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Medical Forum / Diseases and Disorders / Asthma / June 2005

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Exercise induced symptoms

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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
 
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