Asthma

Do you have (sports-induced) asthma and what do you do to manage it?

A couple of weeks ago I had to pull out of a ride when my asthma started to worsen and I did not have my inhaler with me. I never take it anywhere because the asthma only bothers me once every few years when I really exert myself and it's really cold. Reading some articles whilst I was waiting for my friends to finish the ride, I realised I'm being far too cavalier, and there's a (small) risk I'll end up having a fatal attack in the Highlands with no phone signal or something if I don't take it a bit more seriously.

I don't want to ride less hard or stop riding in the cold or whatever, which is what some of the advice says, and I'm sure many of you feel the same way. I also want to minimise the effect on my performance (if that's not too grandiose a term for crawling up hills in a shamefully low gear). Lots of pro athletes "have" asthma (though there is a question about doping), so there's no reason to think we should be any slower or less able to ride in poor conditions than anyone else with proper management.

It would be nice if we could collect together some knowledge that pertains to cycling specifically, to help each other and any future sufferers.

Just to add, the symptoms are not that drastic most of the time. In my case pretty much regardless of how fit I am I'm slower than my friends up hills, which is a symptom:

It might be expected that people with E.I.B. would present with shortness of breath, and/or an elevated respiratory rate and wheezing, consistent with an asthma attack. However, many will present with decreased stamina, or difficulty in recovering from exertion compared to team members, or paroxysmal coughing from an irritable airway.

Hooray, I'm not just a lazy sack of shit - I now have a medical condition to blame.

The wheezing and shortness of breath do happen for me but only very rarely. When I do get wheezy it's bad enough that I have to sit down for 10 minutes, but that usually only happens if I start a ride by going up a big hill when it's really cold.

Also the prevalence is quite high amongst athletes (it's 8% in general population IIRC):

“Athletes are far more prone to asthma-related problems, mainly because of the environments they’re exposed to and the conditions required by the sport, such as the high breathing rates over prolonged periods.

“Cycling is done outdoors, often in dry, polluted air — there are lots of reasons for the high prevalence.”

Given that amateur riders are exposed to as many asthma-triggering factors as the pros perhaps even more in some cases, e.g. urban commuters breathing polluted air — we are just as likely to develop symptoms.

Does this mean that all of us should get tested? “Yes,” says Dickinson, “when we work with squads of elite athletes, we test everybody — it clears up any doubt.”

If you have some of these symptoms maybe worth getting it tested.

My asthma is almost nil..until hayfever season.
At that point I need my inhaler on nearly every ride.

I've had asthma all my life, and really strenuous exercise is one of the triggers. Weirdly, regular slightly less than strenuous exercise has enabled me to keep it under control. For example I was a bit wheezy this evening, so went for a gentle ride to the swimming pool, did a pretty strenuous swim session and rode home with no sign of it.
I also use a preventative inhaler, go to an asthma nurse every few months for a check up, and carry a reliever with me just in case.
In the past I have had serious attacks, leading to hospital stays with a nebuliser. They were terrifying and a real motivator to get on top of it.

I’ve known I’ve had asthma for about 12 years but probably had it for quite a while before then. I’m lucky in that as long as I take my preventer inhaler (Symbicort) I don’t need a reliever, but I really notice if I miss a dose.

Things I’ve found help are getting a proper intensive warmup if I’m going to be doing a high intensity workout, and I’ve also had some success using a powerbreathe. I don’t use one currently as despite religiously following the cleaning advice found I seemed to get more chesty coughs when I was using it, but it definitely made breathing feel easier.

Diagnosis wise I’d say the important thing to remember is it’s not normal not to be able to breathe when you’re doing hard exercise. What was noticeable during my diagnosis was that the severity of it changed day to day, so one day I’d have a normal peak flow, the next day it would be considerably lower. I used to row and my 2k PB on the Concept2 is from before I was diagnosed, so you can do a lot without realising you’ve got it. I know Alex Gregory (2 Olympic Golds) didn’t know he had it until he nearly collapsed at a world under 23 final!

Do you have (sports-induced) asthma and what do you do to manage it?

A: yes B: nothing special, i.e. the same regime as anybody would use if they were paying the slightest bit of attention. Routine beclomethasone, PF reading morning and evening, pre-ride prophylactic salbutamol, avoid racing in cold weather.

YMMV, other preventers and relievers are available, some people are less bothered by cold, some are aggravated by pollution or biological allergens etc. so the important thing is to find out what works for you and also what doesn't.

PF reading morning and evening

Sorry, what does that mean?

Edit: Peak Expiratory Flow.

Basically what Tester said, although I've never bothered with PEF unless it's in a medical setting. I would if I was engaging in proper competitive sport though.

There are also aggravating foods and substances to avoid, which you might have to discover on your own.

I've had exercise asthma my whole life, but always just treated it with salbutomol if it flared up. I was pretty cavalier about it and just down played the effects in my head.

It took a pretty severe asthma attack on a 360km ride this summer to force me to take it seriously. I'm now on a preventer (clenil modulite) which has properly transformed my riding. I have no idea why I resisted going on a preventer up until now, but it's helped so much on intense efforts. Now it's not my wheezing lungs which slow me down on hills, it's just my legs.

On a non cycling note, I find my breathing is far easier and deeper in everyday settings. I always used to feel short of breath when trying to breathe through my nose but that's a non issue now.

So yes - see a doctor, stick to a preventative regime which works for you and you'll be much better off.

Good info folks. I'll definitely be seeing my GP for a preventative inhaler and will see if it makes any difference. I sometimes use the salbutamol one before a ride but I find it very hard to tell whether or not it's doing anything. Maybe a peak flow meter would be handy

I sometimes use the salbutamol one before a ride but I find it very hard to tell whether or not it's doing anything

If you can't tell whether it's doing anything, there's a very high probability that you're doing it wrong. I see an awful lot of really ineffective inhaler technique out there, and if that's you then you're probably getting no more than 10% of the intended dose to the relevant tissues. Talk to your GP or asthma nurse about technique, and consider using a spacer to avoid wasting your drugs.

Your GP can prescribe spacers and basic mechanical PF meters, but if you want to go #tartmode you can buy digital meters so you can see pretty graphs on your PC or phone.

I think it's less my technique and more that the inhaler is 2 years old and a bit busted. Will get a new one.

I am 100% in for graphs and data. Will buy.

https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

Asthma puts you in the higer-risk groups for COVID-19. Not unexpected but worth knowing.

Peeps with exercise induced asthma/bronchitis/bronchospasm, are you considering yourself within that higher risk group for Coronavirus?

I had what we think was asthma symptoms racing a cold 24hr TT. Back in the UK they measured me on a thingiebob and I was at 70% of what I should be. I decided to stop the crack habit then and there and move to sucking on blue things all the school kids had when I was in primary school. Inhalers.
I used a brown one for a while and carried a blue one for a while but didn't have further issues so stopped doing both.
I have a tester thingie but I stopped using that. I probably should get it checked again but I'm not going near a medical facility for a looooong time.

I was diagnosed with “what we used to call exercise induced asthma but we’re not allowed to use that term now” and prescribed both brown and blue inhalers in 2018 but told not to use the brown one unless I really needed it.

I did peak flow test for a month or something and think I was also about 70% capacity.

I’ve never used the brown inhaler but do use the blue one if I’m riding hard. Because I was prescribed a brown (steroid) inhaler in 2018 I got the flu jab letter that winter (which I ignored). Because I’ve not reorder a brown inhaler I did not get the letter this year.

The flu jab letter has been used as a sort of indicator that you’d be in that higher risk group.

My work are giving me the option, continue coming to work (our building is shut but we may get redeployed to support vital services) or if I feel I’m in the high risk group I can be signed off.

I don’t want to take the piss but I also don’t want to put myself at risk.

But the brown one is a "preventer" - you're meant to use that one regularly?

The blue one is for if you've got symptoms. Unless it's a different brown one? Or maybe I got them arse about?

I was told not to use that one unless I was having difficulty breathing ‘at rest’ which I don’t.

I only use my blue one basically when riding with mates who go fast.

I consider my exercise induced asthma or whatever it is to be very mild and (so far at least) inconsequential, especially compared to mrs m_v who takes a preventer daily and her blue one several times throughout the day.

I’m just starting to get concerned that this is not the time to be so blasé about it.

A few weeks before all this kicked off I was thinking about going to get checked out. I'd had a cold but my breathing on the turbo is still hindered and I wondered if I was in any worse state than previous. I probably still have those inhalers from 2015? Do they go off? Maybe I should see if it makes a diff.

asthmatics with concerns about covid19: I very much recommend calling 0300 222 5800 and speaking to one of the asthma nurses at asthmauk. i did it yesterday and we talked through my asthma history, what I should be doing (in terms of isolating etc), and what i should ask my GP for - if anything. it was very reassuring.

in my case i am to request a peak flow meter and a course of oral steroids from my GP, the peak flow meter will indicate any drop in performance should i get sick. if my scores to 60% of my usual score then i am to crack open the steroids on top of my usual blue/brown lungbag combo. every case is different, though and 'asthma' covers a broad specturm so i would urge everyone who is worried to seek advice specific to them.

yeah, the medication has a use-by date.

Yeah, but lots of things legally have use by dates. I think I'm using a 2007 tub of Vicks.
Does it actually go off? Become ineffective? Dangerous? (I'll let you know)

My GP happily doubled the number of inhalers per prescription over the phone this week

I know already, it tastes different when inhaled, more bitter and isn't particularly effective. Mine was years out of date though and I just reordered.

asthmatics with concerns about covid19

If you don't actually catch the virus, Covid is looking like good news for asthmatics; air pollution is down, and public hygiene is up so you're less likely to get any of the other infections which can cause an exacerbation 🙂