Medical Forum / Diseases and Disorders / Asthma / June 2005
Exercise induced symptoms
|
|
Thread rating:  |
Michael Halliwell - 14 May 2005 19:12 GMT Hi all,
Just something I'm noticing and thought I would get some confirmation about what is going through my head.
Ive been asthmatic for most of my life, but only actually diagnosed in the last 3 years. I'm in pretty good control (for the most part) right now with peak flows generally in the 80-85% range. I know that exercise is a trigger for me, but I've managed it pretty well in the past (Taekwondo, underwater hockey, etc).
I've recently started to bike commute to work and I'm now wondering if I may need to check with my doc about taking things up a notch. I'm maintaining the salbutamol/ventolin before exercise that served me well in the past, but with the biking I'm finding thay I'm getting symptoms (cough, some tightness, a bit of phlem in the throat). When I checked last time, I was down in the low 60% range of my peak flow following the ride. Granted, it is a longer cardio workout on the bike, but even so...
Now, my GP hasn't been overly proactive on my asthma so I am wondering if I should just follow up my ride with even more salbutamol/ventolin or if I should be looking at augmenting my treatment regime to try to boost both my normal and, hopefully the exercising, peak flow numbers and reduce the symtoms?
Thoughts?
Michael H
Blues Ma - 14 May 2005 21:10 GMT > Hi all, > [quoted text clipped - 24 lines] > > Michael H Are you being exposed to significant air pollution on your ride to work ? Could be as much poor air quality as exertion. And A GP is rarely the guy to see for asthma treatment. Find an allergist who specializes in asthma or see a real pulmonologist.
raval - 15 May 2005 08:28 GMT I appoint Ditec in such cases.
Richard Friedel - 15 May 2005 08:37 GMT > Hi all, > > Just something I'm noticing and thought I would get some confirmation
> about what is going through my head. > [quoted text clipped - 21 lines] > > Michael H I would stick to Taekwondo based on ki (or Chinese chi) as representing blood oxygen saturation. Western mainstream medicine may be a must in many fields, but on breathing it is definitely no gold standard. It tellingly will not take issue on martial arts breathing techniques, although constantly bending over backwards to make asthma research look as complete as possible.
By focusing breathing on the tanden or hara in Taekwondo the bronchi are kept open and a ki sensation is maintained. One has to learn to breathe "on ki" instead of "on air", which takes some getting used to.
Just like worrying about one's heart may lead to real heart disease owing to psychosomatic effects, worrying about the bronchi, as a principle taught in western pulmonology, may lead to incorrect breathing. Concentrating on one zone (tanden) is healthy, concentrating on another gives you a complex and leads to illness, as should stand to reason.
My GP, though treating asthmatics conventionally, is also prepared to accept Oriental Breathing, but with the rider that he sees results.
Unless you can keep clear of exhaust fumes from cars, I would definitely not cycle too much. Regards, Richard Friedel
Michael Halliwell - 15 May 2005 18:54 GMT > Hi all, > [quoted text clipped - 24 lines] > > Michael H Just as a follow up to some of the replies....I am riding through residential neighbourhoods other than the 1km clostest to my work. Air quality index here has been solidly in the good range...nothing out of the ordinary.
With the TKD, one of my instructors was an MD and she kept threatening to bring in a pulse oximeter because she didn't like my color (nice shade of purple) while I was working out, though I didn't get anywhere near the same degree of symptoms popping up.
Bit of a mystery, but I guess I'll see what I can do about getting in to my GP and getting a referral to a pulminologist. In the mean time, I guess laying into the salbutamol a bit more may be required.
Michael
Tom Graf - 16 May 2005 17:46 GMT > > Hi all, > > [quoted text clipped - 19 lines] > > if I should be looking at augmenting my treatment regime to try to boost > > both my normal and, hopefully the exercising, peak flow numbers and
> > reduce the symtoms? > > [quoted text clipped - 17 lines] > > Michael http://library.nationaljewish.org/MSU/10n5MSU_EIA.html http://w3.ouhsc.edu/phar5442/Lectures/Exerciseasthma.html
Assuming you and your GP or Pulmonolgist have your daily control meds worked out, some of the more uncommon meds work pretty well for EIA. See what your Doc thinks of these: Nebulized Albuterol and Nebulized Intal before working out(using a portable nebulizer). Small dose of Theophylline beforehand (200mg slow release. Atrovent trial. Maybe Singulair(effective for some). The above links list a few others. Sometimes the second line treatments hold some answers. Good Luck. Let us know what you find.
Richard Friedel - 17 May 2005 17:54 GMT Hi Michael,
Notwithstanding your apparent failure with TKD as a martial art I would make the following comment.
By refusing to consider breath therapy or the "natural history" of asthma strictly from the breathing as opposed to the drugs aspect, pulmonologists are little better than useful quacks. Pulmonology is a pseudo-science because of lack of adequate background research.
In the so successful martial arts breath techniques emphasis is placed on sensing ki (or chi) and the effects of concentrating attention on the upper chest or the diaphragm. Does western physiology have to be permanently foxed by this "input" and pigheadedly stick to avenues of approach where new drug applications appear to be in the offing?
As the late Carl Sagan pointed out:
"One of the saddest lessons of history is this: If we've been bamboozled long enough, we tend to reject any evidence of the bamboozle. We're no longer interested in finding out the truth. The bamboozle has captured us. It is simply too painful to acknowledge - even to ourselves - that we've been so credulous."
Like the competitors in the "Tour de France" with their heavy asthma drug consumption and unnaturally high asthma incidence we may all end up some day as pharma's performing circus animals.
I would very cautiously suggest the following for an athletic asthmatic to get a quick experience of the effect of breathing on shortness of breath (SOB) in asthma first download http://www.lrz-muenchen.de/~s3e0101/webserver/webdata/ParowHDA.pdf, a German book just to use the diagrams. Use Acrobat Reader version 5 and not 6.
Stroke or massage your nostrils (page 36) to stimulate diaphragmatic breathing. Classical pranayama exercises speak of thinking about air flowing in the nose for this, but do not generally recommend nose massage.
The effect of such a technique is to direct the breath into the loins (figure 15 on page 36), see also figures 19 - 22 on page 61. This may not be quite correct in western anatomy., but no matter, there does seem to be a swelling and relaxing in these regions.
When doing this routine it is important to draw in the lower abdomen, see page 63. Causing it to expand unduly for prolonged periods may lead to a real horror trip (pulmonary edema).
I find it most productive to use the routine during/after exertion. There should be a feeling of prana radiating and causing a tingling feeling. Concentrating on the tanden (or tantien) as a center for breathing like a chakra. It is just below the navel. Regards, Richard Friedel s3e0101@mailin.lrz-muenchen.de
Michael Halliwell - 18 May 2005 06:30 GMT > Hi Michael, > [quoted text clipped - 53 lines] > breathing like a chakra. It is just below the navel. Regards, Richard > Friedel s3e0101@mailin.lrz-muenchen.de Actually, I didn't fail at martial arts. I've got nice balck trim to testify to that, both in TKD and having spent time with one of the last remaining ken-jitsu dojos. In both cases, it was too many of life's other requirements that have forced me to move along (getting married, moving away, etc).
Unfortunately, your view of martial arts breathing and what I have encountered are not the same. I have yet to come across anthing to convince my pragmatic mind that certain movements of the diaphram will lessen the immunological response of the airways.
Michael
Richard Friedel - 18 May 2005 09:04 GMT My practical encounter with Taekwondo was with a Korean with a magnificent record in the martial art and with his own dojo. He was however dismayed at westerners' fundamentally wrong breathing. He and others teaching breathing with a pranyama or Chinese/Japanese origin relied on learning by doing, i. e. pragmatism. Your understanding of the latter sounds, horribile dictu, more like narrow minded theology or soulless logic than science.
For a study on radically changing breathing by simply directing attention to parts of the body see http://www.bfe.org/protocol/pro10eng.htm
" A. Abdominal versus thoracic awareness
The purpose of this practice was to reduce the subjective discomfort that some subjects noticed when they focussed their attention upon their upper chest. This shift in the focus of attention is often unconscious and may be initiated by the tightness and wheezing in their upper chest. The first step for this practice was to observe whether focusing attention on the upper chest or on the lower abdomen effected inhalation volume. The subjects closed their eyes and then attended and focuses their attention upon their lower abdomen, upper chest, lower abdomen, and then upper chest. Sequential inhalation volumes were recorded. At each focus of attention, they breathed 3-4 breaths."
The author explains how wheeze can be switched on an off by "directing attention". True this may not sound like evidence based medicine to many, but is it not too much to expect folks to choose between arguments based on your " immunological response of the airways" and actually stopping wheeze and taking the bronchial brakes off? Your argument would in principle be an attempt to debunk any psychosomatic effect.
At least in Germany it is common ground between strictly medication-only asthma docs and breath therapists that we all breathe wrongly. Issue should be taken here by pulmonology if it is to qualify as a science. Regards, Richard Friedel s3e0101@mailin.lrz-muenchen.de
Joy - 22 May 2005 09:28 GMT > Actually, I didn't fail at martial arts. I've got nice balck trim to > testify to that, both in TKD and having spent time with one of the last [quoted text clipped - 8 lines] > > Michael There are plenty of us who agree with you Michael. I would say there are few researchers who now are in agreement with the dysfunctional breathing theory. But you know that.
You still should read and learn here. Every now and then, someone will run into and post an interesting study that may help you.
Joy
jackmallory@webtv.net - 18 May 2005 01:17 GMT Common practice is to use the salbutamol b e f o r e exercise, as much as ten or fifteen minutes before.
Michael Halliwell - 18 May 2005 06:38 GMT > Common practice is to use the salbutamol b e f o r e exercise, as much > as ten or fifteen minutes before. Indeed I do...generally I find that 2 puffs in the 15 minute prior range give me the best results...that had sufficed during the rigors of underwater hockey and martial arts. What I am finding, however, is that with the cycling it isn't enough to prevent symptoms from developing.
Perhaps I'm a little more agressive in my riding, or maybe I'm more sensitive to what my symptoms are now that I've become accustomed to clearer airways. Before diagnosis and treatment, my peak flows were generally in the high 60% - low 70% range day-to-day and about 45% when exercising...add about 15% to both values these days. Even so, 60% isn't ideal for working out.
Michael
Brad_Chad - 20 May 2005 06:18 GMT Maybe you should see a naturopathic doctor to find out if Hidden Food Allergies are boosting the histamine levels in your body. You may need to take more anti-histamine. Maybe foods like wheat, dairy, soy, etc. are playing a role in some type of delayed reaction? Start by reading "Dr. Braly's Food Allergy and Nutrition Revolution". There should be other books about this at the library. Check for similar books at Amazon.com. Hidden Food Allergies played a role in my asthma.
Brad_Chad
Blues Ma - 20 May 2005 19:14 GMT > Maybe you should see a naturopathic doctor to find out if Hidden Food > Allergies are boosting the histamine levels in your body. You may need [quoted text clipped - 5 lines] > > Brad_Chad Good advice. The sneaky way food responses can be delayed makes them difficult to pin down without doing the elimination thing, but worth the effort when finding and avoiding your culprits is successful.
Michael Halliwell - 24 May 2005 04:44 GMT > Hi all, > [quoted text clipped - 24 lines] > > Michael H Just as an update. I've seen my GP. She's game to try modifing the program for now and doing referrals if I don't see any improvement. We're going to try boosting the advair component for a bit to see if the added steroid and higher serevent dosage will make a difference.
Regardless, neither of us is willing to give up the benefits of my (quickly becoming daily) cycle commute to work.
I'll keep you posted with further updates as they become apparent.
Michael
Michael Halliwell - 10 Jun 2005 19:46 GMT Further update:
Well, my baseline has come up nicely, as have the health indicators like recovery rate, stamina, etc....but the exercise induced symptoms are not fully dealt with yet. For flat land cycling at a reasonable pace, I'm basically symptom free.
Unfortunately, when pushing things on the flat or tackling hills (pretty prevalent in the river bisected city I live in) the exercise induced symptoms come back with a vengance (i.e. rescue meds every other crest).
Anyone had any luck reducing just the exercise induced symptoms? Everything else seems fine (not that I'm going to push my luck) but this is the only problem I haven't found a solution to (other than not going up hills...which would eliminate about 90% of my possible riding area and confine me to a very small area of the city).
Michael
Tom Graf - 12 Jun 2005 09:23 GMT > Further update: > [quoted text clipped - 14 lines] > > Michael Tom Graf - 12 Jun 2005 10:13 GMT > Further update: > [quoted text clipped - 14 lines] > > Michael That's too much reliance on rescue inhalers, imho. Could be dangerous and make your asthma worse. Search 'Airway Remodeling' on this NG.
What else do you take for daily control?
Michael Halliwell - 13 Jun 2005 05:37 GMT >>Further update: >> [quoted text clipped - 19 lines] > > What else do you take for daily control? Hi Tom,
At present, I'm on 2xAdvair 250/50 - 2x per day, just started on some singulair to see if it'll help. Salbutamol/ventolin as required.
I'll just clarify that when I say hills, I do mean hills...not San Fransisco bad, but our river valley drops the better part of 100 vertical feet from the mean river elevation to the tops....some areas could be better than 150 ft. It leads to sections where there are some nice, long hills (not usually too bad if I am in low gear) and some that are quite nasty.
Michael
Tom Graf - 19 Jun 2005 06:35 GMT Hi Michael,
I started pre-treating before sports with Nebulized albuterol and up to 20mg Intal neb or mdi(Yes it's a PITA but effective) along with daily Pulmicort. Much better overall control this year. My biking goes about the same as yours, however. Great endurance, good pace with some good bursts of speed, some rolling hills but looong hills? Nope. Brings on the symptoms. So I leave em out.
Hard on the heart to ride through problems using the rescue inhaler. And it just may not work at some point. Lungs can also remodel and make it all worse. Anyhow, this is what I have always been advised. Plus you can only use a set amount of Ventolin or Albuterol before it turns on you.
I'm looking into to other pre-treatments that others have used for EIA. Small dose of Theophylline (200-400mg), maybe Atrovent. I'm going to run these by my Doctor.
Tom
00doc - 19 Jun 2005 16:19 GMT > Hi Michael, > [quoted text clipped - 17 lines] > > Tom If you compete you may want to check in with the governing association and make sure theophylline and albuterol are not banned substances. .
 Signature 00doc
Michael Halliwell - 21 Jun 2005 06:42 GMT > Hi Michael, > [quoted text clipped - 16 lines] > > Tom Hey Tom,
Thought I would update you. With the Singulair, I've had an improvement on my basline peak flows overall (up another 5% or so). I've basically been symptom free on the flat land stuff and noticed an increase in performance as a result (about 15% worth).
Did some single track the other day and actually found my legs and wind hitting the wall before the symptoms got to the point of being bothersome (which is a big improvement).
For now, I think I'll stay the course and see how things go....I'm getting close to having 200 km under my wheels so far (only had the bike since early May) and I must say that my overall health is improving. I likely will hold off the big hills for a bit....not going down into as many river valley trails right now due to near-flood conditions on the river. I suspect that the really big hills will still get to me, but if the moderate hills hold, I will be satisfied with that.
Michael
|
|
|