The Asthma Thread
 

Thought I'd start this for folks to share information/stories about asthma, both chronic and acute.

I really suffered from allergies as a kid, to the point of getting shots 2-3 times a week for several years. In the last few years I had noticed I'd have really bad races from time to time where I just couldn't breathe. The trigger to seeing someone about it came at road nationals two years ago when, after riding well in both the TT and the road race, I found myself barely able to hang on in the crit.

Saw a doc and my symptoms checked all the boxes for exercise induced asthma. Prescribed an albuterol inhaler which helps, but I still find myself blocked, especially in the last two months.

Be interested in hearing how other folks are dealing with this, if they are on preventative meds (vs. rescue), how often they have problems, good resources, strategies, Etc.

It's not been fun going from an 800 pound gorilla in some races to a mouse lemur overnight.

interesting thread. I can't comment since I am not sure if I suffer from it still but I know I did when I was younger. I stopped smoking about 2 months back after 10 years and my lung capacity has improved (i think) from what I can feel when going strong on the bike. I still feel like I need more air but I think it is because my lungs haven't expanded / developed to the point they can inhale as much air as they need. When I can't breathe in what I need I get super dizzy and sometimes come close to passing out.

I've had Asthma since I was a kid. My brother had it worse than I did, with lots of late night trips to the ER when he was very little. It was so bad, our parents had to take away our stuffed animals.

Anyway, I've been on daily asthma meds since I was about 11 or 12. I stopped taking them my senior year of college, as I was considering joining the Marines - not sure what I was thinking - and they don't take asthmatics. I seemed to do all right without them, but then again, I wasn't exercising, other than 12-ounce curls. Shortly after ceasing my medicine, I did suffer from a non-exercise induced asthma attack. It was during spring break my senior year. I fortunately still had a rescue inhaler and some Primatine tablets in my bag and was able to deal with it.

I got back on the daily asthma meds a few years later when I started riding again and continually found myself struggling to breath. My pulmonary function numbers were ridiculously low. While my asthma is constant, it is exacerbated by exercise, which is why I keep my rescue inhaler in my cycling bag. I also see my allergist annually.

Lately, I've been a bit more short of breath in general, even just sitting at my desk. So, maybe it's getting worse. Regardless, I stick with my daily meds, and I use my rescue inhaler as needed. I'll also usually take a preventive puff before races.

When the weather turns cold, my breathing gets worse - which also could be a reason why I am struggling a bit more lately to breath. On cold weather rides, I bring my rescue inhaler with me and sometimes need it. I also have switched to V-neck base layers as anything constricting my neck makes me feel like I am choking when I start struggling to breath.

And I also have major allergy issues. In the past five years, I've had a sinus x-ray and CT scan as the allergists couldn't figure out why my sinuses are always so congested and inflamed. I have a prescription for Zyrtec-D, which is an over the counter drug, but I need more than I am legally allowed to buy over the counter, though I am pretty sure I take less than is required for a TUE. I also carry Advil Cold and Sinus in my pocket all the time. And I do daily sinus rinses. Depending on the need, I'll do as many as four a day. Since starting that, I"ve dropped from 4-6 sinus infections a year to 1-2. And they are much shorter.

Keeping the house clean helps keep the asthma and allergies in check. We have carpet and have to vaccuum it 1-2 times a day. The dog drops a lot of hair and dander. Technically I am allergic to dogs, but after living with one for six years, I have built up a decent tolerance to him. Still, if he slobbers on my while playing or scratches at me, I do get welts and hives.

Cats are another story. I can walk into a house that has a cat and know it in 15 seconds. I then leave that house. Intense allergens like cats will trigger my asthma and have me wheezing pretty quickly.

Despite all this, I have been able to race and race fairly successfully. I do turn to my rescue inhaler as well as nasal steroids - like Afrin - to help me breath. And I do have to pick and chose my races based on the weather. I don't bother with really cold races any more as it just rips my lungs apart and has me weezing and coughing like a smoker for a week.

Cats kill me. I once walked into a house and 10 minutes in asked "do you have a cat?" Turns out it had died a few months before but the people though I was clairvoyant and not just allergic when I asked that.

I've been trying to stack allergy meds and antihistamines on top of the inhaler. Hit or miss.

When I started racing, we moved next door to a pulmonologist. This was in Denver, often cool, usually dry. I came back from a hard MTB ride one day and asked my neighbor, "Hey, what causes this:" <WHHEEEEEEeeeeeezeeeeeeeee>.

She said, "Asthma! Exercise induced. How the hell do you race like that?" She brought home some gear and did a curb-side check on my flow before and during symptoms, and prescribed albuterol before any intense riding (any time I suspected I'd experience symptoms).

Albuterol has made a huge difference. Now that I'm in Austin, I only need it if it's cool and dry, but the dryer it is, the warmer I'll have trouble. I only seem to have trouble with intense efforts. It pretty much has to be intervals or a race equivalent. Tempo won't do it. Two puffs before a ride, and I'm good to go with no symptoms unless it's a really long ride. After 3 hours or so, I can start to have trouble again, but the albuterol kills it w/in minutes. I don't believe there is any connection to allergies for me.

One note that might be useful is how to take the dose. I see people all the time who are doing it differently than me. My neighbor/pulmonologist made sure I knew exactly how to take it, and checked back with me a couple months later to watch me take it again.
-Exhale fully, until there's nothing left, then exhale some more
-Hold the inhaler about 6" away from my wide open mouth, pointing in.
-Puff once, and about 0.1s later, start inhaling steadily, so that it takes 3-4 seconds for the full inhale
-Hold my breath until it's uncomfortable
-Wait 5 minutes, then repeat the above once

She said that it's best if every little pocket of my lungs is filled with medicated air, and the method above allows this. If you put the inhaler in your mouth, it's still wet when it hits the back of your throat. If you taste it at all, then that is wasted medicine that isn't doing its job. When I take it, I can taste a tiny bit on exhale, but nothing at all on the inhale.

I'm sure that some of you have used the attachments that make the harmonic tone when you're inhaling at the correct rate. These are great trainers for both distance and rate.

Interesting stuff WR. Thanks.

I think my asthma is both allergic and exercise induced. Cats get me, and cold air gets me too. I've been using albuterol before hard efforts and I think it works pretty well, though I still get a slight burning sensation and a bit of a cough after a race. At least, after a race now. This summer I was fine, once the fall hit I started to have more trouble. I have a daily steroid inhaler but I haven't been using that. Maybe I should be.

I should probably go see a pulmonologist to get a real diagnosis sometime.

Subscribed.

Still battling chest tightness and lung tickle and coughing with more intense activity. Got tested last year (when it was worse) and they did not diagnose me with asthma. But I am still curious and wondering why I have these sensations. Looking forward to reading more on this.

Had exercise induced when younger, though I don't seem to reach that threshold the same way now at 45. My lungs will burn after a harder run though.

When I was smoking I wound up on Singulair and Advair. I had horrible reactions to both and quit smoking and dropped the meds shortly after. Within a few months of quitting smoking my capacity was improved by a huge margin based on the historical data my pulmonologist had logged for me.

I started cycling again about a half year after quitting smoking. Aside from being generally out of shape, my asthma hasn't been a huge issue. The colder drier air setting in is causing some burn after a ride lately though, but not really a full asthma attack.

I keep a rescue inhaler around, mostly so I can get to sleep at night if the allergies set off wheezing. Day to day when up and about, it will only bother me under extreme dust or mold exposures and I can generally just wait out the attack once I get to clear air.

The worst attacks I ever had were when I discovered I was massively allergic to a new pet rabbit we had. I finally understood what it feels like to a severe asthmatic when they have an attack. Literally would wake up from a dead sleep and not be able to breathe...I nearly called an ambulance a few times. Asthma is not fun.

Just an FYI, if you are on the meds I described above and start feeling "odd", depressed, fatigued, generally horrible....you may want to talk to your doctor about dropping them. I felt like I had Lyme disease or MS or something and it was a reaction to those meds it turned out. Lot of bad symptoms for me from them.

BTW, this sounds almost exactly like exercise induced asthma, though maybe a mild case. If I hit my full threshold, I'll be out of air and get to a point where I'm almost barking to get air in. Most normal cases it's just lung burn, followed by some fluid congestion and a bit of a cough for a half hour after the workout.

My story is similar to yours. Childhood asthma due to parents smoking. Well, my mom stopped, my father stopped when he died of cancer.

Anyway, allergy shots too. Terrible allergies. 1-5 scale I was a 5 to EVERY GODDAMN THING.

As I aged stuff got better. By 20 I felt good, no asthma and moderate-to-sometimes-bad allergies. Around 27, the asthma came back a little bit. I got an albuterol inhaler "in case" and would use that before cold-air exercise to prevent onset of symptoms. I also religiously take claritin or allegra 24-hour tablets, once/day every day. There are still about 10 days in spring and 10 days in fall where my allergies are horrible. I use the albuterol in the morning and in the evening (1 puff only each time) to give a little clarity to my chest rattle and hope to prevent a real "attack".

I've never had it bother me cycling except in cold air, and usually after I warm up or do a hard effort or two it goes away. Intense effort seems to open my lungs rather than incite an attack, so I feel safe doing it. A couple of times I've asked around and usually like 1/15 guys around here (engineering and .com nerds) have inhalers so I don't carry one when riding. I may regret that someday, but it's been 20 years since I had anything close to what I'd call an emergency in re the asthma.

ohoh, I once got into a fight with a girlfriend because she had me pick up a friend of hers from the airport. Said friend had a cat and it ****ed my car for like 2 months with the dander.

Developed asthma in my early forties along with a severe allergy to perfumes or basically the chemical base in them. Had cats as a kid and early twenties but never had a problem and now have four dogs. I got tested and took allergy shots for nine years and a pulmonary specialist tired a number of medications until we hit on Advair. It is a miracle drug as far as I'm concerned. It is to prevent asthma attacks but useless once it hits. I used to live on albuterol and prednisone and maybe I might use the albuterol once a year if I get a bad cold. My doctor also advised if I was going to actively exert myself to give myself a couple of puffs of albuterol before the exercise so you might try that.

This is over a twenty year period now so I'm obviously sold on the benefits of Advair.

I've had asthma off and on my whole life including a few trips to the ER. Right now it is under control and as someone that has read thousands of pages of research on the subject, I'll impart what I know in a very long winded thread "soon". Be forewarned; some of it is voodoo alternative medicine that your doc will snicker at but it helped me.

Its nice to have an asthma thread, I'm tired of non asthmatics telling me they know what its like because they had a chest cold once, or maybe instead of trying to suck in air we should just HTFU.

My folks used to light up unfiltered Pall Mall's at the dinner table. During dinner.

I'm going to look into the Advair and the 24 hour allergy meds as well.

Claritin generic is super cheap. $.05/day.

amazon link

I was in my mid-20s and just getting into cycling when I started to get short of breath after really intense rides or going up big hills that before then I could just muscle up (full disclosure I had no idea what I was doing then). As it happens, it turns out I had a malignant tumor in my right lung. The docs didn't even think I was going to survive -- they all said I had at most five years to live. Happily, almost 25 years later, I'm still here, though I have but one lung. I definitely run into problems on the bike sometimes, particularly when I get a cold or allergy (cats kill me) and it's really hard for me to climb above only 1000-feet. I was told that the main problem is my inability to exchange air, that having just one lung makes it harder for me -- even though I use a lot more of my one lung that most people use of both of theirs (present company excluded I imagine).

However, I've been trying to do some research on it and have posed the question of whether I can improve my breathing and climbing and my intake/outtake through training. Looks like I'm going to get to go to a cycling camp in central California next year and my goal is to learn better ways I can use my one lung. I will say that despite being a bit of a wuss, I've climbed higher and ridden farther than I ever thought possible, having spent much of the first 15 years after having Cancer exercising like I had half a lung. I'm sorry it took me so long to realize I can do things I previously thought impossible.

I've had allergies my whole life but didn't figure it out until I was in college. I grew up with cats and smokers at home. Went the allergy shot route after diagnosis for several years which helped. I am allergic to maple, oak, grass, pine, all weeds, mold, mildew, with the tree stuff being a 5+ using a skin scrape test. When I started racing about that time, I remember having trouble breathing at the limits but I always felt that it was my aerobic fitness and strength being out of balance. I took up racing again in 2011, still struggling at the limits. During a hard, long effort I would get so out of breath that I came close to passing out. Recovering from a sprint took 2-3 minutes. That's when I decided to ask my doctor about it. She put me on Allegra 24 hour daily year round and an albuterol inhaler. It came with one of those tube things that make it easier to dispense like WR described above. 20 minutes before every hard workout or race, I take between 2-4 puffs. The bad side effect is that it makes my heart race. My HR will be 20-30 beats higher than a known output on the trainer. It calms down after a half hour or so, but if I don't time it right, it is racing at the line. There have been times in long races or rides where I took a puff on the bike, but only when the rasp is tight and I know that it will fix it. I have a standing offer to try a preventative but have declined so far. That is the next step.

Asthma and cats. Hate them both.

Occasional asthma my whole life (now 49). Not really life changing; I learned not to bail hay, not to mow the lawn, and to stay out of barns at a young age.

Since I've been cycling, which has been about a decade, my asthma has gotten worse. The theory is that cycling has increased my exposure to allergens.

During the spring and summer for the last few years I've been on Advair or Symbicort, but never had to use Albuterol; the Advair or whatever has controlled it.

This fall has been disastrous. I live in Boulder, and ever since the floods at the beginning of September, I've had the worst asthma of my life. Nothing has controlled it; even albuterol, while helpful, hasn't eliminated it. My CX season has been very disappointing...my max HR is probably about 8 lower than it should be, and I just can't fully respirate. No amount of warmup or albuterol has enabled really hard efforts.

The theory is that because of the flooding, there is a lot more mold around, including outdoors, because a lot of stuff is still moister than normal. And, there's a lot more dust, too, as cars drive over flooded stream deposits. Apparently most Boulder allergists' offices are busier than normal..

My doc says to wait for the first hard freeze...I'm holding my breath...(pun intended)...maybe I'll do OK in the last couple of races of the season.

Any other Boulderites out there also struggling?

Be wary of steroids. It caused me many problems, 35 pound weight gain in 4 month, hypothyroidism to go off the charts, sever cramping in numerous muscles to the point a had to stop riding even typing for more then a few minutes. I saw a natural path and she helped figure out the causes of the athma. I have had to change my diet and still use Ventolin occasionally. A natural product I have found to work really well is RespirActin.

We've had this discussion here several times - but no harm in re-visiting it.

Excellent information - thanks! I suspected there must be a better way of using the inhaler.

When you get it checked out again - have them look specifically for CVA - "cough variant asthma"..It's quite rare, but well known.

The cough-variant is what I have. It's induced both by exercise and cold / dry weather. The good news (for me) is that the exercise-induced symptoms only hit me when I stop riding - and I'm okay while riding. And it only happens in winter.

Now - I'm trying to persuade the pulmonologist to persuade my wife that we have to move south, to a climate that is healthier for my lungs! :D

My Exercise Induced Asthma was diagnosed in 2005. Since then it has progressed to be "Stress Induced Asthma" including both exercise and things like, say, Public Speaking.

There I was standing in front of an audience a few years ago giving a speech, and I couldn't breathe. I gasped my way to the end of the speech, and sat down. The audience was critiquing my speaking ability, and almost all of them said something along the lines of "There was a lot of gasping and wheezing going on". Yeah ... me trying not to faint from lack of oxygen.

Sounds like my symptoms.

Oh man! that sounds like the worse day ever...

I had EIA as a kid but seemed to grow out of it. No issues during my late teens, twenties and most of my thirties. Then out of the blue it returned on a ride one day. I think that like many, it was probably triggered by pollen. Anyway, I found that while albuterol was somewhat effective, it's short duration of action would cause me to wake up in the middle of the night feeling short of breath (never nice). I tried a steroid only controller which seemed a little better, but as noted above, Advair has completely cleared up my asthma to the point that I don't think about it any more. I do accept that my propensity to develop EIA likely increases and decreases with various triggers, but I'm more than happy to take it prophylactically and not worry about whether I might end up out of breath on a given day.

I'm asthmatic also. It was severe as a child, outgrew it for 50 years or so, and has come back in the last 10 years. It is well under control with a Symbicort inhaler but colder weather increases symptoms. But I'm still interested in the mechanics of breathing as I've learned from hiking in mountainous terrain that good mechanics can improve performance. A recent article in Velo News had good info on how exercise can improve oxygen up take. http://velonews.competitor.com/2013/...he-bike_306454 What drew my attention was muscle imbalances that effect breathing and oxygen uptake. That outlook fits in with what I've been learning recently about the mechanics of breathing.

Basically, while the diaphram is the primary muscle for breathing, the process is aided by the intercostal muscles spanning the rib cage. These muscles help open the chest on inhaling and to close the chest to exhale. The entire rib cage is crisscrossed with oblique bands of muscle, inside and out, that move the ribs to expand or contract. A simple experiment illustrates the effect. If you drop the chin and hunch the spine a bit and then inhale, air moves slowly and with difficulty into the chest. When you raise the chin and straighten the back, you can feel the chest opening up and air easily rushing in. The link shows what muscles to work on. Also I found a book "Yoga Anatomy" from Human Kinetics the clearly shows the mechanics of breathing and the muscles involved. http://www.amazon.com/Yoga-Anatomy-2...s=Yoga+Anatomy While VO2 max capacity is mostly genetic, it is clear oxygen uptake can be improved, even if only slightly, by strengthening those muscles involved in expanding the rib cage.

We are familiar with the athlete who after a hard effort is bent over double, hands on knees, trying to catch their breadth. This is a position I knew well as a child as it was the only position during an asthmatic attack I was able to sleep in. This bent over position is the one we typically see on a road bike. It gets weight over the pedals but also opens the chest for better breathing. Furthermore, a straight back helps maintain the chest cavity in the best position for both inhaling and exhaling. There is still a bit more to this breathing business so I can't recommend Yoga Anatomy enough, especially for asthmatics.

I had asthma when I was younger, it went away for a few years then came back. In the last few years attacks were common and there has been more than once where I took 16 puffs of the inhaler and nothing happened. The debate of 'Do I take another puff and risk a heart attack or risk passing out' were common. There used to be at least one attack each night. When it got bad nothing really helped.

I've been able to mitigate it and now its at the point were I may need it once a week if that.

Here's what I did (warning; some of this stuff sounds crazy)

• Reduced my triggers
• Got an allergy test. I was allergic to cat dander, grass, and dust mites.
• For dust mites I replaced my carpeting, and put hypo allergenic covers on my mattress and pillows. The couches are also leather. Anything that is fabric which dust mites or other insects can live in should be washable (and washed often). Any fabric not used often should be bagged in plastic.
• The other way to control mites is to keep the humidity under 50%, and use a HEPA Filter to clear the particles in the air. Since my area is fairly dry, I just use a filter. If I were in SF or Seattle, a dehumidifier may help greatly.
• Truth be told I recommend the above regardless of dust mite allergies. A carpeted, damp, fabricated house is an unsanitary house.
  
• Found the right allergy medication
• I used Claritin for years but it really didn't work. Tried Allegra and Zyrtec. For me Zyrtec works. Its good to try all three and see what works best.
  
• Trained myself to breath correctly (i.e. Buteyko)
• My breathing was erratic and took in much more oxygen than I had to, causing myself to hyperventilate. That is under control, greatly reducing my symptoms.
• I learned to use my diaphragm instead of my chest to breathe. It did not feel right initially but breathing via the diaphragm helps. I used to breathe using the chest and once I stopped my asthma was reduced greatly.
• Almost exclusively breathe with the nose. I won't open my mouth to breathe unless my HR goes over 140. In addition to helping hyperventilation, it filters allergens.
• When sleeping, I would almost always get attacks. What helped was making sure to breathe out of my nose while I slept. If I woke up and noticed any symptoms of mouth breathing, I would tape my mouth shut, forcing myself to breathe out of my nose. Its something that usually has to be done for a few days then its not needed.
• Essentially, I just breathe less now. In fact when I do feel an attack coming on a few controlled pauses in my breathe help. Right now I can 'pause' my breathing for 35 seconds. Before I couldn't do it for 10.

If anyone wants info on the breathing technique I can forward the book / video I used, but I'm not going to promote the product here.

I have to agree with the Ferret on technique. The time honored way of dealing with health issues by relying only on chemicals needs to be modified by adding in better behavior. I have been learning to breath through the nose even when climbing and O2 is harder to come by. To my great surprise it works almost all the time unless I'm near the limit of aerobic capacity, then I breath through the mouth for a short time.

Coordinating the pedal with breathing also helps and this also helps high altitude mountaineers on Everest. Opera singers also pay close attention and work on breathing with the diaphram, both to increase oxygen uptake and voice control.

I didn't read all of the posts in this thread but thought I'd chime in that after losing alot of weight and becoming much more fit from riding my asthma that I've suffered with for years was no more. After regaining some weight due to temporary illness, it returned.