Cycling with Asthma

trek_dan · August 2018

About 6 months ago I went to my GP after experiencing breathing difficulties, eventually culminating in me collapsing during an XC MTB race which I stupidly entered even though I knew I wasn't right. Initially was diagnosed as a chest infection (twice) and was given antibiotics but knew something was up when the symptoms didn't get any better. Still don't have a firm diagnosis but was initially believed to be caused by Hayfever Induced Asthma but now GP thinking it may be Adult Onset Exercise Induced Asthma.

I was somewhat surprised at the Asthma diagnosis as it literally seems to have come on overnight. However on the breath puff-measuring thingy, I showed a 15% improvement when using the blue inhaler. Have since been using a brown inhaler morning and night - it does help, but not entirely and if I push myself any harder than a bimble pace (or any pace at all on a climb) I feel as if my throat is about to seize up and I just can't draw enough breath into my lungs again. Which usually leaves me in bits at the side of the road clasping for the blue inhaler from my jersey pocket. I do crossfit and same thing happens in those classes. Usually I'm OK to continue after blue inhaler but my performance is not good at all.

Very disconcerting as I've gone from last winter being top 10 in local CX races, and while I've never been a strong climber being able to do OK on the road bike club runs but now I'm off the back immediately and any longer climbs I'm stuck at walking pace. Longer rides I still seem to do OK if I ride at my own pace as my endurance is still reasonable but like I said my climbing is slow. I couldn't imagine doing something strenuous like a CX race again.

Has anyone else experienced this? I'm thinking I need to start building my fitness up again slowly over time and stop pushing myself on what I 'used' to be able to do. I'm 31 and apart from being a little overweight (mostly due to not being able to exercise properly all summer) otherwise in good health. Just feels like its too early to throw the towel with cycling and retire to the back of the group on the old boys club run

arthur_scrimshaw · August 2018

It may be that you have not yet found the correct preventer for your symptoms - it took me nearly two years to find mine and I tried probably 8 different types. If the blue sabutamol improved things you could ask to swap the brown preventer for a purple one which was the one which did the trick for me. This is a mix of the sabutamol and a steriod (I'm not medically trained and this is just my experience) - I think the brand name was seretide - this is it https://www.medicines.org.uk/emc/product/3825/smpc
I only suggest this as I found the process of getting my asthma under control a real hit and miss affair but when I did it transformed my life. My asthma didn't start until I was 40.

craigus89 · August 2018

How has the diagnosis been confirmed? Have you had a spirometry test? The peak-flow reading is not always a good guide to symptoms as it is only a measure of your large airways, small airway constriction can only be measured with spirometry which is like a peak flow test but done into a machine that measures you for 5-10 seconds.

I have had asthma all my life and have recently been having quite a bit of trouble again over the winter and through summer. I found out through recent hospital referrals etc that many GP's don't really have a clue when it comes to asthma. It is quite complicated. I have been to A&E and turned away because my peak flow was good despite me clearly being mid attack.

Ask your GP for a referral to the lung centre. We often just accept what doctors tell us and let them fob us off. Be pushy, you have to be your own advocate when it comes to health.

trek_dan · August 2018

Craigus89 wrote:

How has the diagnosis been confirmed? Have you had a spirometry test? The peak-flow reading is not always a good guide to symptoms as it is only a measure of your large airways, small airway constriction can only be measured with spirometry which is like a peak flow test but done into a machine that measures you for 5-10 seconds.

I have had asthma all my life and have recently been having quite a bit of trouble again over the winter and through summer. I found out through recent hospital referrals etc that many GP's don't really have a clue when it comes to asthma. It is quite complicated. I have been to A&E and turned away because my peak flow was good despite me clearly being mid attack.

Ask your GP for a referral to the lung centre. We often just accept what doctors tell us and let them fob us off. Be pushy, you have to be your own advocate when it comes to health.

I've only ever had the peak flow reading tests which was taken as proof. I have an appointment week after next so will look for a referral.

Arthur Scrimshaw wrote:

It may be that you have not yet found the correct preventer for your symptoms - it took me nearly two years to find mine and I tried probably 8 different types.

This is interesting as I'm not convinced the brown preventer inhaler is actually helping.

navrig2 · September 2018

How old are you and have your living conditions changed recently?

When I was about 23 I was diagnosed as having exercise induced asthma. Prior to then there had been no sign at all of asthma.

This was not long after I moved into a new (student) flat. It was cold and damp with some minor damp/mould patches on certain walls.

I was given the blue and the brown inhalers and got by for a couple of years. At that stage I wasn't exercising much but smokey pubs and brisk walks could have an impact (exacerbated by beer!).

After a couple of years I moved to a shared house with central heating. Within a few months I felt much better and generally the asthma lifted. I started playing squash again and to all intents and purposes the EI asthma disappeared.

Two years later I moved into another shared house which had a resident cat (I knew I was allergic to cats but reckoned that I could keep away from it). The asthma returned and I went back to using inhalers. I only stayed there 6 months then moved to Aberdeen where I bought a flat. No cat, no damp, decent heating and good ventilation.

The asthma went away and has not returned. I hung onto an inhaler for 10 years with the occasional puff. Eventually I spoke to the GP and was taken off the register.

I put it down to allergic reaction to mould spores and cat dander rather than proper exercise induced asthma. It only really showed up when I exercised (which I suppose is the definition).

I haven't used an inhaler in 20 years.

photonic69 · September 2018

Have you considered that it might be EILO? Most, if not all people have never heard of it. I hadn't until recently. A friend's daughter (very talented cyclist) was suffering from what was considered Exercise Induced Asthma but after numerous visits to the Royal Brompton Hospital for tests it was diagnosed as EILO or Exercise-induced laryngeal obstruction.

Have a read: https://en.wikipedia.org/wiki/Exercise- ... bstruction

Mad_Malx · September 2018

Mold spores are very common trigger and not always obvious - might be behind cupboards etc and you are exposed every night if you live in rooms with humidity and poor ventilation (but warm dry air is nice for house dust mites). Post infection wheeze is also common and can last for a while after either bacterial or viral infections
Persist with the steroid (brown preventer) for now - the effects are often gradual because they reduce airway inflammation rather than the wheeze directly, which reduces your likelihood of wheeze being triggered. If Froome had taken his preventer he probably wouldn't have needed so much salbutamol .....

As others mention, it may take a while to get the right combination and doses, and combo inhalers like seretide are useful for many. Get a specialist referral if you aren't improving.

kingrollo · September 2018

I have had asthma all my life - day to day it doesn't bother me - but as a cyclist its so frustrating - because of my asthma I have never been the greatest cyclist - it is very frustrating to put loads of training in - then see a newbie 1 month in leaving you for dead on the hills.

One point I will emphasis is to get past the gp and get to respiratory consultant - that will take a while and your gp probably won't be at all keen to refer all.
I phoned the charity asthma uk and spoke to a nurse - told about my poor peak flow about 350 max (should be about 600) - She sent me an email in which she said

"don't settle for a peak flow of 350" - showed this to gp after a few visits they eventually referred me - have had loads of tests (which aren't fun by the way) - and I have been trying weird and wonderful inhalers - not much improvement yet. But my point is there is treatment and knowledge out there which the GP doesn't have.

BTW - consultant told me there is only uncontrolled and controlled asthma - exercise induced asthma is the former.

trek_dan · October 2018

kingrollo wrote:

I have had asthma all my life - day to day it doesn't bother me - but as a cyclist its so frustrating - because of my asthma I have never been the greatest cyclist - it is very frustrating to put loads of training in - then see a newbie 1 month in leaving you for dead on the hills.

One point I will emphasis is to get past the gp and get to respiratory consultant - that will take a while and your gp probably won't be at all keen to refer all.
I phoned the charity asthma uk and spoke to a nurse - told about my poor peak flow about 350 max (should be about 600) - She sent me an email in which she said

"don't settle for a peak flow of 350" - showed this to gp after a few visits they eventually referred me - have had loads of tests (which aren't fun by the way) - and I have been trying weird and wonderful inhalers - not much improvement yet. But my point is there is treatment and knowledge out there which the GP doesn't have.

BTW - consultant told me there is only uncontrolled and controlled asthma - exercise induced asthma is the former.

My peak flow was down at about 400, went up to near 500 after using blue inhaler. I've tried a couple of different brown inhalers and have had no improvement. I'm now being referred to a GP, to then see if he deems it serious enough to refer me to the respitory clinic for further tests. Nothing is happening quickly and it gets frustrating as I still can't exercise properly :?

craigus89 · October 2018

trek_dan wrote:

My peak flow was down at about 400, went up to near 500 after using blue inhaler. I've tried a couple of different brown inhalers and have had no improvement. I'm now being referred to a GP, to then see if he deems it serious enough to refer me to the respitory clinic for further tests. Nothing is happening quickly and it gets frustrating as I still can't exercise properly :?

Unfortunately nothing happens quickly. All you can do is keep pushing and hassling everyone. My referral to the resp department was 5 months away even though I was having a bad spell, no way of speeding that up unfortunately.

Have you been shown proper inhaler technique?

trek_dan · November 2018

Finally got a referral from the GP after he agreed that the standard asthma medication isn't working. Taken 10 months to get to this stage.

craigus89 · November 2018

trek_dan wrote:

Finally got a referral from the GP after he agreed that the standard asthma medication isn't working. Taken 10 months to get to this stage.

Sorry to hear that. At least you have it now, lets hope that it isn't a busy ward like mine was, my appointment came through scheduled for nearly 6 months away.

don't be afraid to just keep hassling!

ric/rstsport · November 2018

for clarity the brown inhaler, is a corticosteroid (from memory, this will likely be pulmicort, which is budesonide). these inhalers aren't meant to give relief in the same way the blue one does. (i can't tell if you've been told this or not). Anyway, there's no immediate relief from the brown inhaler, i think they call them 'preventers' -- you take it for long periods of time to reduce the inflammation. the blue inhaler (salbutamol?) is for immediate relief. it takes several weeks for the brown one to start working.

if you've got exercise induced asthma, they may offer you serevent (or similar) which are longer acting than the blue inhaler.

there are also other options of inhalers. but if you race it's worth checking whether any of the one's you're trying fall foul of WADA regulations.

There is also montelukasts which is one of the LTRA drugs - i don't know much about these.

voodooman · November 2018

After complaining to the asthma nurse at my annual check up a fortnight ago, I was referred to the specialist at the hospital (a week later). I've never really struggled, but always aware that it holds me back a bit when really pushing on either the bike or running..... So imagine my surprise at being diagnosed with Samter's Triad! A combination of asthma, nasal polyps and extreme hayfever like reaction to (in my case) ibuprofen and often red wine and other alcohols. I thought the hayfever tablets were making my life easier, but in fact they've probably masked symptoms for a decade.

So now I'm on a month of prednisolone, 8 weeks of antibiotics (an infection is common in polyps apparently), 3 months of nasal steroids (as well as the brown inhaler) and regular salt water sinus flushing. An operation in Feb and then micro doses of ibuprofen to keep tolerance levels steady and hopefully prevent re growth. What can I say? Yeah the steroidss make my skin very dry but unbelievable with breathing, it's like night and day. The cold snap over the weekend hurt my nose because I'm not used to breathing through it. I no longer sound permanently bunged up and no more chapped lips from breathing through my mouth. Asthma as well has got much better, maybe because I'm able to breathe through my nose. On speaking to my dad..... you can imagine the rest.

trek_dan · November 2018

voodooman wrote:

After complaining to the asthma nurse at my annual check up a fortnight ago, I was referred to the specialist at the hospital (a week later). I've never really struggled, but always aware that it holds me back a bit when really pushing on either the bike or running..... So imagine my surprise at being diagnosed with Samter's Triad! A combination of asthma, nasal polyps and extreme hayfever like reaction to (in my case) ibuprofen and often red wine and other alcohols. I thought the hayfever tablets were making my life easier, but in fact they've probably masked symptoms for a decade.

This sounds very similar to me, I haven't been able to breath through nose properly for as long as I can remember.

MissedTheBreak · November 2018

Apparently it’s hit and miss with asthma sufferers but I was put onto a new preventative inhaler called Relvar about 18 months ago. Changed my life!

I take it once a day and have not had to use a blue inhaler in about a year. Also, my peak flow is back up to 600 according to my recent check-up. As I say, it won’t work for everyone but it really has made a massive difference for me!

Johnpsanderson · February 2019

Interested to read this. In hindsight i've always had some asthma like symptoms as an adult - tightness in the chest after races, coughing going into warm air from cold. I always had about 6 weeks of apparent 'flu' in the spring, just as the early racing season was kicking off. But I didn't pay much attention to it.

I stopped cycling competitively in 2012/13, and began to cough a lot about 3 years after that. Since then my attempts at a comeback to serious cycling are thwarted each winter by colds which quickly turn into chest infections, which then lead to lots of wheezing and coughing and slow recovery - distrupting any attempts to get consistent training together.

I'm taking: seretide as a preventer (max dose of 250 4x per day), fexofendaine to dampen any allergic responses, montelukast as another string to the bow, mometasone as a nasal spray to try and reduce phelgm (which inevitably goes into my chest and then needs to be coughed out). Unless I get a virus this seems to do the trick - but it doesn't stop problem arising when I get a cold...

Most annoyingly, when I feel fine my peak flow is 800+ (I literally blow the peak flow meter to the end of the gauge). When I am coughing so badly I vomit it only drops to about 650!

trek_dan · April 2019

PhotoNic69 wrote:

Have you considered that it might be EILO? Most, if not all people have never heard of it. I hadn't until recently. A friend's daughter (very talented cyclist) was suffering from what was considered Exercise Induced Asthma but after numerous visits to the Royal Brompton Hospital for tests it was diagnosed as EILO or Exercise-induced laryngeal obstruction.

Have a read: https://en.wikipedia.org/wiki/Exercise- ... bstruction

As an update I have been doing better with Asthma symptoms following medication and proper diagnosis, my Asthma symptoms are now under control. I have been diagnosed with EILO as the above, which can only be managed.

MishMash95 · May 2019

This is quite an interesting topic, I've recently been suffering with symptoms that seem to line up with asthma. All started with excessive chest tightness around 6 weeks ago, followed with a noticeable sensation of what feels like tired/dry lungs after exercise. For me, this seemed to trigger a rather bad bout of health anxiety, getting me exceptionally worried about something being seriously wrong with my lungs.

I had initially assumed that the correlation was to do with moving to London (moved 8 months ago), however up until 6-7 weeks ago, was generally feeling okay. Starting to think that it could be related to the increased pollen counts. No idea what the expected symptoms are, as I don't seem to exhibit standard hay-fever symptoms, but this persistent tight chest sensation is definitely getting me down, and feels like its capping my cycling ability.

Have been prescribed a blue inhaler as a test to see if it relieves symptoms, though so far doesn't seem to do much, or if it does, only provides partial relief for say 20 minutes. Naturally, still doubting asthma as the cause, as I don't really know what I expect asthma would feel like vs other conditions, as at the moment, it just feels like a persistent discomfort, and while I can still exercise at intensity, it feels harder to get the lungs to fully expand :S

Interesting to read how a house with some amount of mould was the core problem, partially wondering whether its during the exercise itself that causes it, or just the background triggers (pollution, mould, dust etc;) that are inflaming the airways.

trek_dan · May 2019

Sounds more like your tired/run down rather than having respitory problems, especially if the blue inhaler isn't having an effect.

Cycling with Asthma

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