I have suffered from Exercise Induced Asthma ever since I started running, especially once I started racing and training at a higher intensity level. I didn’t realize at first what was happening. At the end of a race I would feel dizzy, nauseous, and weak, and take up to an hour to feel better. I chalked it up to my hard effort and really didn’t worry too much about it. But, as these things do, it got worse. Here’s a little timeline of my history with Exercise Induced Asthma.
May 1996: I was running a 10k in Yucca Valley. It was shortly after Alan and I had met, and he was going to pace me to a PR. He did that, but I don’t remember the last 2/10 of a mile because I was so seriously oxygen deprived that I passed out at the finish line. While I never coughed or wheezed, I was not getting enough oxygen to fuel my muscles, and it took me over two hours to fully recover. For a while I couldn’t even lift my arms up. On a happier note, I did finish second overall and first in my age group.
Later that same week while on an easy run, I had my first incidence of a full blown asthma attack. I coughed, I wheezed, I cried (it’s very scary and emotional if you don’t know what’s happening) which made it even worse. Because my mother had suffered from asthma all her life, I figured out what was going on, made a doctor’s appointment and got my first inhaler.
December 1996: I ran my first marathon, in Honolulu. Starting about mile 16 in the race, I started having problems breathing and began using my inhaler. It slowed me down considerably, but I finished.
1997: My doctor tried a variety of medications. At one point, I was using three different inhalers and a pill that I took daily. It did help, but that’s an awful lot of medicine.
1998: I created a holster in which I could carry my asthma inhaler. After seeing a woman using a similar one at the San Diego Marathon (it was a gift so she didn’t know where it came from), I used the belt loop part of a flashlight holster with a big paper clip. The inhaler fit perfectly and was easily at hand whenever I needed it. I should have patented it and gone into production. I was asked about it at every race I ever did.
June 2002: The first marathon I ever dropped out of because of my asthma, Rock and Roll in San Diego. You can fight through a lot of things, pain, tiredness, but you really need to be able to breathe, and I couldn’t. I also dropped out of the same race two years later. The only races I’ve ever dropped out of for any reason.
2006: After a knee injury slowed my times and I just got tired of fighting the asthma, I ran my last marathon. For the next few years, I continued to run and race, but never trained at a very high level. I still had the asthma problems during races, but they were infrequent enough so that I stopped taking all the preventative medications and just stuck with my rescue inhaler (albuterol).
2013: With renewed enthusiasm for running, I decided to train hard with a goal of running a sub-2 hour half marathon for the first time in years. That meant adding speed workouts back to my schedule and running longer and harder. It also meant the return of the asthma. Alan (who suffers from asthma too) had been having great success with montelukast, which is the generic version of Singulair. I decided I wanted to try it as well, and after multiple allergy and other tests given by my doctor, I picked up my first prescription.
In my first race while using the montelukast, I still had a few issues. I think one of the problems is that I was taking it in the evening before bed. I should have taken it in the morning, a couple hours before the race. Hindsight is 20/20, but I will know this for next time. I did, however, accomplish my goal of running a two hour half marathon.
Fast forward to 2015. After running the Rock and Roll Marathon last June, my first in over eight years, I am now training for the SLO Marathon, which is in April. I have stated that I want to run a strong race, so that means thinking about asthma medication again. I’ll be sticking with the combination of montelukast, along with a rescue inhaler. I don’t start using the medication until about three months out from the race. That is when I start to increase both the intensity and distance of my runs. I’m hopeful that the combination of medication and sticking with my training program will get me across the finish line one more time.
That’s my story. Now a little bit about Exercise Induced Asthma.
What is Exercise Induced Asthma?
If you cough, wheeze or feel out of breath during or after exercise, it may be more than exertion that is the cause. If you feel tingling in your extremities, dizziness, or like you are breathing through a straw, you may be experiencing Exercise Induced Asthma. Even if you’ve never had any breathing issues in the past, EIA may be causing you to slow down, drop out, and begin to wonder if exercise is all it’s cracked up to be.
Having Exercise Induced Asthma does not mean that you should stop exercising. On the contrary, exercise helps to strengthen your entire cardio pulmonary system, and proper treatment of the condition can help keep you active, whether you are an elite level swimmer, an age group runner, or a weekend warrior.
Symptoms of Exercise Induced Asthma
Some of the symptoms of Exercise Induced Asthma include coughing, wheezing, shortness of breath, tightening in the chest, fatigue during exercise, and poor athletic poor performance. These can happen during or after exercise. Many people don’t realize they have EIA because they think the symptoms are their body’s response to exercise.
My personal symptoms start with a feeling like tingling in my extremities. I always think that they feel like they are not getting enough oxygen. I start to feel weak and my body suddenly needs to slow down. If I try to push through, I feel like the continued lack of oxygen will cause me to faint and even feel like I have encroaching blackness in my peripheral vision.
As asthma attack can be a life threatening occurrence. Get immediate medical help if your symptoms continue to worsen even after using a rescue inhaler or if your symptoms continue after you are finished with your workout.
Causes & Risk Factors
While no one really knows why one person suffers from EIA while another doesn’t, some things that increase the likelihood of an attack include cold, dry weather, air pollution, high pollen counts, chemicals (such as chlorine in a swimming pool), and having a cold or other respiratory infection.
Again, my personal experience is that warm, humid climates make it more likely to have an attack (contrary to everything I have read, but have heard from others). I also have difficulties at high altitudes, especially during the adaptation period. And while I will occasionally have an EIA attack during shorter, high intensity exercise, I seem to have more problems during lower intensity, but longer efforts.
Those who have asthma that is triggered by other causes are more likely to have EIA, as are children, smokers, and high intensity exerciser (like runners).
So what is an athlete to do? For many people, a couple puffs from a quick relief inhaler such as Albuterol is enough to control symptoms. These are called bronchodilators and can help open the airways during an attack as well.
If a bronchodilator is not enough, speak to your doctor regarding the medications that are available to prevent asthma attacks. This type of medication is taken on a daily basis to help reduce inflammation and keep your airway open.
In order to prevent an EIA attack, several things are known to help, including a long warm-up of 10 minutes or more, trying to breathe through your nose, covering your mouth in cold dry weather, and if allergens cause you to experience EIA, avoid them as much as possible (maybe skip a workout on a high pollen or pollution day).
Don’t stop exercising. As I mentioned, exercising improves your lung function, so it is an important factor in the control of asthma symptoms. And don’t be discouraged. It may take a while to find the right combination of medications. I have finished 36 marathons with (in spite of) Exercise Induced Asthma, with a PR of 3:16, and many races of shorter distances, so it is possible to race and train at a pretty high level.
Remember, I am not a doctor! If you are experiencing Exercise Induced Asthma symptoms or feel like you are having difficulties breathing during exercise consult your own physician. While I researched the topic, I am speaking from my own experience and yours may be completely different.