Experience From - Damon Lease, George Beinhorn, R, John Mahon #1, Scott Sullivan, Fred Vance, Rick Kischuk, Mr. Bill, Pete Petr , Jeff Selinger , Chuck Zeugner , Rick Lewis , Bob Rayburn , John Mahon #2, Heidi Schutt , Rich Schick ,
Chuck Zeugner wrote:
"I was recently diagnosed with asthma. My doctor prescribed two types of drugs for me to take. I've asked the typical questions of the doctor and pharmacist and read the ppi. I'm wondering about bronchodialator strategy. Ultra running doesn't really fit into a nice niche. I know that I'll have to experiment. I'm hoping someone else on the list has already done so and can save me from running down a few trails to nowhere.I am also asthmatic, although I consider it fairly mild by some standards. When I characterize my asthma as mild, this means that I don't have what would be called "attacks", where my breathing becomes very difficult or I am in grave danger. I primarily notice a tightness in my chest, and occasional light wheezing.
I'm supposed to take Proventil (albuteral) before exercising or whenever I become wheezy. The fine print says to avoid taking it more often than every four hours and that the normal dose is effective for up to six.
Easy physical activity doesn't cause me any problems. Speedwork, hill training, smoke, and cold weather are triggers. Exhaustion probably is too. How do other runners who have asthma handle drugs? Do you carrythem in your butt pack? If the effective time is six hours, would you go on and take a dose at the six hour mark? Does anyone know how long term exercise affects Proventil?
Any comments on drugs? I don't want to second guess my doctor, but I know that "normal" medicine doesn't always seem to work the same for active people. "
I have adult-onset asthma; it first appeared six years ago (at age 30) during a nasty bout with bronchitis, and it has never gone away.
I have run a sub-18:00 5K and a sub-3:00 marathon since then, and I've finished a number of ultras, with my longest run so far an 83 mile DNF at Vermont last summer. So, it is certainly possible to run long and hard with the condition if properly treated.
I've been through a number of medications and doctors over the last 6-1/2 years. And, I've learned a lot about what triggers my asthma, and what treatments work best for me. These may or may not work for you.
First of all, albuterol is usually the primary dilator that people use. There is a longer lasting dilator out there (Serevent is its name, I think). It didn't work too well for me. I always carry albuterol when I run. Actually, I always have it with me. It is available under a number of trade names, and it comes in a blue, yellow, or white "puffer", as I tend to call them.
The real goal is to get your asthma under control so that you never need to use the dilators. The dilators work to reverse the effects of irritation, but the best thing is to prevent irritation to begin with.
This can be achieved a number of ways, and I've tried a lot of them. Currently, I use a steroidal drug called Flovent. I take it twice a day, as opposed to four times a day for the drug (pink puffer) that I used previously.
Other options that you might try include Intal, which is chromlyn (sp.?) sodium , I think. It works very well for some people, and not well at all for others. I think that this drug is usually most effective for people with Exercise-induced asthma (EIA). It didn't work for me.
Another option is Tilade, which also didn't work for me. For severe asthmatics, prednisone in pill form is often used. This medicine causes me severe gastric distress, and I cannot use it.
There is a lot of info on the net about asthma, and it might be worth your time to look into that info, rather than relying on what I've written here.
I have been through a number of tests to identify my asthma triggers, and pets came out number one. Since moving from the polluted air of Silicon Valley to Alaska, and banishing the cats from my bedroom, my asthma has gotten much better. We also have a shorter pollen season up here. While cold also triggers some minor attacks, I seem to have gotten past that pretty well. If not, I'd have a very long off-season, or do lots more treadmill miles.
Last summer at Vermont, I used albuterol just before the start, and not again during the race. I was very pleasantly surprised by that, expecting to use it along the way. My doctor in CA used me as an example to the young kids that he treated, telling them that they could still do most anything they wanted, if they got their asthma under control.
As for the time recommendations on Albuterol, I tend to use it when needed, and only then. This can somtimes mean every 2-3 hours, and other times, not for 24 hours or more.
I wish there were less drug-intensive options out there, but I haven't found them yet.
Okay, this comes with all the standard disclaimers: I'm not responsible, etc., etc.
Anyway, I've read--and I can't recall where--that certain nutritionists attribute the widespread asthma in the U.S. to dairy products. Kids' asthma gets worse in summer when they're eating ice cream, etc.
I also knew a fellow who cured himself of asthma permanently (he'd been free of it for years) with breathing exercises. Again, I have no references or referrals.
I am a physician and an ultra-runner but do not have asthma. (I certainly see a great deal of it in ER.) my only thoughts are two:
Chuck - my symtoms of asthma triggers include those of yours, as well as perfums, animals, some hair products, and other weird stuff. (Also have been diagnosed as having some emphysema. I'm not a smoker, but worked for years in smoke filled offices; maybe that's why, I don't know.)
As to medications: the specialist I go to says he treats me as he does an "athlete" and not as the "average" guy in the street. The following are what I take:
I do carry my Proventil at all times. I stick it in my pocket, or fanny pack, when in non-running attire. When running, normally take the Proventil with me in a small pack on a belt. (If it just a run of a few miles, then I don't carry it, as it has just been taken 15 minutes before starting those few miles and wouldn't need it.) In some longer training runs, I have forgotten to carry it along, and a few times had some problems it would have helped. In a long race, I routinely take 2 puffs every four hours and it seems to help my breathing. (Often wear a breathe-rite on long runs and it seems to help, maybe because I need to get as much oxygen in my lungs as I can due to the emphysema - again don't know?) I know that the older I get (I'm 60), the asthma seems to get worse. Maybe there are just more polutents in the air than there used to be?
Here are my experiences with asthma. About three years ago I had steadily deteriorating asthma condition. At the time my ultra activities consisted of one or two 50 miles a year, plus few marathons and 50Ks. My doctor kept prescribing additional medication as the asthma got worse. At my peak medication, I was taking Uniphyl (a theophylline derivative), Seldane, a proventil inhaler, and one other drug I can't remember.
Despite all these drugs, I could run ultras with no problems from the asthma.
I always carried my proventil inhaler with me and took a puff before any run as directed by my doctor. Once I started running, I only used the inhaler when I needed it and this was rare. I never took more than one additional puff during up to 12 hours of running.
I became alarmed by all the drugs going into my system, and pursued a course of controlling the asthma without drugs. The first step was a new doctor and lots of tests. My asthma triggers are dust, mold, pets, many foods, and various pollens. Most of these allergies are not strong enough for a severe reaction, but prolonged exposure all the time was taking a heavy toll.
I put myself on a strict avoiding all food that I had even the slightest allergy to. This was very difficult and basicly eliminated all eating out. I got rid of all carpeting and drapes in my house, covered the mattress and box spring of my bed in plastic, eliminated all dust collecting junk from most of the house, got a HEPA air filter to remove allergens from the air, and kept the house a lot cleaner.
Within one year I was completely off all the medication except occasional use of the inhaler. I still carry the inhaler with when I go on long runs, but I have not used it in more than a year. I feel a lot better physically, and my running has improved. I have been able to reintroduce many of the foods I had been avoiding into my diet and still keep the asthma under control.
I am happy to provide more details and discuss this off-list with anyone that's interested.
First, the disclaimer: I'm not a doctor, and anything that I say reflects only my own experience and my interpretation of said experience. I'm not a lawyer either. :)
I've had allergen/exercise/cold-induced asthma since 1992 when I turned 40 and moved to California. The medications I've taken at one time or another include everything that Dr. R, John, and Scott have mentioned. I've got the same types of triggers that John and Scott mentioned. I was running ultras for a couple of years before I became asthmatic. I've never been hospitalized, but have been times when I thought about going to the ER, but never did.
" My doctor prescribed two types of drugs for me to take."I'll bet the other drug was something to lessen your sensitivity to allergens, like Vanceril or a similar corticosteroid, but maybe something like Cromalyn. Personally cromalyn didn't seem to do anything for me. I love the corticosteroids though. (I believe theophyline is a dilator like albuterol, but taken orally. I've tried it, but prefer the inhaler.)
"I'm wondering about bronchodialator strategy."I'll bet you are, because that's what gives you immediate relief, but if you don't use the other stuff, you get to the point where you can't take the dilator often enough to do any good. Don't forget to use the other stuff, even if you can't feel any results when you use it.
"How do other runners who have asthma handle drugs? Do you carry them in your butt pack?"On runs of less than six hours, I don't carry my dilator (albuterol, Proventil, or Ventolin). On longer runs, I carry it, but I reverse the cylinder in the inhaler and put something over the nozzle to keep it from being accidentally actuated.
"If the effective time is six hours, would you go on and take a dose at the six hour mark?"No, I usually forget about it.
"Does anyone know how long term exercise affects Proventil?"I'm not sure what you mean by long term, but I can cover two time frames for you. Over a period of 24 to 48 hours, I only tend to be symptomatic at the start of the run, for 30 to 45 minutes during the first hour.
There are times, when I have started a long run (over 3 hours) and found myself wheezing because I forgot to use my dilator. By slowing my pace, I was able to keep going, and eventually I begin to breath better and forget about the episode. I wouldn't advise doing this on purpose. I've got a feeling that there are times and people for which this might not work.
Over a time frame of several years, my asthma has steady improved. I also took allergen injections for about five years, but I stopped those about a year ago. My doctor precribes Vanceril 2 puffs, 4 times a day, and Ventolin, 2 puffs, 4 times a day, but over the past 6 months, I've forgotten to use the Ventolin except before I go out on a daily run. In the last three monthns, I don't often remember to use the Vanceril, but I always try to use it more than I do the Ventolin.
I'm hoping that maybe the injection and inhaler therapy has paid off, but only time will tell. I've had remissions for a period of 2 or 3 months, but nothing like now.
"Any comments on drugs?"My choice is ethanol, caffeine, ibuprofen, and corticosteriods. ;) Seriously, I don't know how I would have done without a brochodilator. As for treating the problem rather than the symptoms, I don't honestly know what has been most important, injections, corticosteriods, or exercise. My gut feeling, is that it is a combination of the injection and corticosteroid inhaler therapies.
One last comment:
Being asthmatic has one advantage, you really learn to enjoy a good breath of fresh air fully expanding in your lungs. It's like cool clear water when you're dehydrated and thirsty. How many other people can appreciate a good hit of clean air?
I've been following a similar approach using a mostly organic raw food vegetarian diet, in addition to the environmental changes mentioned and alternative health therapies, with a lot of success.
Chuck and any one else that wants to read this.....
I have had asthma and allergies all my life. Back in the 50's we did not have "whiffers"/ "puffers" so I had to suffer, be laughed at school and not participate in sports. When I started running in 1983, I would use my proventil inhaler at the start gun. (5k,8k,10k,12k....what ever I ran) In 1988 I did a "drug" study involving albuterol. What they were measuring in an 8 hour time frame were: how long after inhaling,full dilation was reached;what was the best "reading" and how long to drop off point. What I found out was, I reached full dilation in 3/4 hour( 45 min). Now think about that, I was taking a whiff at the start gun. That meant I was finished with the race before full dilation. The longest I lasted before "locking up" and needing to ventilate again was 6 hours. Sometimes I would lock up after eating lunch. I have done several asthma drug studies since and I learned a lot after each study. I did the base line studies on the drugs used to make "Serevent" and "Flonase"/"Flovent". Serevent and Flovent are "long acting" prophalatic type medicines. The one problem with Serevent is that it gives the patient a false sense of "not needing any other medications". neither Flovent or Serevent will work for "immediate/instantanious " relief.
I have run several 100's and the only one that got me was Western 1994. That year there had been a motorcycle race over the trail and the dust was finite. The dust going into Duncan Canyon was Thick. You could see dust just hanging in the air. I took 14 hits of albuterol in 12 hours. When I got to Foresthill, I took a peak flow test and was at 300ml of air. I was 50% comprimised. I was able to get to Highway 49 before the clock ran out I took no more albuterol after Foresthill. If I would have had my nebulizer with me, I would have used it at Foresthill.
I agree with your thoughts on having to experiment with what works. I wear shorts that have pockets and ALWAYS carry a proventil inhaler with me. I am never without it.
If you have a good asthma center in your town or a medical college nearby, I would encourage signing up for the drug studies. You can really learn from them. Besides, you can get paid for it and sometimes get some "neat" stuff. I got my nebulizer for doing the Tilaid study. The doctor then gave me some albuterol to use with the nebulizer "in case of a real emergency". I have never had to use it in an emergency situation.
Now here is my routine: I take 2 puffs/2times a day of Flovent; 2 puffs/2times a day of Serevent; 1 Claritin a day: and proventil as needed. I dialate before each training run or race/event. And if I need, I use during the run. Here is where you have to experiment. Sometimes I have to ventilate in the first 2 miles and then nothing for the rest of the event. Depending on the length of the event, will be the determining factor. In 24 hour events, I have to ventilate based on pollen in the air, temperature or after meals. The normal daily dose is 8 hits BUT if you need more to get through the event by all means VENTILATE. Do not try to "work" through it. Don't worry, just ventilate. As far as over dosing, remember, you are not doing this every day. When I finish an event, regardless of the amount of hits of medicine, I will go till bedtime or later before needing any more medication.
Sorry for the length of my response, but I do know of what I speak from personal experience.
I just found out last night that I have had asthma for a while, albeit a mild case. I found this interesting to say the least, as I am having one of my better years running, endurance wise, but have noticed I am a step slower.
I am curious as to what caused you to be tested for asthma.
The reason I ask is that I am wondering whether I should be tested. I had an 'incident' last year which an EMT attributed to hyperventilation, but the ER doctor termed electrolyte depletion. I seem to breathe heavily compared to other runners, and am short of breath at times, (but then I figure that goes with running).
Reading the archives, many of the EIA runners seem to control their asthma to the point where they don't use any medications. If I am doing 'well enough' without any help, should I check it out any way ? I hate to consume scarce medical resources for performance improvement in a voluntary activity. Are the tests simple, or complicated and expensive ?
By the way, I tried to research hyperventilation after my 'incident'. Information is very sparse, but it in itself can have symptoms quite similar to asthma and electrolyte depletion. I am speculating that some of the breathing difficulty incidents described may be simple hyperventilation. This seems especially possible at high altitude as your breathing regulatory mechanisms might already be confused.
Caveats... I am a beginning ultra runner. I am not a doctor. I have not done any altitude running. I just throw out the idea for your discussion. I did not see it discussed at all in the archives.
For humor, one quack site says that 50% of all people hyperventilate all the time ( wouldn't that make it the norm ?). This causes fatigue and lack of energy, which you can cure with their special therapy.
I'm not and MD, but here's what I have learned. Asthma used to be thought of as a reversible contriction in the airway. Now things are a bit more complex. I read an article recently that observed that asthma is an inflamatory disorder.
"Treatment" has three parts; reducing (chronic) inflamation, avoiding triggers, and treating acute episodes. Inhaled corticosteriods seem to be the treatment of choice for inflamation, that is to say a preventitive. Of course there's probably a lot to be said for relaxation or other non-drug "therapies."
If I were in your shoes I would go see a doctor. I thought that the constricted chest and wheezing and coughing was normal. It's not. If you have any doubt, see your doc. If you don't have asthma, then the heavy breathing just means you don't train enough! ;)
Traditional Chinese Medicine, among other non-Western medicines, have been treating asthma and every other imaginable human dis-ease including cancers for thousands of years.
My daughters, diagnosed by Western medical practioners as "asthmatic", went through acupuncture and herbal therapy and now only require occassional herbal therapy, in the form of capsules resembling vitamin supplements, to ward off the triggering of an attack as well as reduce the inflamation when they often forget to take the herbs.
I ran for years before I found that I suffered from EIA. Like you I thought tight lungs was just the way runners were. At twin Lakes on the way back on my first attempt at Leadville, I found that I could not even run slowly down hill without getting out of breath. the medics were extremely unhelpful suggesting I breathe O2 for a while than carry on. I dropped.
My doctor admitted being out of his depth when I told him that this did not happen on 50 mile runs but did at 55 over high altitude. He even thought it might be edema but dismissed the idea. Through his efforts I went to see an asthma specialist who recommended a treadmill test. I thought that this might be useless as I never noticed any unusual shortness of breath at normal.
I breathed into a "machine " (don't know the tech term for it) which showed that air was getting to most of lung extremities, but not all. I breathed an albuterol sulphate mixture for 20 minutes then did it again. This time the air was shown as reaching all parts of my lungs. Taking these tests as baselines, the next day I did an 8 mile run with hills and then rushed to the clinic for another test: the contrast was significant. this time there was a great deal less of my lungs which wer reached by the air.
Since then I use an Albuterol inhaler before runs and if the run is long I use it as needed at 2 or more hour intervals. I don't think I run any faster but I enjoy my runs more. (also I managed to get beyond twin Lakes while breathing enjoyably the next year: of course I had other excuses for not finishing which I will eliminate this year!)
So, yes, go get your lungs checked.
I've had asthma for some time now. Had been having breathing problems but my family doctor never did anything about it. I had a real problem one time when he was on vacation and his partner was covering the calls and told me about my asthma. When my doc came back he sent me to the hospital for a barrage of test. As a result I now go to a specialist (also a runner) for my asthma. He is treating me as he said he would a pro athlete.
Drugs I take are:
Serevent - 2 puffs 2 times a day
Vanceril - 8 puffs 2 times a day
Intal - 2 puffs 15 min before exercise
Proventil - 2 puffs 15 minutes before exercise and as needed.
I carry the Proventil at all times as this gives almost instant relief. I definitely carry it along on runs. Once I forgot it and that was a day it turned out I had a problem running in a bad neighborhood, so always take it on runs now. During ultras I use it about every four hours.
Whenever I have some really bad chest congestion, which asthmatics are subject to, and my regular inhalers don't get rid of, the specialist puts me on prednisone. This stuff works, but it is only for when you have a problem. You normally get a heavy dose for several days, and then tapering off doses. You cannot just stop taking it. Went on a trip once when on it and miscalculated when I would return to pick up my taper dose by one day - some bad time driving on the road home that day w/out tapering feeling like my head was about to blow off.
Although not a smoker, I have a little emphysema also. Probably from working in smoke filled offices for my whole career until the last few years when smoke free environments became a reality. I'm retired 5 years and 61.
I just can't run the speeds i used to. But I can finish ultras which is quite a rush, and have even finished Ironman with asthma. Hopefully you have caught yours before it is too bad and you are going to a doctor who will help you.
I too have recently been diagnosed with EIA! I have been complaining for about 3 years now - I just can't breath, I run a bit and then have to walk, too bad it took so long - most docs just look at you funny when you try to explain what's going on - and then off they go to their next patient - no answers! It was very frustrating. And finally, one suggested it might be EIA, prescribed an inhaler - used it the next day, went for a run - WOW, I could run nonstop - it was exciting.
But in the meantime, I went to our local Vitamin Cottage and inquired if there were any herbs that would help with breathing - they recommended "Lobelia Herb Extract" - I add a half of an eyedropper into a glass of water - drink it, and then run, seems to work well.
For those of you with asthma I highly recommend the website below. Hit the Asthma link, do the free registration and personal interview and then learn more about asthma, and your specific situation than by virtually any other source, to include going to most MD's. (This is because they simply couldn't afford to go into such depth as it would be too time consuming.)