Weird Asthma Behaviour

[robeambro]

Hi all,

I'll try and be as concise as possible.

I've had mild asthma since forever, and when I was a kid I'd get a bit wheezy more often, but in the last few years I'd mostly gone over it, especially after moving to the Netherlands. Fast forward to last October, I moved back to the UK (Scotland). I have noticed that I'm getting wheezy very often, and only using the inhaler seems to help.

How it happens:

Mostly, it happens at the very beginning of a ride, when increasing intensity to anything remotely near threshold efforts. Today it happened 10 minutes into a ride, I was going slow but had to do a 1m effort over a steep incline to allow for a car to pass me at the summit. Recently, it had happened plenty of times both on the road and while Zwifting.

Symptoms are just wheezy, constricted breathing.

Triggers are unknown, may be either some allergy (vegetation in Scotland is far different than in the Netherlands) or improper warmup?

Reducing intensity and/or stopping does not do much, I remain wheezy. Even if it seems like it's gone away, the moment I start pedalling again I get wheezy, and only using the (blue) inhaler works. Or at least I think, usually after 10-15 minutes I tend to lose my temper and stop waiting for it to go away, and take action.

Now, I'm not a doctor, but it seems to me that this is definitely asthma. However, I can't quite figure out why I didn't get any of this in two years in the Netherlands - this could have maybe been related to the fact that pan flat solo cycling means very little threshold work?

Am I doing something wrong? Do I need to warm up for longer? It's already difficult to fit proper training in my day, and having to warm up for like 30m prior to actual efforts would be a bit tricky (and sometimes difficult). Do I need to warm up in a different way? Is there a way to "train my body" to overcome this, or shall I just get a couple puffs before riding? I don't quite like doing that as I feel like I'm "cheating", but lately it's getting pretty annoying..

Any help appreciated!

[jfranci3]

I'd look at air polltion (ozone) or fragerences.

Ozone is used to remove scents (cigarette smoke) in buildings. It also is present on hot days - particually the first few hot days of summer. It tends to sit in your lungs for a day or two, making you feeling like you've only got 80% capacity.

Fragerences - These are a big trigger for me. Pretty much any synthetic scent. It's not the scent as much as it is the base. You might be releasing a fragerece with your sweat.

[robeambro]

I'd look at air polltion (ozone) or fragerences.

Ozone is used to remove scents (cigarette smoke) in buildings. It also is present on hot days - particually the first few hot days of summer. It tends to sit in your lungs for a day or two, making you feeling like you've only got 80% capacity.

Fragerences - These are a big trigger for me. Pretty much any synthetic scent. It's not the scent as much as it is the base. You might be releasing a fragerece with your sweat.

Thanks. I'm doubtful it would be ozone as in Scotland the air is fairly clean and surely we don't have many hot days
Surely I'm hoping it's not something to do with my sweat, that would be hard to kill!

[TobinHatesYou]

Possibly mold in your living space.

[robeambro]

Possibly mold in your living space.

That would be very much possible, albeit none is visible. I feel like 90% of UK houses are moldy anyway..

[Dennisbley]

Consider seeing a doctor to get pulmonary function tests. If your ability to breathe out is measurably impaired at rest you may need more aggressive treatment.
There may be triggers in the new local keeping your airways reactive.
Consider taking an antihistamine daily for a week or two to see if less wheezing.
Treating asthma is all about treating the triggers.
Isn’t Scotland famous for the bush called grouse? Allergies to local pollens, molds a very common cause of asthma flairs

The breathing test is important because if it is just exercise induced only then take the albuterol prior to exercise.
If it is regular old asthma you need to go after triggers


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[sychen]

I have pollen allergy bordering exercise induced asthma. Especially in spring I take a couple of puffs of ventolin at the start of the ride( early morning 6am). Bad days will have me weeze/caught/vomit in the first 30mins (if no ventolin) then mostly OK for the rest of the ride. Mainly seems to clear the overnight congestion unless the air quality is horrible (aka bush fires).

Sent from my Pixel 4 XL using Tapatalk

[robeambro]

Consider seeing a doctor to get pulmonary function tests. If your ability to breathe out is measurably impaired at rest you may need more aggressive treatment.
There may be triggers in the new local keeping your airways reactive.
Consider taking an antihistamine daily for a week or two to see if less wheezing.
Treating asthma is all about treating the triggers.
Isn’t Scotland famous for the bush called grouse? Allergies to local pollens, molds a very common cause of asthma flairs

The breathing test is important because if it is just exercise induced only then take the albuterol prior to exercise.
If it is regular old asthma you need to go after triggers


Sent from my iPhone using Tapatalk

Thanks. I will surely be seeing my GP, haven't had it checked in some 5 years. I think I had my ability to breathe out checked and it was surely low, but can't recall the value.

I tried antihistamine but to be honest they did not seem to work for the overnight congestion (which is kinda of a constant for me here, more often than not I woke up with a stuffy nose and might sneeze a few times.. Goes away after a few minutes). So I assumed that they weren't really working for me. But maybe they would reduce the asthma, to be honest I didn't pay attention to this!

I have pollen allergy bordering exercise induced asthma. Especially in spring I take a couple of puffs of ventolin at the start of the ride( early morning 6am). Bad days will have me weeze/caught/vomit in the first 30mins (if no ventolin) then mostly OK for the rest of the ride. Mainly seems to clear the overnight congestion unless the air quality is horrible (aka bush fires).

Sent from my Pixel 4 XL using Tapatalk

I can safely say that mine will not get as bad as to have me vomit! But yes I do wheeze and get troublesome respiration that kinda makes exercise quite difficult an unenjoyable. Do you feel like Ventolin helps you with the overnight congestion if I understand correctly? I haven't seen this in my own experience.

[sychen]

The ventolin helps me clear the lumgs/congestion in the morning.. Add in antihistamine as well. Have tried 1 or both in different weeks and definitely need both on bad days.

From where I live.. Group ride starts around 30mins away.. Perfect in most cases to clear everything up without anyone around.

There is a spectrum of severity for me.. Not easy to know exactly how bad every morning.

Extreme cases of vomit comes from to much mucous stuck and my airways spasming out of control when I need o2 for the muscles. Ventolin relaxes the muscles and prevents the vomit from occurring.

Sent from my Pixel 4 XL using Tapatalk

[Djakninn]

Where in Scotland are you. I'm in the NE out in farming country. My brother has full blown asthma and I have very mild EIA, so mild that i haven't used my inhaler for about a year. When mine is triggered it sounds as if it's similar to yourself in doing higher efforts and there's a constriction around the chest/shoulder area, i pretty much feel like that area can't relax and i can't get a proper deep lungful of air. The reason i asked where you stayed was, the farmers were doing a lot of hay baling end of August/start of this month. Coincidentally, the wind had been pretty high making everything dry and as such the pollen had been spreading everywhere as a result, this was evident on my last outside ride when i was leaving a village and noticed a strange smell, about 3-4 miles down the road a combine was doing it's business and the cloud it was producing was unbelievable with the dryness of the hay and the high winds, i was struggling to catch breath from about that village til i completed my route.

[otoman]

Consider seeing a doctor to get pulmonary function tests. If your ability to breathe out is measurably impaired at rest you may need more aggressive treatment.
There may be triggers in the new local keeping your airways reactive.
Consider taking an antihistamine daily for a week or two to see if less wheezing.
Treating asthma is all about treating the triggers.
Isn’t Scotland famous for the bush called grouse? Allergies to local pollens, molds a very common cause of asthma flairs

The breathing test is important because if it is just exercise induced only then take the albuterol prior to exercise.
If it is regular old asthma you need to go after triggers


Sent from my iPhone using Tapatalk

Thanks. I will surely be seeing my GP, haven't had it checked in some 5 years. I think I had my ability to breathe out checked and it was surely low, but can't recall the value.

I tried antihistamine but to be honest they did not seem to work for the overnight congestion (which is kinda of a constant for me here, more often than not I woke up with a stuffy nose and might sneeze a few times.. Goes away after a few minutes). So I assumed that they weren't really working for me. But maybe they would reduce the asthma, to be honest I didn't pay attention to this!

I have pollen allergy bordering exercise induced asthma. Especially in spring I take a couple of puffs of ventolin at the start of the ride( early morning 6am). Bad days will have me weeze/caught/vomit in the first 30mins (if no ventolin) then mostly OK for the rest of the ride. Mainly seems to clear the overnight congestion unless the air quality is horrible (aka bush fires).

Sent from my Pixel 4 XL using Tapatalk

I can safely say that mine will not get as bad as to have me vomit! But yes I do wheeze and get troublesome respiration that kinda makes exercise quite difficult an unenjoyable. Do you feel like Ventolin helps you with the overnight congestion if I understand correctly? I haven't seen this in my own experience.

Hi, sorry you’re having so much trouble with your asthma. I empathize both as a physician who treats asthma as well as a cyclist who found myself coughing and wheezing up climbs before getting treated.

You said a few key things. Breathing out is diminished as you said with asthma, peak flow will be reduced and can easily be measured with a cheap handheld meter. You also note a lot of a.m. nasal issues = “bedroom allergies” aka perennial allergic rhinitis. You’re likely allergic to one of the common indoor triggers: mold, pet dander, dust mite feces, cockroach... you might very well have a seasonal allergy component as well, hard to know from afar.

How I treat patients is to jump all over symptoms when we’re sure of a diagnosis just to get you feeling better. Then, when feeling better, start peeling back meds while instituting prevention/avoidance measures. Allergy testing can be very helpful info. So for you, I’d strongly consider albuterol inhaler pre-exercise (with a spacer), allergy treatment with topical nasal steroid daily (inconsequential systemic absorption), oral antihistamine (fexodenadine, loratidine), montelukast (Aka Singulair in the US). Maybe a prednisone pack if you’re acutely feeling bad. If that works great. If not, allergy testing to see if you need shots. At that point considering long acting beta agonist/glucocorticoid inhaler added on. CXR and CT have limited utility in non smokers and without suspicion for pneumonia, etc.

For me I was on seven different meds to achieve symptom control, very annoying. So got on allergy shots and have made a dramatic improvement in lung function and reduction in preventive meds while only now needing albuterol pre-exercise during the summer (grass pollen for me is bad).

FYI, pulmonary function tests can be skewed in active aerobic athletes. Your lungs are so big and “powerful” that you can look like you’re in normal range for the statistical model of the test when in actuality you’re abnormal for you. In other words the negative predictive value for PFTs for you would be poor. Many pulmonologists will go by a “did the albuterol work?” test in highly conditioned aerobic athletes rather than PFTs.

Hope this helps, best of luck my friend.

[robeambro]

Consider seeing a doctor to get pulmonary function tests. If your ability to breathe out is measurably impaired at rest you may need more aggressive treatment.
There may be triggers in the new local keeping your airways reactive.
Consider taking an antihistamine daily for a week or two to see if less wheezing.
Treating asthma is all about treating the triggers.
Isn’t Scotland famous for the bush called grouse? Allergies to local pollens, molds a very common cause of asthma flairs

The breathing test is important because if it is just exercise induced only then take the albuterol prior to exercise.
If it is regular old asthma you need to go after triggers


Sent from my iPhone using Tapatalk

Thanks. I will surely be seeing my GP, haven't had it checked in some 5 years. I think I had my ability to breathe out checked and it was surely low, but can't recall the value.

I tried antihistamine but to be honest they did not seem to work for the overnight congestion (which is kinda of a constant for me here, more often than not I woke up with a stuffy nose and might sneeze a few times.. Goes away after a few minutes). So I assumed that they weren't really working for me. But maybe they would reduce the asthma, to be honest I didn't pay attention to this!

I have pollen allergy bordering exercise induced asthma. Especially in spring I take a couple of puffs of ventolin at the start of the ride( early morning 6am). Bad days will have me weeze/caught/vomit in the first 30mins (if no ventolin) then mostly OK for the rest of the ride. Mainly seems to clear the overnight congestion unless the air quality is horrible (aka bush fires).

Sent from my Pixel 4 XL using Tapatalk

I can safely say that mine will not get as bad as to have me vomit! But yes I do wheeze and get troublesome respiration that kinda makes exercise quite difficult an unenjoyable. Do you feel like Ventolin helps you with the overnight congestion if I understand correctly? I haven't seen this in my own experience.

Hi, sorry you’re having so much trouble with your asthma. I empathize both as a physician who treats asthma as well as a cyclist who found myself coughing and wheezing up climbs before getting treated.

You said a few key things. Breathing out is diminished as you said with asthma, peak flow will be reduced and can easily be measured with a cheap handheld meter. You also note a lot of a.m. nasal issues = “bedroom allergies” aka perennial allergic rhinitis. You’re likely allergic to one of the common indoor triggers: mold, pet dander, dust mite feces, cockroach... you might very well have a seasonal allergy component as well, hard to know from afar.

How I treat patients is to jump all over symptoms when we’re sure of a diagnosis just to get you feeling better. Then, when feeling better, start peeling back meds while instituting prevention/avoidance measures. Allergy testing can be very helpful info. So for you, I’d strongly consider albuterol inhaler pre-exercise (with a spacer), allergy treatment with topical nasal steroid daily (inconsequential systemic absorption), oral antihistamine (fexodenadine, loratidine), montelukast (Aka Singulair in the US). Maybe a prednisone pack if you’re acutely feeling bad. If that works great. If not, allergy testing to see if you need shots. At that point considering long acting beta agonist/glucocorticoid inhaler added on. CXR and CT have limited utility in non smokers and without suspicion for pneumonia, etc.

For me I was on seven different meds to achieve symptom control, very annoying. So got on allergy shots and have made a dramatic improvement in lung function and reduction in preventive meds while only now needing albuterol pre-exercise during the summer (grass pollen for me is bad).

FYI, pulmonary function tests can be skewed in active aerobic athletes. Your lungs are so big and “powerful” that you can look like you’re in normal range for the statistical model of the test when in actuality you’re abnormal for you. In other words the negative predictive value for PFTs for you would be poor. Many pulmonologists will go by a “did the albuterol work?” test in highly conditioned aerobic athletes rather than PFTs.

Hope this helps, best of luck my friend.

Wow, thanks Otoman. Definitely a few key points there, that I'll follow up with once I see my general practitioner. Seems like I can definitely defeat this thing somehow, just need to figure out what's the trigger(s).