Hill Climbing with Asthma

kingrollo

I have asthma since I was kid. I haven't had a full blown asthma attack for over 40 years though. It get bad (ish) when I have a cold or flu - but thats about.
When cycling, especially in the winter months I have to take it easy for the first 20 mins or so - but then Im ok - except when it comes to hills - where it absolutely kills me ! - I really grunt up the hills - and ain't good for much when i get to the top !

My peak flow tests are pretty poor - Im nearly always asked to repeat them ("Im sure that can't be right - lets try again")

I use brown and blue inhalers

Anybody else struggle like this ? - what can be done ? - if anything !

964cup

We need a sticky for this; it seems to come up more and more frequently.

If you're still on Beclomethasone (Becotide, the brown inhaler) and Salbutamol (Ventolin, the blue one) then you're on old-fashioned medication. Get a referral to a proper consultant asthma physician. You should be looking at a combined therapy - either Serevent, which combines fluticasone (steroid, like your brown inhaler, but a better one) and salmeterol (long-acting beta antagonist, like a slow-release version of your blue one), or Symbicort which combines a different pair of steroid and laba (budesonide and formeterol). You could also try montelukast (aka Singulair) which is a leukotrine receptor antagonist, which may help to control your asthma, and potentially a nasal spray like mometasone or beconase if the physician thinks your nasal mucosa are also implicated. Other things to talk to the physician about are:

Dymista (a magic bullet for some, did nothing for me)

Uniphyllin (theophyllin) - can be very effective, but may have side effects. I hated it, even though it probably worked, as it gave me headaches. It also needs careful monitoring of concentration in your blood (and its effect on other blood values) which under the the NHS was not good in my experience.

Omeprazole - this is a proton pump inhibitor, used to treat gastric reflux and heartburn, but reflux can be a contributory factor to airway irritation. It certainly works for me.

The key thing is to demand proper treatment, and not let yourself get fobbed off with some antiquated nonsense from your GP. I've been asthmatic since I was 2, including a collapsed lung and all sorts of childhood nastiness, but becoming a self-educated bolshy patient in my thirties, and insisting on proper treatment, was a revelation. My pf is now around 630 (and won't get any better thanks to airway remodelling, sadly), I have no symptoms most of the time, and I'm as happy on hills as my general fitness (and hobnob habit) allows.

For reference, I'm 47, 185cm, 80kg. I'm on:

Symbicort 400 2 puffs twice a day
Mometasone nasal spray one puff each nostril twice a day
Montelukast 10mcg once daily
Omeprazole 20mg once daily

I haven't had to use a salbutamol inhaler (the blue reliever you take when you're feeling breathless) in as long as I can remember. [Disclaimer: I am not a doctor. Your mileage may vary.]

nicklong

Really interesting. I've been treated in both UK and France and still just ended up on Becotide and Salbutamol. Although they did say that I should take anti-hayfever meds throughout the summer.

I always take 2 blue puffs before going out on the bike - felt a bit self conscious doing it before races due to accusations of doppage, so used to do it in the car serendipitously! It helps calm me though (placebo?).

kingrollo

Wow thanks 964 - thats a really comprehensive reply.

Im just returning to cycling after an injury enforced break. At the back of my mind is the thought how much is down to not being fit enough. I was up to around 100 miles a week - but now dropped down to 50-60 in the winter - I have no aspirations to be a racer - I would like to break past the 15-16mph average though.

The other dilemma is my peak flow - which from memory is around 160 - is this down to poor technique using the flow metre - or is it really that crap - I suspect the later.

The initial asthma check at my GP is done by a nurse - these are so generic I have refused them for a number of years - leading to many runs with gp (my depression & anxiety has impacted of my life more than asthma - yet they offer nothing for that - but keep badgering for an asthma check!) - I guess I am going to have to eat humble pie....

Anyone ever tried these powerbreathe devices ?

diamonddog

I developed' 'late onset' asthma at 49 until then no signs and always active and healthy. I tried a lot of the meds mentioned above and some gave me bad side effects so I am on becotide, salbutamol and mometasone nasal spray as per the specialist. Some sufferers also need a small controlling dose of prednisone perhaps 5mg daily others may need a higher dose but they can have bad side effects if on a regular high dose. TBH I have periods when the salbutamol isn't needed, I take it before a ride if required and I have never needed it during or after a ride.


When in good health I find I have no particular problems on the hills and can usually push a hard pace. I can tell if the asthma is starting to kick in due to a cold etc as I do a short turbo warm up before the ride, I have often tried to push through it and done a ride but find that to be of no value whatsoever and finish off cutting the ride short.

diamonddog

Sorry just to add, as others have mentioned if you feel the need demand to see a specialist, it could help your condition.

964cup

PF of 160 is terrible. See http://www.asthma.partners.org/NewFiles/Appendix2.html. You should be at least above 500 if properly medicated (I'm obviously making assumptions about your gender and height, of course). In an adult male, a genuine 160 would mean hospitalisation and a nebuliser. If you can cycle at all your true PF must be higher than that, so technique may be playing a part. It's another reason to go and see a specialist, as they'll do some proper tests - you should ask for a lung function test; for them to do some bloods; and to see the asthma physio, who will teach you some proper breathing techniques. If you're producing any phlegm you should get that tested too, for infections including NTM (non-tubercular microbacteria) and aspergillis.

Where do you live?

I left oral prednisolone out of my meds summary because I'm not a fan of it when used prophylactically - the side effects, even at low doses, are considerable. On the other hand, if you're at a PF of 160 I'd expect your doctor to have put you on 8 days of pred at 40mg/day just to see if they can relieve your airways (again gender/age/weight assumptions apply). Another way to tell if your GP has been paying attention is to see if, when prescribing prednisolone, they give you a reducing dose (40mg for two days, then 30mg for two days and so on) or the full dose for the whole period. Reducing doses are old school.

There's some exciting stuff coming - thermoplasty, vagus nerve ablation - which promises surgical "cures" for asthma, and a new wonder drug (calcityrol) in testing, but in the meantime I'd focus on getting the right treatment. Don't be afraid to make a lot of noise about it.

As before, I am not a doctor - I'm talking from my experience, not giving qualified medical advice.

964cup

ETA - get a peak flow meter (they should have prescribed you one, but they're buttons to buy), keep it at home, use it twice a day, chart the results. It'll help you quantify how you feel, and give you clues about what provokes your asthma, and it's very useful data to take to a proper chest physician.

kingrollo

964Cup wrote:

PF of 160 is terrible. See http://www.asthma.partners.org/NewFiles/Appendix2.html. You should be at least above 500 if properly medicated (I'm obviously making assumptions about your gender and height, of course). In an adult male, a genuine 160 would mean hospitalisation and a nebuliser. If you can cycle at all your true PF must be higher than that, so technique may be playing a part. It's another reason to go and see a specialist, as they'll do some proper tests - you should ask for a lung function test; for them to do some bloods; and to see the asthma physio, who will teach you some proper breathing techniques. If you're producing any phlegm you should get that tested too, for infections including NTM (non-tubercular microbacteria) and aspergillis.

Where do you live?

I left oral prednisolone out of my meds summary because I'm not a fan of it when used prophylactically - the side effects, even at low doses, are considerable. On the other hand, if you're at a PF of 160 I'd expect your doctor to have put you on 8 days of pred at 40mg/day just to see if they can relieve your airways (again gender/age/weight assumptions apply). Another way to tell if your GP has been paying attention is to see if, when prescribing prednisolone, they give you a reducing dose (40mg for two days, then 30mg for two days and so on) or the full dose for the whole period. Reducing doses are old school.

There's some exciting stuff coming - thermoplasty, vagus nerve ablation - which promises surgical "cures" for asthma, and a new wonder drug (calcityrol) in testing, but in the meantime I'd focus on getting the right treatment. Don't be afraid to make a lot of noise about it.

As before, I am not a doctor - I'm talking from my experience, not giving qualified medical advice.

It might not be 160 - its years since I have been. I am pretty much symptom free except for going uphill. When I am tested for PF they are very concerned - they ask 'can you run up a flight of stairs' - when i tell then I cycle with other cyclists for around 50 miles they are amazed - they they say its PF technique - that fits given how well I am.

I am going to book an asthma check soon (just getting over a cold) - but yes you can get a PF meter for £8 which might be a sound investment...

The Rookie

My PF stayed above that when I was hospitalized with pneumonia, I'm pretty sure it will be above that.

Maybe look at your cadence, climbing at a high cadence is better for your muscles but requires more oxygen, slowing the cadence a bit will reduce your Oxygen demand.

kingrollo

The Rookie wrote:

My PF stayed above that when I was hospitalized with pneumonia, I'm pretty sure it will be above that.

Maybe look at your cadence, climbing at a high cadence is better for your muscles but requires more oxygen, slowing the cadence a bit will reduce your Oxygen demand.

Im reckon the cadence is slow enough to be honest !

The Rookie

OK, was just something to consider.

mac9091

Glad i clicked on this. Cheers 964cup according to the Appendix i have a normal PF of a 55 year old and im only 30, clearly my meds are not working.

I have been on the same meds Becotide (2 puffs twice a day) and Ventolin (2 puffs as and when required) since i was diagnosed about 10 year ago and being in the military have been in a constant fight not to be kicked out. Clearly they are not managing me correctly as nothing has improved although id say i have a mild case and my last full blown asthma attack was years ago and have only had to nip into hospital on a couple of occassions for a go on thier nebuliser.

Will probably get fobbed off about seeing a specialist and i doubt i'd get to see Col Duncan Wilson but i can try.

As for the OP: I'm built for climbing (60kg on a good day and 5ft 9in) i've seen videos where one claim its better to keep a high cadence and stay seated and another one claims its better to stay in a higher gear and stand. Vids can also be found to argue that seated or standing is better on long and/or short hills, its whatever is comfortable for you at the time.

I tend to start seated, attack standing in the middle and return seated for a bit before attacking the top. Cadence seated is over 100 and standing i try to stay between 60-65.

Overall i'd be inclined to stick it to you and say your unfit (with regards to climbing) and trying to push yourself too hard up the hills. Do you do much climbing? and do you push yourself hard up most climbs?

964cup

@mac9091 - push your MO to change you to a combined therapy - try Serevent. Should mean you don't need the Ventolin, and the science says that the combination of steroid & LABA in the same inhaler has a synergistic benefit.

WRT climbing the issue for asthmatics is that the standard advice of balancing cv load against muscular load is harder because we can end up with oxygen caps as we bronchoconstrict under stress; IME this is worse when riding above FTP. Standing at low cadence may help move the stress to the legs and give the lungs a chance to calm down; so, of course, does just changing to an easier gear and slowing down. Ultimately, subject to any other issues like airway remodelling, allergic response, bronchiectasy, COPD or persistent infection, it is of course still about fitness.

If your doctor hasn't/won't talk to you about the other issues I listed, get a better one.

kingrollo

O/P Here,

Peak Flow meter arrived today - my best reading was 250 !

Obviously some of this may be down technique - so intend to practice a bit before booking in with an asthma check. The asthma check at my GP practice isn't best - basically a nurse reads a script about asthma - takes you weight and peak flow -

I think I need an action plan to get this sorted - I need to research the inhaler types based on 964cup posts at the start of this thread - is it just trial and error - ? or are there types of asthma

basically I feel fine - but just can't go hard at anything without incredible lung tightening - although I rarley go into a full blown asthma attack (like never actually)

964cup

kingrollo wrote:

I think I need an action plan to get this sorted - I need to research the inhaler types based on 964cup posts at the start of this thread - is it just trial and error - ? or are there types of asthma

There are types, and a variety of causes. You need to get away from the GP and get a referral to a proper asthma medic. Nurse should accept that you have a serious issue if your PF is really only 250.

eric_draven

I had Asthma up until being about 15/16,it then returned in my late 20's,would cripple me at climbing,also couldn't hold my breath as long when surfing when getting a pretty heavy drubbing underwater,I was prescribed Ventolin used to use this before exercise and when i had a cold,it did work to a degree but still wasn't great,4 years ago I started to have a medical at work now every year,i was given a lung function test,and was told I had the lungs of a 74 year old at 38,I went to the doctors to have this checked and was sent to an asthma clinic,i was prescribed Symbicort 4 doses a day 2 on a morning 2 on a night,went back to the doctors after 4 weeks and my lungs had improved massively,my breathing has improved no end still not perfect,but without it I would not of contemplated going to the alps with a road bike like i have on my last 2 trips