likely talk to my primary care physician about it then. Hopefully it won't involve any expensive tests, as it would be very mild and situation dependent asthma anyway.

Look up exercise-induced asthma.

Possibly exercise induced asthma ... and yes, an inhaler helps.

As for what inhaler ... you'll have to go see your Dr.

Longtime asthmatic here, all my life. It's always hindered my aerobic capacity, but I have some good days now and then on the bike. This week has been pretty good since the rain washed a lot of airborne nasties out.

Yup, ephedrine helps. It's probably illegal or requires a temporary use exemption in most competitions. It's just the original version of Sudafed -- pseudoephedrine -- which cost Romanian gymnast Andreea Raducan her gold medal in the 2000 Olympics. Ephedrine was originally developed as an appetite suppressant but was later found to be useful for sinus congestion and asthma relief.

Side effects include high blood pressure and aggravating existing thyroid conditions. I have both but still need those anyway. Nothing else works as well.

The form of ephedrine most often taken as tablets for asthma often include guaifenesin, an expectorant that loosens mucus but make produce more coughing up phlegm for the first hour or so after taking.

I also use Flonase or generic nasal inhalers and albuterol chest inhalers. Despite the ads and claims, albuterol is not a rescue inhaler. It takes too long to be effective and by the time an asthma sufferer actually needs a genuine rescue inhaler it's too late for albuterol or any corticosteroid inhaler to do any good.

These help a little but not as dramatically as a single 12 hour Sudafed (I buy the generic pseudoephedrine from Walgreens for $10 per pack of 20).

I carry the generic bronchial asthma tabs -- ephedrine/guiafenesin -- in my saddle bag for emergencies. They dissolve quickly and I'm usually good to go in about 15 minutes after a bout with airway constriction.

And, yup, my BP and heart rate go nuts for the rest of the day. I haven't checked it since I got home from a hard ride Wednesday evening, but I'm betting my BP is 140/90 and pulse near 100 (Note: I checked later and it was indeed 139/89 and pulse 90, hours after finishing a hard, fast 22 miles). Without
the meds it'll be normal -- 120/70, pulse 70. That's about as good as it ever gets. But I need to breathe.

My compromise is I don't race. I don't even push myself to match other people's pace on group rides. If I don't have the lungs that day I drop out. I'm not gonna risk a stroke over a weekend group ride. So I mostly go my own pace on solo rides, push where I'm comfortable pushing, or join less competitive friends for very casual 12 mph rides.

Only inhalers containing epinephrine should be considered true rescue inhalers, but those require a prescription. Even those need to be used before the airway closes. Once that happens an epi shot is needed.

BTW, exercise induced asthma is a thing, but it's usually related to the same underlying causes for any form of asthma. The stressors are simply worse when you're pushing hard on open roads, whether cycling or running -- pollen, mold/mildew/fungus, all carried in roadside dust, along with dried out airway.

I mention this because of the occasonal snide remarks I've read elsewhere online about otherwise healthy athletes suddenly developing exercise or stress induced asthma during a race and needing an albuterol inhaler.

Well, that's what asthma is. The threshhold only changes a bit when we're pushing physically. And anyone who believes ordinary use of albuterol inhalers as prescribed is doping needs a reality check. I only wish it turned me into superman. All it does is just barely keep my airway open so I can finish a ride. I'd need to eat the contents of a year's supply of inhalers to get any doping benefit.

I have the same experience. After a few seasons of hacking I woke to the realization i have Exercise Induced Asthma. When planning a heavy breathing interval, hillclimb or sprint effort I take a few hits of inhaler prior to riding. My wife has asthma and offers her albuterol inhaler but learned I am allergic to it. I use another kind that is prescription only, this I obtained after learning the hard way. See a doctor Team Sky said 1/3 of their riders have EIA.

Use alburerol (prescription, so see a doc). Almost certainly EIA. I have it, too. Since I do a lot of high HR work, I use a fluticazone discus every morning. Then I don't need albuterol. Ask your doc.

Albuterol is a rescue sprayer. It is not a corticosteroid. As is frequently pointed out, internet forums can have a lot of misinformation. Again, ask your doc. If necessary, get a referral to a pulmonologist.

I've heard some sarcastic remarks about that as well -- "How do so many peak fitness athletes suddenly develop 'asthma' and need inhalers?"

There are a lot of valid reasons. They're exposed to a helluva lot more airborne contaminants kicked up from roadside dust than most folks. The most common aggravators include mold/mildew/fungus spores, along with pollen. I've seen otherwise healthy and fit asymptomatic people suddenly develop constricted airways and need ER treatment when they traveled to an unfamiliar location for camping, hiking or other activities. They hadn't adapted to the local airborne/dustborne contaminants.

Bike racers much contend with new locales and contaminants they've never adapted to all the time. I'd bet mountain bikers have a very high incidence of exertion induced asthma too.

And that doesn't even get into the possible contaminants from manmade stuff -- pollution, dumping, the usual stuff that comes off cars from routine driving. There's an incredible amount of tire dust along every road in the world. No idea how much that may affect some folks who otherwise never experience asthma symptoms until they're huffing and puffing in a peloton with other bikes, support vehicles and crowds stirring up the contaminants.

Whoops, my bad. That's what I get for spouting off the cuff. I was confusing my albuterol inhaler with my Flonase and Symbicort inhalers.

I'll admit the whole mess over albuterol gets on my nerves. It's a piss-poor rescue inhaler, which I've heard from every asthma sufferer I know. It never works for me or anyone I know as a true rescue inhaler. It's only useful as a preventive inhaler. I use it before a ride. Some days I don't even carry it in my jersey pocket because it does absolutely no good at all, and I've heard the same from other asthmatics who carry albuterol.

Part of the problem is it's a powder. Most of it sticks to the mouth and never reaches the airway. Same with those stupid disc inhalers. And the more congested the airway, the weaker the ability to inhale sharply enough to draw it into the airway. So we might as well just swallow the stuff a few hours before exercise. And it can take a dozen puffs, spaced about 5-15 minutes apart, to even being to offer any relief.

It's a sham perpetrated by the industry because of the pressure to take epinephrine rescue inhalers off the OTC market because of a few stupid druggies abusing it to get high. (Same thing will happen soon with loperamide, the most common OTC anti-diarreahal, because a few morons insist on taking dozens or hundreds of the tabs at once to get a mild opiate buzz, and end up in the ER with impacted colons.)

Epinephrine inhalers are the only true rescue inhalers. I don't care what the claims are for albuterol. Nothing else works in a true asthma emergency except epinephrine. And if you don't use the inhaler immediately the airway closes and you need the epi shot. I've hauled my cousin's kids to the ER over identical emergencies when they ignored the symptoms and didn't use their epi rescue inhalers in time.

/rantoff

Rub some dirt on it

That is what I was telling an ER doctor when he asked me why I needed an inhaler all of a sudden like. We breathe air from several different communities. For me, ranches, farms, orchards etc.

Albuterol works well as a rescue sprayer for me and my wife, who is a chronic asthma sufferer. One has to know how to use it:
It works a little better for us if we press the button about 1/4 the way through the inbreath.

What we're really supposed to do is to use a special air chamber between the sprayer and mouth, which sort of vaporizes the material before it reaches the mouth:
A little awkward to carry and use on the bike though, so on the bike it's the naked sprayer.

My wife always uses hers immediately before a hard bike ride, so it is also a prophylactic.

Just what I was thinking.

Yup, I'm familiar with the techniques. Even have the shotgun bong in the closet. It's still a piss-poor rescue inhaler for many folks I know, not just me.

It may be a consequence of living in Texas, the worst place I've ever lived for allergies and asthma. It's home so here I stay. But every allergy and asthma season I wonder why I don't move.

One of the worst locations is my favorite rural route, which often leaves me wheezing and gasping for air. I've often needed to stop at the peak of a climb to recover. But we had some heavy rains last week and my last three rides this week have been great. No asthma, and several PRs and cracked the top ten on a couple of difficult segments.

If we got heavy washing rains more often it'd be great. Better than albuterol.