Riding/Training with Asthma?

Hob Nob

As i'm sure there is lots of you out there, as a newly diagnosed 30 something, i'm after some advice really.

I've recently been diagnosed with it, and just got my little blue puffer. Asthma doesn't affect my day to day life much, apart from the occasional tight chest/annoying cough moments, which the inhaler pretty much instantly cures which is a novelty!

However, today was the first time I have used it when riding. I took a puff before I left for work this morning, and off I went. After my gentle spin up the hill outside my house for the warm up, I took up a reasonable pace (so I don't thrash myself on the way in - probably a level below tempo). I noticed almost straight away my heart rate was elevated compared to what I would have previously considered 'normal'. Yet this didn't feel uncomfortable, so I carried on. It pretty much stayed the same all the way in (50 mins/24k).

However I felt very different, what i'm trying to find out, is if this is normal! I seemed to be able to operate up and around ~170bpm and feel alright, whereas before I would be fairly uncomfortable. I also experienced for the first time my legs giving up before my lungs.

My doctor/asthma nurse are fairly useless, as I clearly don't fit in the generic '30 mins a day walking exercise' box so they can't really tell me how it will make me feel or what I should expect.

I guess i'm after a bit of reassurance that i'm not going to collapse at the side of the road all of a sudden. I can't imagine I will, as i've made it over 30 years already, but it would be nice to know what to expect & how it may affect me (or if i'm lucky, improve things!)

ut_och_cykla

My memory says that daughters asthma medicine gave raised heart rate generally - not just when exercising and legs giving up before lungs would make sense if lung function has been a limiter until now. So pretty normal but you shoul d probably put some energy into finding out more about the stuff you are taking - isn't there a asmthma nurse or someone you can speak to? Ask your GP!

themogulman

My asthma gets worse in the winter and early this year I was suffering massively.
First I would ask the GP for a preventitive inhaler(brown) and I wouldnt use the blue before exercise.
Second take some high quality fish oil capsules as there is some evidence to suggest the anti inflammetory benefits can help reduce the need for the blue inhaler.

Since doing this I have only needed the blue inhaler on a few occasions.

Good luck.

ut_och_cykla

Yeah +1 for Omega 3 capsules & vitamin C - seemed to help my daughter too!

dw300

Mines very mild now, was a lot worse when I was young. I tend only to have problems when I'm congested after a cold and the congestion is bothering my airways. Sometimes hayfever symptoms can cause a tightness too. Dust, grass, pollen .. once you know you can try to minimise these things.

If I'm having to use the blue inhaler one an almost daily basis during a bad period, i'll just take it prior to starting, which usually does the trick. Sometime i'll take it during a ride if necessary, but again, that's usually the problem solved.

One thing you'll need to get used to is just getting to know the patterns of onset. ie. Will it get worse with continued exercise or simply stay at the current level. You don't want to risk a full blown attack that requires a blue ligt run to the local casualty. I know from cycling having forgotten my inhaler, that I can still pedal as fast as the air I can breathe in will allow me .. I've wheezed my way through the last 30 miles of a ride before due to absent-mindedness, but at least I know I dont need to worry about aggravating it by pushing on through it.

It's just like breathing whilst having a guy stand on your chest, and the intensity of the attack is like the size of the dude. Sometimes you'll have a little Jack Russell on there, sometimes Eamon Holmes.

I've heard people say that onions help .. not sure if they do, but I like them!

Cookie91

Well this is an appropriate situation for why i study respiratory physiology at uni

Basically your doctor or nurse should of told you the side effects you may experience. Without boring you with details though the blue inhaler (Salbutamol) binds to the muscle in the airways causing it to relax, however it also has effects on the heart which include the increase heart rate, and sometimes people get muscle tremors.

None of these are anything to worry about, if anything salbutamol would aid performance, hence why stronger beta-2 drugs are banned in cycling.

If your still finding your asthma hard to control go back to your doctor and ask about a preventative treatment rather than a quick fix, or if your having no problems with the blue inhaler just continue as you are.

StillGoing

This is interesting. In my life I've had two doses of mild pneumonia and three bouts of severe bronchitis. When cycling I regularly run out of puff despite my legs feeling ok. Even on hills the limiting factor is my ability to breathe as the legs feel fine. Someone suggested I might benefit from an inhaler as the lungs may have been damaged with the infections but I always laughed it off. Might have to revisit this after reading other's experiences.

cyco2

I have been using the 'blue' for many years and have found that without it I cannot exercise at max which I believe is one of the reasons for a lower heart rate.
I found that I was using the inhaler erroneously as well because I thought that I should only use it when needed, i.e. just before when more effort was needed during a ride. This was because I didn't know how long the enhanced effect would last. During a race I used it several times. Later a nurse told me 2 1/2 hours was the effective duration but for me not at race pace.
However, this is what I have found. I now use the inhaler before I start riding because it has a greater chance of getting in to the tiny airways. Because although I didn't feel it, once I had started riding, the airways with the heavier breathing were starting to inflame.Therefore the inhaled 'gas' would not be able to penetrate so far. Because I ride so much it may pay me to go on to the 'brown' inhaler.

themogulman

Just to add to my previous post.

My exercise induced asthma was increased with cold/dry air, pollen and pet allergy(the cat sleeping on me all night before a big ride!).

The brown inhaler has solved all my problems and I cant recommend it enough. There are some long term health issues in taking a blue inhaler frequently(wikipedia it I cant remember). Plus the fish oils help with lots of other things not only a possible asthma benefit.

Slack

Similar story to others really.

Having been diagnosed with asthmatic tendencies 20 years ago, all I take are two puffs of the blue inhaler before exercising. I don't have a heart rate monitor, so can't comment on whether it affects my HR or not. All I can comment on, is that I am still alive 20 years on.

Nowadays, I only take the inhaler if I am expecting to be out for a beasting. For steady mileage riding I don't bother. You will in time work out what triggers your asthma symptoms and act accordingly - riding hard in cold dry air, before warming up properly is a classic one for triggering the symptoms.

Hob Nob

Thanks for the advice everyone.

I have tried a bit of Googling obviously there is a lot of information out there, but I find it always helps with first hand relevant experience with others who are maybe riding as much as I am.

I'm certainly noticing a higher HRM, both on average & peak. Also worth noting I felt a bit 'jittery' with exercising as well (I play county league squash to quite a high standard so a lot of anaerobic stuff, wouldn't normally feel nervous but last night I did).

It's done some strange things to me when I ride as well, now i'm starting to build up a pattern. I have noticed anything at an aerobic level I feel fine at, and can seemingly push a bit harder than previously, yet once I go anaerobic, I go pop way quicker than previously. I will speak to the Docs ref this, but I am initially putting it down to my lungs working differently now & it's just going to take a while to settle into the change.

Lastly, looking at it from probably the wrong perspective, but once I manage to gain some control of the situation, learn about my triggers, what works for symptoms etc - from a performance perspective if I carry on as I am with treating as I go & having a puff prior to exercise (or going onto the brown daily) can I expect to see some improvements? I would assume as my body is working as it should, I would be more efficient & 'better', for want of a description.

Will also get onto the Omega 3 & Vit C as well, i'd rather put natural stuff in me when I can

Cookie91

Hob Nob wrote:

Lastly, looking at it from probably the wrong perspective, but once I manage to gain some control of the situation, learn about my triggers, what works for symptoms etc - from a performance perspective if I carry on as I am with treating as I go & having a puff prior to exercise (or going onto the brown daily) can I expect to see some improvements? I would assume as my body is working as it should, I would be more efficient & 'better', for want of a description.

Do you mean that the medication you take would make you better than if you didnt have asthma ever? (answer is no) Or do you mean that once under control you can progress just like you would normally? (answer is yes)
One thing worth pointing out, is that the airways are hypersensitive and are therefore more prone to producing more mucus than required. This makes you more prone to chest infections so make sure]that you keep an eye on any symptoms for a chest infection.

themogulman wrote:

The brown inhaler has solved all my problems and I cant recommend it enough. There are some long term health issues in taking a blue inhaler frequently(wikipedia it I cant remember). Plus the fish oils help with lots of other things not only a possible asthma benefit.

Firstly, the brown inhaler isn't for everyone (nor is the blue). Do you have any papers to justify the long term effects of salbutamol (blue) or is this just chinese whispers, the airways do become less sensitive to the blue inhaler as we get older yes, but that happens to everyone regardless of whether we take it or not.
Also the brown inhalers as im sure you are aware contains a steroid which is more prone to long term effects.

themogulman

I took part in a guy doing a trial on people with exercise induced asthma. It was at Nottingham Uni. It was for his final year uni course dissertation.

He was trying to see if using high quality fish oils as a substitute was effective.

Just check Wiki if you want to know more. I am no quack. But the advise I have recieved from medical people have been that extended use of the blue is not a good path to take.There is a huge amount of stuff online about the issues of long term use of the blue inhaler.

Is it better to take 1 dose of brown to prevent or 4+ to cure? I know which way I would go.

TheEnglishman

I suffer exactly the way you do and 1 brown is simply the best. Or 2 brown if I'm not controlling my asthma symptoms with 1.

If you asthma is controlled you shouldn't have any attacks - you should just be like anyone else.

So, brown all the way.

AlahDamIt

Not sure if it helps, Ive had asthma for about 20 years, Im crap at remembering to take my preventative inhalers. I only really got into road cycling this year. What I tend to do is take a couple of puffs whether I need them or not before I go out and im ok no issues. If I don't I start to wheeze. My asthma is normally triggered in the autumn or laughing or drinking, so I get through lots of blue inhalers. May be I wouldn't If I remembered to take the pink ones I should take :roll: .

dw300

And remember to take the inhaler properly, not like you see in TV dramas .. you're suppose to inhale deeply and hold your breath for up to 30 seconds. If you breathe it all back out again a second later then it won't do as much good.

kathrynwhite

I had asthma as a child and have recently got an inhaler again due to sports-induced asthma.

I've found that GPs aren't great help in dosage during sport. One of mine suggested "after a mile of cycling". I don't think taking a puff every 4 minutes would do me much good.

I take a puff or two before I leave to go cycling/running (as the GP recommended) and then again if I feel my chest getting tight. Also, before a large hill I tend to take a puff (this might just be psychological preparation but I did see some do it on the Tour as well).
I have experienced higher heart rate too, glad I'm not the only one!

I think I prefer the blue inhaler to having to take a steroid brown one every day. I don't like the thought of always having that in my body. Also, as a child I was horrifically bad at remembering to take the brown one.

As a child I would use my inhaler before and during cross country races and then before and at half time in rugby matches.

Cookie91

themogulman wrote:

Just check Wiki if you want to know more. I am no quack. But the advise I have recieved from medical people have been that extended use of the blue is not a good path to take.There is a huge amount of stuff online about the issues of long term use of the blue inhaler.

Is it better to take 1 dose of brown to prevent or 4+ to cure? I know which way I would go.

Wikipedia is not medical evidence that salbutamol has long term adverse effects, however if you wish to be that way. Infact the brown (steroid) inhalers can give some long term adverse effects to some people.

Yes the one dose of brown works for YOU, doesn't mean that it will work with someone else. Our bodies are all different, and you are not a medical professional and therefore you should not be whistle blowing random chinese whispers you have picked up from wikipedia.


Hob Nob in response to your original query, i would advise that you take medical advice with a pinch of salt from the internet.


The mogulman im still waiting for this bombardment of medical papers to say why the blue inhalers has long term adverse effects.

themogulman

Cookie91.

Whats the beef?

I stated also that there is a huge amount of stuff online also, and as I have a life the "bombardment of medical papers" will not appear.

I posted to give MY experience and MY advice and also stated i am no quack. Get over it man and move on to your next mission in life.

Cookie91

themogulman wrote:

Cookie91.
Whats the beef?

I stated also that there is a huge amount of stuff online also, and as I have a life the "bombardment of medical papers" will not appear.

I posted to give MY experience and MY advice and also stated i am no quack. Get over it man and move on to your next mission in life.

I appreciate you sharing your experience of the condition, however you should not deter people from using certain medications, or i wouldn't take that i heard this i heard that etc...

fastandfurry

themogulman wrote:

The mogulman im still waiting for this bombardment of medical papers to say why the blue inhalers has long term adverse effects.

There is clear evidence that long acting beta-agonists (e.g. Salmeterol) kill some people with asthma...http://www.clinicalcorrelations.org/?p=144

There is no clear evidence as to the mechanism (i.e. why this happens) that I'm aware of, but it seems likely that by repeatedly hitting the same receptors in your lung (the beta - 2 receptors which are responsible for opening up your airways in response to adrenaline), that over time these receptors become less sensitive, so if nothing is done to treat the underlying asthma (e.g. by using corticosteroids) then when you have a serious asthma attack, your body is less responsive to the adrenaline that you will naturally produce to try and open your airways, and to the rescuse medications (usually salbutamol) which both use this receptor.

The 'blue inhaler' (salbutamol/ventolin) is a short acting beta-agonist working through the same pathway, so you might expect that heavy repeated use (i.e. multiple puffs at several points during the day every day) would have the same effect. This is why doctors will advise you to go and speak to them if you are using it regularly.

Having lived and trained with asthma since age 16 (that was quite a long time ago now!), I would recommend taking your asthma seriously and keep on pestering the doctor until you feel that your symptoms are properly controlled, as it can be very debilitating - disturbed sleep, feeling distracted at work, and, of course, the effect on sport and the risk of dieing in extreme cases.

Doctors will usually start off by giving you the cheapest medications first, and then escalate depending on how your symptoms progress, however, many doctors do not understand asthma in combination with sport well - I was told that I was 'probably just unfit' at one point, when I was training ~ 20 hours a week for rowing! A VO2 max test soon settled that and my medication was escalated.

themogulman

Thanks fastandfurry.Just to clarify that was Cookies post.

Cookie happier?

If people post on a bike forum they are probably not looking for an expert medical diagnosis but maybe other peoples experiences.

In my first post I said"go and see the doctor" if the doctor did not feel that a brown inhaler was suitable they would not prescribe. I also suggested a completely different way of control through fish oils.

giant_man

Had asthma since a kid, nearly died when I was 10, took up cycling 20 years ago, helps enormously with my breathing.

Still use an inhaler when I need to, cold snaps are not good nor is choking or laughing a lot would you believe, something silly will set it off, but as I say, suffering a lot lot less since I've cycling ....

Tom Butcher

My daughter recently had shortness of breath on a bike ride - wasn't a particularly hard ride so it seemed unusual. Turned out she'd had a similar episode in a cyclocross race and then a few weeks later she had another on a fairly leisurely ride with me and her brother. Something obviously wasn't right so I took her to the GP who gave her a blue inhaler.

Since then she's had another episode during her last cyclocross race on the first lap so we pulled her out.

I've noticed she breathes almost exclusively through her mouth - I'm encouraging her to breathe through the nose but she says she feels she can't get enough air in - this is in everyday life not just exercise. She also seems to have difficulty breathing deeply. Only noticed this when she was using the inhaler - she seems just to take the air into the mouth rather than down into the lungs.

Do people think I need to go back to the GP with her. The last attack was after she'd used the inhaler but as I say I'm not convinced she is actually taking it into the lungs. At the moment I'm thinking just persevere trying to get her to learn to take deeper breaths using the diaphragm and keep encouraging her to shut her mouth and use her nose to breathe. She only ever has these episodes cycling - she plays football and can run herself into the ground doing that without shortness of breath and previous to this year had never had a problem on the bike either.

Trev The Rev

Tom,

If she has no problems running about playing football it could be she gets anxious cycling. She might be very keen to perform well for her Dad and / or herself, which might make cycling stressful for her. Thinking about breathing might cause anxiety in itself. Running about playing football she won't be thinking about breathing and will be more relaxed.

Trev.

Cookie91

fastandfurry wrote:

themogulman wrote:

The mogulman im still waiting for this bombardment of medical papers to say why the blue inhalers has long term adverse effects.

There is clear evidence that long acting beta-agonists (e.g. Salmeterol) kill some people with asthma...http://www.clinicalcorrelations.org/?p=144

There is no clear evidence as to the mechanism (i.e. why this happens) that I'm aware of, but it seems likely that by repeatedly hitting the same receptors in your lung (the beta - 2 receptors which are responsible for opening up your airways in response to adrenaline), that over time these receptors become less sensitive, so if nothing is done to treat the underlying asthma (e.g. by using corticosteroids) then when you have a serious asthma attack, your body is less responsive to the adrenaline that you will naturally produce to try and open your airways, and to the rescuse medications (usually salbutamol) which both use this receptor.

The 'blue inhaler' (salbutamol/ventolin) is a short acting beta-agonist working through the same pathway, so you might expect that heavy repeated use (i.e. multiple puffs at several points during the day every day) would have the same effect. This is why doctors will advise you to go and speak to them if you are using it regularly.

Having lived and trained with asthma since age 16 (that was quite a long time ago now!), I would recommend taking your asthma seriously and keep on pestering the doctor until you feel that your symptoms are properly controlled, as it can be very debilitating - disturbed sleep, feeling distracted at work, and, of course, the effect on sport and the risk of dieing in extreme cases.

Doctors will usually start off by giving you the cheapest medications first, and then escalate depending on how your symptoms progress, however, many doctors do not understand asthma in combination with sport well - I was told that I was 'probably just unfit' at one point, when I was training ~ 20 hours a week for rowing! A VO2 max test soon settled that and my medication was escalated.

Ah you see the salmeterol inhalers is not the blue inhaler (salbutamol) as we were discussing, yet again people twisting things to suit their debate.
Also i do believe that i mentioned that the beta 2 receptors loss their responsiveness to agonists with age. Whether this is accelerated with medication is not clearly defined.
Another thing worth mentioning, even salmeterol is not a direct link to death or any adverse effect, there are numerous other short acting relievers out there which would relive symptoms of a severe asthma attack that would otherwise leave to death.


Anyway, i do agree with what you are saying about other inhalers such as corticosteroids, or oral tablets such as montelukast (very good for effort induced asthma) in controlling the asthma, and other medications such as symbicort. I was just stating that one routine and drug may not work for EVERYONE. I have just been stating facts, not opinions.

Oh and before anyone wishes to be completely anal about it, yes if you take a nebuliser of salbutamol repeatedly you will induce yourself into a heart attack, (this is an overdose though, not a direct negative effect from normal repeated use)

maglianera

As a "crap GP" and also mild exercise induced asthma sufferer here is my opinion. The British Thoracic Society's guidelines state that mild or exercise induced asthma is treated with a short acting beta agonist such as salbutamol in the first instance. The OP's symptoms sound mild. If the pattern is in keeping with exercise induced symptoms I would advise 2 puffs before exercise and that it can be repeated if necessary during the exercise.
The side effects of salbutamol include tachycardia and tremor but are usually dose dependent ie the more you take the worse the side effects.
Steroid inhalers- brown ones, can be used if symptoms are not controlled on salbutamol as required. However if symptoms are only an issue when exercising a preventer or brown inhaler is probably not indicated unless symptoms are very severe. Before going down that road I think I would need to clarify exactly whether the symptoms were only asthma related or if there were other causes such as poor conditioning or a cardiac cause or other respiratory cause for shortness of breath.
It may be that I take more of an interest in issues like this with my patients as a cyclist myself but I think most doctors would take the same approach.

Hob Nob

Just as an update.

I went last week for a Spirometry with reversability testing. I haven't got all of the actual numbers to hand but with the various breathing tests I can remember:

Pre inhaler my lung capacity is 76% of the average for my age/height/weight, then after the controlled dose of blue inhaler in a spacer device thing with a retest I went up to 105%.

Got another appointment with the doc in a couple of weeks, but initially they think I will need to go on the preventer inhaler as well.

QUestion is, how bad is it? Numbers are great but i'm not really sure what it all means, apart from my lungs are almost down 25% on power?

Cookie91

Hob Nob wrote:

Just as an update.

I went last week for a Spirometry with reversability testing. I haven't got all of the actual numbers to hand but with the various breathing tests I can remember:

Pre inhaler my lung capacity is 76% of the average for my age/height/weight, then after the controlled dose of blue inhaler in a spacer device thing with a retest I went up to 105%.

Got another appointment with the doc in a couple of weeks, but initially they think I will need to go on the preventer inhaler as well.

QUestion is, how bad is it? Numbers are great but i'm not really sure what it all means, apart from my lungs are almost down 25% on power?

Unfortunately there is a lot of values which we look up to classify severity when it comes to reversibility. Ideally you need to know the FEV1, FVC and the FEV1/FVC ratio.
Lung capacity (volume) increase that large would suggest a significant response however you do need to know the FEV1 to classify this. The increase in volume is likely to be due to be from relief from gas trapping.

25% on volume does not mean 25% on power. Fortunately someone with small lungs can be more efficient than someone with large lungs, therefore size is not everything.

My advice, be patient and wait to see what the doctor says. Putting you on the preventative is the next stage on the British thoracic societies guidelines that 'maglianera' mentioned.