About those lungs

[Bklynmom]

I am going back on Advair and Singular as my Dr. suggested. I have never had a real asthma attack, just the tightness in the chest, in Spring time I cough until I get on my meds regularly. I don't get chest colds (I am the stuffy nose queen) - never even had bronchitis. My blood test for allergens was negative - chest x ray completely clear too.

Unfortunately my problems started after September 11th - we live just down wind of lower Manhattan, and although I wore a paper mask to pick up my son at school, my Doctor thinks this is what triggered the asthma.

I am going to see how I feel after a week back on Advair and Singular - if I don't see improvement, I will ask about a specialist. What kind of a specialist do you recommend?

[amymisk]

See a pulmonologist, lung specialist.

I loved to see this post, since I was just diagnosed with EIA. I am an RN and didn't even recognize the symptoms. My riding was generally much more work this spring/summer than previous years and I was even on the trainer this winter. I spent most of my rides coughing and short of breath, which only got better if I stopped for a 10 15 minute rest.

My pulmonologist gave me two inhaler, proventil and Foradil. Proventil is short acting for short rides and Foradil is for my long rides. I don't need maintanence meds since I only have issues with exertion, true exercise induce.

The pulmologist did tell me to include a good warm up since not warming up can make the asthma worse and cause an attack much sooner.

I just rode 60 miles on Sunday and could not believe the difference.

[Torrilin]

(just a suggestion... don't use the trade names for your asthma drugs. It's common for the same drug to be sold under many different trade names for asthma, and with many different delivery methods. If you use the medical name, there's less chance of an accidental overdose. Also memorize the doses you take in milligrams rather than number of pills/inhaler puffs if you can.)

My asthma started kicking in again last week (after 14 years of no attacks). Tight chest, rapid breathing, increased mucus production... all only when exercising. Exercise induced asthma, right?

Wrong.

We're pretty sure I'm reacting to some kind of plant pollen (spores are unlikely since it's been very dry here, and I have minimal animal contact and no history of trouble with animal dander). Probably not pollution levels, since similar activity levels in Los Angeles gave me no trouble and Madison has less pollution. Definitely *not* exercise induced, since I'd been exercising regularly before this started with no trouble. So we're blaming pollen since there are several sorts of pollen that have triggered me in the past.

The increased breathing needed for heavy exercise means you take in more animal dander, pollen, spores, and pollutants through your lungs. More of your trigger means... an attack! Yay! That's why even someone who doesn't have exercise induced asthma can have an attack while exercising.

Solution? Put me on a maintenance medication and start tapering activity back in.

For what it's worth asthma attacks have stages. Not getting to the coughing your lungs out and wheezing stage means you're stopping the attack early. This is *good*, but it doesn't mean you don't have attacks. Shortness of breath, a "tight" feeling chest are usually the first signs of an attack. I'd had a ride or two where I got that far and went "huh" hydrated and not thought more about it. Dumb, but it really did feel a lot like I'd been pushing a bit too hard.

Pulmonary specialists are good. Some allergy specialists are good too. If the doc comes up with a treatment plan and hasn't checked a peak flow, used a spirometer on you, or checked your blood oxygen content this is Not A Good Sign. Good asthma doctors want baseline tests of your lung function, so they can judge how well the medications they prescribe work. It's not unusual for a stethoscope exam to sound clear, when in reality your lungs are at reduced capacity.

[Crankin]

I also have the "tight chest" asthma, occuring without warning, usually when I have a viral infection or under stress. I never have just a cold. I can descend into bronchitis or pneumonia like in a second or it might just go away. Last winter I went on Advair and Singulair. After 2 and a half months of slowly recovering from the bronchial infection, i finally went back to my pulmonary doc and he laughed and said that both of those meds are not "magic bullets" and unless you have cerain types of triggers, they are worthless (they were prescribed by a PA at my internist). So I am back to just taking Ventolin before a ride if i feel that I need it. And the warming up thing is SO true. I often feel like crap in general for the first 30 minutes of a ride, unless I am going slowly. This is why I sweep when my husband and i lead rides, because most people expect that you go off like a bat out of H*** and when I lead, I am not going to do that. However, I notice that on group rides, by the second half of the ride, I am usually up front with the leaders and could go on forever when others are fading fast.

[Bklynmom]

Thanks for all this advice - I am going to see if my usual Spring allergy/asthma routine works - if it's not better by Monday, time for a specialist.

My guess is that it's an allergen, (mould) not EIA, but I think I need a Dr. to do some real tests!

I am lucky that I don't have wheezing and respiratory infections - lots of people suffer much more seriously than I do.

I think an element of this is that I have never pushed myself physically this much before. I am in the best shape of my life, but why not make it even better.

Thanks for everyone's advice - I may print some of this out and bring it with me to the Dr.!

[robinmary]

I have adult onset asthma and it kept me off my bike for years. I am just starting to ride again and I find that things go much better if I have taken Claritin in the morning as well as using flovent (this is for lung inflamation) I use albuterol before I ride and make sure I have it with me when I ride. So far, I haven't had to may issues. I live in VT so there is no way to avoid hills.

Robin
What I'm saying is using your meds help.

[latelatebloomer]

Just this year I discovered that my spring breathing issues on inclines are not a lack of fitness. I did a really challenging indoor cycling training program this winter, so I knew I was VERY fit this spring - but on hills I started to feel like a scuba diver who's oxygen tank had been turned off. I even had to cut short a group ride and be escorted slowly back to the car (and really I should have had them go get a car, 'cause I had spots before my eyes sometimes on the way back.) I had already started an extensive allergy test regimen, and soon discovered that I am "moderately" allergic to mold & tree pollen. No sign of asthma, in fact the guy who ran the pulmonary function test said I hit a new high for their machine! So the savvy allergy lab guys and I figured out that the allergy + my extreme outdoor exercise = asthma-like attack. I started immunotherapy shots that will hopefully improve the sensitivities to mold & pollen next season, but I did a little research and found out how common this is with cyclists, and I pressed my doctor a little to let me try the inhaler. (she wanted me to wait for the long-term fix, but she doesn't exercise and I don't think she understands how hard we work to attain a fitness level, and how awful it is to feel it slipping away.) The inhaler works well, no side effects, but I can find the bottom third of my lungs again! By the way, I'm 47. As I understand it, I might have had this issue my whole life, but never stressed my system enough to discover it.

[TexasLuckyDog]

I had a lot of these same issues. I actually got nervous about having a possbile heart issue so I had my heart checked out (it was fine).

I was put on Singulair for allergies even though it is an asthma med. It's the difference between night and day in my breathing improvement so I guess it was all pollen induced airway irritation.

[Bklynmom]

After a week and a half on Advair, SIngular, Zertec and Nasonex, and a bike fit, the asthma is gone. I have a bit of a cough after the ride but this seems normal.

The meds helped, but I think having my bike fit by a pro fitter here in Brooklyn made a big difference too. He felt I was really crunched up on the bike and unable to breathe properly. He raised my seat (abut 4 CM), adjusted my cleats and gave me a slightly longer stem - now i can breathe comfortably. And, now I get it when people say your pedals should feel like your floating.

Thanks to all for the helpful advice!

Lisa