Exercise Induced Asthma â€“ an Ultra Runners Perspective
By Neil L. Cook, Head Multisport Coach, Asphalt Green, NYC, NY, USA
I never had a problem through years of running. Gradually through the late 90’s I started to feel “out of shape” when I went out to run. A tightness in my chest, an inability to push my body. I went for allergy and pulmonary testing. I had some minor allergies and was given medication for them – mostly dust and animal dander. My pulmonary function as tested was down, so I started using Singulair, Advair and Maxair. There was a minor improvement. When I was retested my pulmonary function was above average. But, the problem persisted – many times when I went to run I felt a tightness in my chest, and an inability to push, like I was out of shape. I looked forward to the traffic lights being red on the way to the park!
Over a period of 3 to 4 years I developed Exercise Induced Asthma (EIA). The symptoms were a tightness in my chest and a feeling of being â€œout of shapeâ€ when I ran. The beginning of almost every run was difficult and very unenjoyable.
Then I noticed a strange thing. I could race, significantly better than my training runs. The tightness in my chest and the inability to push disappeared. In triathlons, regularly the swim was a problem – I’m an excellent swimmer, and finish at the top of my age group regularly. After a minute or two my breathing settled down and I was fine.
My doctor switched me from Advair to Asmanex, retested and everything from his point of view was fine. He also reduced the medications I was taking – no more Singulair. But, I experienced the same problems.
Then I noticed that when I ran a race, I’d struggle on my jog to the park – my warm-up. Wait 5 to 15 minutes for the start of the race, and then I’d be fine. So, I tested my theory. Run a bit, stop for 5 to 10 minutes and start again. No problems. In triathlons I jogged, used my Maxair inhaler, waited 5 to 10 minutes and did an easy swim warm-up. My swim became what they should have been, I was amongst the first in my wave out of the water. I didn’t have a problem at the start of any of my swims any longer.
I think the fast acting inhalers are good and necessary, but I also think you need to get your respiratory system to the point of constriction, use your inhaler and wait 5 to 15 minutes and start again. It’s worked for me.
BTW, the better shape I’m in the less the asthma is a problem.
I went for allergy tests and a pulmonary function test. I had mild allergies and reduced pulmonary function. At first that was a relief. There was an explanation to the difficulty I was experiencing. When I started taking the medication â€“ Advair, an inhaled steroid â€“ I expected relief. What I got was more of the same.
The doctor than prescribed a fast acting inhaler â€“ MaxAir – to use 15 minutes before I started running. This worked on occasions, but not all the time. When I returned to the doctor for a follow-up exam, the pulmonary test indicated no reduction in pulmonary function. The doctor was happy. I was puzzled and still struggling.
A few years later the doctor switched me to Asmanex. I continued to use Maxair. I continued to have problems when I ran, cycled or swam.
I discovered a work-around, and I realized that my doctor needs to do the testing differently for the test to truly reflect what happens to my breathing. If you have EIA these two things may also help you.
First, I warm-up well before I begin my workout or a race. I will spend at least 10 minutes running easily â€“ thatâ€™s as hard as I can run at the start anyway. Then I take a 5 to 10 minute break. No activity and I try to remain relaxed. I avoid any stress. Then I do my workout or the race.
This is what I believe happens. As soon as I start to run, my lungs react to the stress and the demands for more oxygen. The reaction is EIA â€“ my breathing becomes harder â€“ restricted â€“ the exact opposite of what I need. I need at least 10 minutes for this to work. Then, I stop exercising and relax. 15 minutes before I started to run I used the fast acting inhaler. I co not know the mechanism that is in effect, but it seems that the inhaler doesnâ€™t have an effect on me until after I start exercising. Then, it takes about 15 to 20 minutes to work (10 minutes warming-up and 10 minutes relaxing).
This technique has worked well for me, both in training and racing. Actually, I discovered it when I raced. I used the fast acting inhaler 15 minutes before leaving the house. I jogged to the start â€“ about 10 minutes. I had timed the warm-up to get me to the start just before the race was to start. But, the start of the race was delayed. I had to stand around for 10 minutes. My breathing was labored during my warm-up and I wasnâ€™t looking forward to a good race. But, as I stood at the starting line relaxing, my breathing settled down. As I started the race, I was waiting for the tightness in my chest and the breathing difficulty. But, it never came.
This got me thinking. The pulmonary function test when I was on the inhaler was always normal. But, I never had a problem breathing when I was relaxed and not running. Next time I go for a checkup Iâ€™m going to ask to have the pulmonary function test done after I have run for at least 10 minutes. I suspect the results will be very different. I donâ€™t know that there is anything different the doctor will be able to do, but at least the doctor will know that I continue to have difficulty breathing when I run!
About Neil Cook
Neilâ€™s coaching career started in 1965. He is a graduate of Springfield College, Adelphi University and Columbia University Teachers College. He is currently coaching running, swimming, cycling and Triathlon â€“ beginner to advanced competitor, men and women, individual and groups. He is a Serotta certified Advance Bike Fit Specialist and a multisport coordinator and Head Coach for Asphalt Green Triathlon Training Institute. He is head coach for the Mercury Masters. He has been a competitive athlete in high school and college and began competing as a runner in 1978 and as a triathlete in 1999.
He is sponsored by Hammer Nutrition/E-Caps and Asphalt Green Triathlon Training Institute.