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I was just diagnosed with, get this, "exercised induced cough-varient asthma." Joy! Basically, if I peg my HR for more than 10 minutes, I have an coughing spasm that can last an hour. Based on this new development, I can't imagine ever wanting to race bikes. (I wasn't terribly motivated to race before I got the asthma, but this gives me a better "out" than, "That looks awefully painful.") Since the Pubuterol is almost worse than the attack itself, I think twice before I push myself.

So for those of you who have asthma, yet still get out and go hard, here is your chance to inspire! Tell us your story. Did you always have asthma or did you get it as an adult? Has it affected your riding? How? How not? The DOH! award goes to anyone who received an asthma induced hospital visit after or during a ride.
 

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Your fine just plan ahead

I have had asthma my whole life. I spent more time in the ER then the class room as a kid. But it went away in my late teens and early 20s but hit me again in my late 20s. It was in my early 20s that I got into tri and then cycling. I still have to use advair 500/50 and nasonex everyday. In addition I use albutrol before rides when it is cool out. The trip to using it is to it 15 to 30 min before you start and to give yourself longer to warm up in the cool or pollen filled air. This kind of medication can affect your ablity to clear latic acid but I still race! So it is NO way to get out of racing!

Here is the bad news....coughing makes it worse but you can learn to control the cough but it is really hard to do. however, waking up on a vent or get epi injections will inspire you to learn not to cough it makes it much worse!
 

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similar story

I'm 39 and have had asthma since I was a tot. Many cranky nights with my head under a towel over a boiling pot of water...one of many home remedies my ma tried. I've used Albuterol for several years now, mostly only as needed as a preventative, thank God. My worst attacks have been allergy-related, some from lots of beer (gluten) :( and cig smoke, some resulting in a trip to the ER for a shot of adrenaline.

As for riding I take a hit of Albuterol pre-ride and that usually does the trick for both cold and exercise-induced asthma. I have switched to mostly mountain biking now, all on a singlespeed, so I'm breathing real hard anyways, don't need any extra help! :)

SR

PS - the L.A. air quality doesn't do me any favors either, hence the name.



andy02 said:
I have had asthma my whole life. I spent more time in the ER then the class room as a kid. But it went away in my late teens and early 20s but hit me again in my late 20s. It was in my early 20s that I got into tri and then cycling. I still have to use advair 500/50 and nasonex everyday. In addition I use albutrol before rides when it is cool out. The trip to using it is to it 15 to 30 min before you start and to give yourself longer to warm up in the cool or pollen filled air. This kind of medication can affect your ablity to clear latic acid but I still race! So it is NO way to get out of racing!

Here is the bad news....coughing makes it worse but you can learn to control the cough but it is really hard to do. however, waking up on a vent or get epi injections will inspire you to learn not to cough it makes it much worse!
 

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I've had exercised induced asthma about 10 yrs now. I am 50. No racer here, but do enjoy long distance rides. Yearly averages 2000-4000 miles. Thankfully,my only sympton is a nagging cough that drives my wife nuts. If I start to get symptons I try to remember to take the inhaler before a ride. If I forget, I pay for it when I get home and may have to use it then. I remember quite a while ago the doc telling me that if I cough more after taking the inhaler it is working. The previous posters seem to be right on about preventive measures before working out. I have noticed also that a longer cool down helps. If I ride hard and just cold turkey hop off the bike the cough is worse.
Usually it seems to act up in cooler weather - PA resident. However, in summer I've had it hit me out of the blue and when I wasn't really pushing hard. Pollen?
 

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Asthma for 21 years

I've had asthma since age two, and like another poster, I spent more time in the ER, doc's offices and at home on a neubolizer than in class. I think that in 2nd grade I missed 22 days, and that's not countings half days.

When I turned 15 I started mountaing biking. At the time I lived in the desert in Baja, Mexico, thus I would get really sick during the summer months (hot weather + dirt + smog build up). I was on Seravent, Theodor, and a bunch of other stuff for two years. I always kept riding during this time. Basically, just a proper warm up, 30-40 minutes at an easy pace, and then start hammering. If it was windy or dusty, skip the ride. Well worth it.

currently I race and have had no symptoms for well over a year now. I could almost say that I have been cured, but Asthma can and will always come back. My advice would be don't race just yet. Let your lungs get used to the exercise for about a year, take your med's and learn to listen to your body. When you race, take your med's 1/2 hour before you race, that way you won't feel some of the side affects.

Good luck!
 

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Mine Decreases As Fitness Increases

My "Excercise Induced Asthma" seems worst in winter (cross-country skiing). When I'm fit I rarely have problems. My wife has more serious asthma and as long as she uses her inhaler before a ride and takes it along for additional hits if she needs it she's fine.

Good luck!

Howard
 

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My asthma doesn't sound as extreme as some other cases. The worst part for me is the beginning of a ride. I hurt somethin' awful if we start out on a hill climb. If I get a chance for full recovery, I am good to go for the rest of the day. I get anxious about racing because of the possibility that the pace could start off very quick. I need a good warm up before races.

I don't have to start using any medications until April. That is when the allergy season starts here in the Willamette Valley.

I am concerned about the effect the medications have on me. Last year, I experienced some extreme dizzy spells on long mtb climbs. I had to bail out of an ultra-endurance event because I could not recover from the dizziness. It was directly related to an elevation in my heart rate. I will be looking for an alternative that would allow me to minimizing my useage. I may be better off getting a monthly steriod shot to get me through May and June allergy season.
 

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Free2Pedal said:
I was just diagnosed with, get this, "exercised induced cough-varient asthma." Joy! Basically, if I peg my HR for more than 10 minutes, I have an coughing spasm that can last an hour. Based on this new development, I can't imagine ever wanting to race bikes. (I wasn't terribly motivated to race before I got the asthma, but this gives me a better "out" than, "That looks awefully painful.") Since the Pubuterol is almost worse than the attack itself, I think twice before I push myself.

So for those of you who have asthma, yet still get out and go hard, here is your chance to inspire! Tell us your story. Did you always have asthma or did you get it as an adult? Has it affected your riding? How? How not? The DOH! award goes to anyone who received an asthma induced hospital visit after or during a ride.
I know this is an old post but I felt I need to throw in my 2 cents.

I have the exact same thing as you do. I found out last year on the top of Moose mountain when I was mountain biking. I couldn't get any air and couldn't stop coughing. A friend that I was biking with that day is a surgeon and told me I need to get checked out. I had chalked it up to being oout of shape.
To make a long story shorter I got checked out my Doc gave me an inhaler and I haven't looked back. It does give me a bit of adrelelan rush for about 5 minutes when I first take it and after that I have no problem keeping up to anyone else.
Don't let it stop your dreams
 

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long winded, sorry!

Hate to say it, but I'm kind of glad to hear others are in the same situation as me! I've been looking at various message boards, and it doesn't seem like there are very many riders with full-blown asthma out there. Generally, people are really surprised when they find out I have asthma. My story:
I was never very athletic as a kid, and could never keep up in gym class because I would be so out of breath after running just 1/4 of a mile (the most popular PE class games, of course, always involved running). My teachers chalked it up (as did I) to being lazy, out of shape, and generally unathletic. The one sport I could do, however, was swimming (my first love). In high school, I started to have trouble breathing when I swam too, and then I really knew that something was up. Turns out that I have full-blown (ie: not exercise induced) asthma, aggravated by allergies.
After starting meds, I was determined to be more active (not one of those asthmatics that sits on the sidelines and explains "I have asthma"). I started running, biking, skiing, etc. Quickly gave up running (bad knees) and it's a bit hard to downhill ski in the midwest, but biking stuck. Unfortunately, the initial euphoria of the "miracle- drugs" wore off. I've tried a bunch of medications, but generally Advair and Albuterol work the best for me, along with Zyrtec for the allergies. I still get a hacking cough that lasts for hours afterwards riding in cold weather (even with the albuterol) or on hills (i die. i get dropped. it's okay.).
I do race, albeit not very fast (especially early in the season). I take a puff of the ol' inhaler about 1/2 hour before the race, warm up for about an hour, and concentrate on keeping my breathing steady. Albuterol makes me kind of jittery (like i just had a double espresso), and taking more than one puff in an hour makes me really dizzy, so i try to use it sparingly.
The first race I had to drop out (collegiate racing starts in February, even in the midwest) because i couldn't breathe, and it is incredibly frustrating to have your lungs give out before your legs! I carry an at-home nebulizer "just in case" (disguised in a cycling-shoe box :))... i hope never to end up in the ER, especially given some of the places we race! ;)
I've also found that (during cold weather rides) heating up your water helps (warm water relaxes your chest- if it doesn't freeze 10 min into your ride). On any ride I carry a camelbak (even road riding), because as I breathe heavier, my throat tends to get sore, which aggravates the asthma. Water helps, and I drink more with the camelbak. Supposedly yoga helps (some claim "cures") asthma too, but I'm still looking into that.
it is possible to control your asthma enough to push yourself athletically, despite what my doctor keeps telling me ("don't exercise! you'll just give yourself an asthma attack! blah blah blah") :p
happy riding!
 

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Similar expericen here . . .

andy02 said:
. . . hit me again in my late 20s. It was in my early 20s that I got into tri and then cycling. I still have to use advair 500/50 and nasonex everyday. In addition I use albutrol before rides when it is cool out. The trip to using it is to it 15 to 30 min before you start and to give yourself longer to warm up in the cool or pollen filled air. This kind of medication can affect your ablity to clear latic acid but I still race! So it is NO way to get out of racing!

Here is the bad news....coughing makes it worse but you can learn to control the cough but it is really hard to do.
One of my frequent MTB riding buddies, after getting sick of hearing me coughing behind him and at regroup stops, told me that I had exercise induced asthma. I couldn't believe it, and didn't want to believe it. Why would something like that show up all of a sudden in a 46 year old? I have been a competitive swimmer most of my life, and it never bothered me before.

The first doctor visit resulted in scrips for Avair 250/50, taken twice a day, albuterol for relief during eposides, and Allegra during allergy season. This ended up being an unsatisfactory mix. I kept getting attacks when riding and working out. My worst 2 incidents were following a gym "triathlon" contest (2K row + 2mi treadmill run + 2 mile elliptical trainer), and an 18 mile MTB ride. In each case I got into coughing fits and spasms that were intense at the time, and then carried on for days, preventing sleep. One of those two fits was so violent that I got a hernia on my upper abdoment that ultimately had to be surgically repaired last Monday, leaving me unable to ride or work out for at least a month.

The second doctor visit, because of my continuing frustration, led to a change in the meds. We are now ignoring the Allegra, taking the Advair only once a day, added Singulair 10mg (once a day), and using the albuterol (2 good hits) prior to cardio work (riding, gym, swim). The Singulair was a breakthrough change: I have had very little trouble since. I also got scrips for 5 day course of Prednisone to "break the cycle" once into a major coughing fit that doesn't quit. I used the Prednisone cycle once, starting the day of the 2nd doctor visit, finding it very effective, and haven;'t had to got that route since. I also picked up a narcotic cough suppressant scrip just in case.

Using the Albuterol as a prophylactic rather than after an attack starts should have been better explained/prescribed initially. I agree with Andy02 and other posters about using it 15-30 minutes before exercise. I take 2 good hits. I also am careful to warm up slowly now, rather than take off hard right from the start (difficult for me; I am a drop dead sprinter, not a slow twitch type). I also agree that you must be extra cautious as the temperature drops. I live in the desert, so my coldest day riding is still well above freezing, but even at 45 degrees the episodes are more common and more intense when I don't take the albuterol first and ease the warmup.

On occasion, with the news meds, I will start to cough a little within the first 30 minutes into a ride, but now I can work through it and it will go away after a few more minutes.

One downside, I am noting that my lung capacity seems to have slipped a little. I can't tell if this is related to the asthma itself, or the meds in some way. It shows up to me more in swim practices than in anything else. I can no longer hold the same intensity during particular swim sets where I used to be dominant.
 

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Excercise induced not so bad

I too have exercised induced asthma. I'm 23 and I was diagnosed when I was in my late teens.

I was a competitive swimmer during my teens and in college. I started biking seriously not quite 2 years ago. I find that during the beginning of the season (biking or swimming) when I'm a bit out of shape, I have a lot of trouble breathing, although it doesn't usually hit hard until *after* I stop. However, as the season progresses and I return to my previous form, I have no symptoms. I generally carry an inhaler (albuterol) in the early season, but ditch it after a few weeks.

Admittedly I seem to have a fairly mild case, and one that I can entirely "cure" by staying in shape. It certainly sounds a lot better than some of these responses I've read.

Today I had my first outdoor ride of the season (Rochester, NY). I didn't look at the temp before I left or I might have stayed indoors, it was 25 F with a 13 windchill. Ouch. My asthma only bothered me a little, because I've been using the indoor trainer fairly regularly this winter (2-3 hours a week) just enough to not loose too much. The cold really did me in tho, I only lasted 45 minutes.

I can't imagine how some of these people bike in single digit weather. I have decent clothing (could use some better gloves) but my lungs didn't like it, and I attribute some of that to asthma, and some to not being a little off form.

Hope it warms up.

-Spyky
 

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No your not the only one I spend more itme in the ER then the class room as a kid. I took what was called marax (speed) until I hit 90 pounds in the six or seventh grade they changed me to albertol (it wasn't aproved for kids smaller then that at the time). It didn't get better until college then I for the first time started working out and racing tri. A couple of years ago it started commig back HARD but my doc put me on advair (500/50 really it is two meds in one inhaler type thing) and nasonex (helps reduce the affects of triggers for me). I still use albutrol 30min before rides unless my peak flow is above 750. A intresting point is that I have a peak flow of almost 200 L/min higher then I should for my size. If you are have trouble with asthma KEEP GOOD RECORDS of your peak flow it will help you and your doc get your asthma under control. I now know that I could have been faster a lot sooner if I had been breathing better from the start. Albertol is a quick fix but not the best.
 

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Exercise induced bronchoconstriction

It's a nit-picking point, but the term "exercise induced bronchoconstriction" (EIB) is now preferred to "exercise induced asthma," since many people can have an occasional bout of symptomatic bronchial constriction which is unrelated to the chronic airway inflammation and hyperreactivity which are the hallmarks of asthma. However, those who do have underlying asthma are more likely to experience EIB. In other words, not all EIB is asthma, but most asthmatics get EIB. It sounds like some of the people who have posted here do have real asthma which is complicated by EIB. Some probably have simple EIB (without asthma) which is appropriately treated with a prophylactic dose of albuterol. I'm in the latter category-- after strenuous rides in cold/dry air, I tend to wheeze and cough for a little while, but otherwise I'm asymptomatic.
I hope this helps. Just so you know, I'm currently doing my subspecialty fellowship in pulmonary and critical care medicine, so I know a little about the topic. Now for the Dr. Phil-esque disclaimer-- The advice presented here is intended for entertainment and informative purposes only (alongside the banana hammock Ebay auctions and podium girl posts) and should not be considered a substitute for blah blah blah...
 

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Asthma - Me Too

I too have asthma, but it doesn't hinder my cycling too much. In the winter, I ride with something over my mouth warm the air when I inhale, and it takes me longer to warm up. I also don't push as hard in the winter because I don't want to start "gulping air." However, during the warm months, asthma really has no effect on my riding at all. I don't race myself, but I sometimes ride with people who do, and as long as the weather's warm, I am able to keep up.

I know that pushing hard and exercising my lungs has greatly improved my asthma to the point that my symptoms are virtually non-existant as long as I use common sense and take my meds. I've seen a nice improvement since I was switched to Advair. I use Albuteral before riding and take Nasacort once a day. I have also taken Allegra, but I don't like it because it makes me feel dehydrated.

Over the years I've learned that the key to living sympthom free is seeing a good doctor who knows how to treat asthma. I've discovered that just because a doc has MD behind their name doesn't necessarily mean that they know squat about treating asthma.
 

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Your last little blurb makes me glad I am not a medical doctor! Well, that and too many varibles to deal with. I just but "simplist possible model" in front of any kinetics jargon and about 10 pages of equations and I am good to go.

Back to the asthma talk- I do think that more cyclist could have asthma then you might think. The only way I found out that mine had gotten bad was I was having to use the albertol at night a few time a week. When my doctor and I tried other meds my spirometry went up and up as we increased the dose. I started at a normal volume but now it is 20% higher. That likely kept me out of ERs as I got older I guess. I just wonder how many other people might also have inflammation issues and not really know.
 

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Wasn't trying to overstep my bounds...

It wasn't my intention to single out any one person and try to make/change a clinical diagnosis over the internet-- I hope no one took my post the wrong way. I was trying to bring across the point that people without asthma can have symptomatic EIB, and that the term exercise induced asthma is somewhat misleading-- exercise exacerbates symptoms in most people with asthma, but does not cause asthma itself.
Andy02, everything you've mentioned in your history is consistent with asthma. It's a fairly typical pattern for people to "outgrow" childhood asthma in their adolescence only to have it "come back" in their 20s and 30s. And even with "normal" spirometry, the usage of albuterol "at night a few times a week" is a red flag and would have put you in the moderate persistent severity category for asthma according to the most recent NHLBI guidelines.
I agree with grizzly bear that treatment of this disease is something best left in the hands of a qualified practioner. Note that I did not specify a pulmonologist or allergist (or even necessarily an M.D.) I know many general internists who can manage all but the most difficult cases as well as any pulmonologist I know. On the other hand, I also agree that no MD can know everything about everything-- but those who don't know much about asthma are generally pretty good about referring to specialists when it's appropriate.
There, now I've done it-- I've REALLY overstepped my bounds now. Apologies to all. I'm just trying to be helpful... :)
 

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A problem with inhalers

I saw this news story today and thought that those who use inhalers would be interested.

http://story.news.yahoo.com/news?tmpl=story&cid=594&e=1&u=/nm/20040323/hl_nm/health_inhalers_dc

Asthma Inhaler Ingredient May Counteract Benefits
WASHINGTON (Reuters) - One of the drugs used in inhalers to treat asthma can counteract the benefits of the others, U.S. researchers reported on Tuesday.
The finding may explain why some patients who use the inhalers actually get worse over time, the researchers at the University of Pittsburgh School of Medicine said.
The ingredient is albuterol, in a class of medications called beta-agonists. In inhalers it is combined with steroids to open airways and ease the gasping of patients with asthma and other lung diseases.
But in a report presented to the annual meeting of the American Academy of Allergy, Asthma and Immunology in San Francisco, the researchers said a bad form of albuterol can accumulate in the body and worsen symptoms instead of helping.
Sometimes these patients end up in emergency rooms, said Williams Ameredes, an assistant professor of cell biology and physiology who led the study.
The trouble, said Ameredes, is that albuterol has two forms or isomers -- a so-called left-handed version and a right-handed one. These isomers refer to the molecular structure.
The "right" version relaxed the airways when used with the steroid dexamethasone but the "left" version in fact increased the inflammatory signals that caused the airways to tighten, he said.
"One potential explanation is that long-term repeated usage of albuterol may result in accumulation of the (left) isomer of albuterol, which we know persists in the body three to four times longer than the beneficial (right) isomer, which is normally metabolized in about three hours," Ameredes said in a statement.
It is now possible to make a version of albuterol that contains only the beneficial, right-handed isomer, Ameredes said, and drug companies should examine this possibility.
 

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good job of CYA

I wasn't questioning what you were saying, I thought it was kind of funny. I never heard of asthma comming back until it did. So I thought I might a good idea for people who had it as a kid to know. If you are in good enough shape you don't usally wind up on a vent like you could have as a kid. It is more gradual.

I most enjoyed your large attempt to make everyone happy and not making enemies! great CYA in action!
 

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I don't know the stucture of Albertol but will look it up tomorrow. However, if the paper is right and I never belive anything in popular press and only primary lit when I fully understand the methods it will be pricey. I do a little bit of isomer stuff and it is hard. The only way to do it to either; a. seperate the R and S version, or b. make only one isomer. Making only one isomer is even harder. Enzymes are the only good catalyist for this and I doubt they have a albertolase (joke).
 

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Old news

This has actually been known for quite some time now. There is already a company which markets the pure R enantiomer of albuterol (levalbuterol, or trade name Xopenex) and the preliminary data are promising. As far as I know, it is only available as an inhalation solution for nebulizers, and is not available in the more common MDI (inhaler) form. In my limited experience with the medication, I have not noticed a big clinical difference as compared to standard racemic albuterol. It sounds good in theory, but it hasn't made a huge impact yet.
 
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