Asthma/RAD and cycling

Discussion in 'Health Nutrition and Supplements' started by roadcyclist, Nov 13, 2006.

  1. roadcyclist

    roadcyclist New Member

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    Hi! Couple of years ago when I went in to see a doctor for a cold, and after my peak flow was measured and a bunch of other breathing, long capacity, etc tests were done I was diagnosed with asthma and/or reactive airways disease (RAD). I know that my breathing issues are induced by bronchitis and when I get a cold it is very likely that it develops to pneumonia. Since the diagnosis, I have had couple of times that I got a cold and then my lugs just died and I had to get on steroidal and bronchodilator in hailers to for a while to recover.



    I ride and race bikes (road) competitively. When I am going thru one of the episodes described above, I can tell that my breathing is pretty shallow and I don’t feel good on the bike. Only once I had an “asthma attack” and that was when I was racing in altitude and I think it was the combination of the altitude and not feeling 100% that triggered it then. My question is not about when I am sick or use the inhalers described above. It is for when I am feeling “good”: When I measure my peak flow, I can see that my peak flow is relatively low (400-450) for my age/height (24/5.9feet). I don’t use bronchodilators but when I do, I can see it increases my peak flow closer to “where it should be”. Is this affecting my riding and/or racing? If yes, how and why? Does anyone experience a similar problem and if yes, how do you deal with it?



    I don’t use the meds often unless I really have to. I try not to get a cold and I am careful as to managing it since I know if can get ugly. I want to find out how this physiological problem is affecting my performance.



    Thanks!
     
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  2. antone

    antone New Member

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    Asthmatics can get air in ok but can't get it out very well. Thats your decrease in peak flow. It sounds like you need to manage your asthma instead of reacting to flare-ups and find out what triggers your attacks. Get on a daily long acting bronchodilator and (non systemic) corticosteroid, like Flovent. Sounds like you have a mild case and could get away with low doses. Not taking a bronchodilator will stop you from performing at your max for several reasons but the number one I think would be a decrease in O2/CO2 exchange. Getting oxygen in is very important but getting CO2 out is just as important. Good luck, John
     
  3. roadcyclist

    roadcyclist New Member

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    Thanks for the good advice John. I'll probably see a doctor again soon to look into what kind of medicine to use. I have used Flovent + Albutral before and it worked well. I’ve also been on Advare once and that worked too. So my question is, should I expect to take this medicine indefinitely? And if not, am I hurting myself? Can I not use it during training and off season and start using it when time for hard efforts and races come up? Or not using it during off season and winter when intensity is lower will hurt my health and my performance. I guess I am looking for the trade off between the use of medicine and benefits of it. Thank you again. I am planning to find and see good doctor that also understands cycling but in the mean time anything I can get anywhere is appreciated.

    And the reason I've started thinking about all these recently is because I've noticed that "I can feel my lungs" and have rather shallow breaths lately-again.
    -m
     
  4. antone

    antone New Member

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    Depending on your age you may need to take something like advair forever... but if you are young and take care of business now you may "outgrow" rad and have a good chance of it not returning when you hit your 40's. The meds really are most important and should be taken daily am/pm. I used to live next to Lake Merritt in the 70's and loved to cruise thru Piedmont and the Berkeley hills, past the Clairmont Hotel and into a very trippy time...
     
  5. roadcyclist

    roadcyclist New Member

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    Thanks for the advice; I am grateful that I am getting some good feedback here. I am 24 and discovered this problem 2 years ago. I'm going to start on the Flovent and Albutral that I have and was told by doctor to use when I start feeling the way I do now. And I'll see a doctor soon to change/modify what to take.



    Yes, I cruised down Claremont canyon behind The Claremont yesterday after my ride. I've been riding these roads for the past 4 years. 70s around here must have been exciting. It is probably not as "trippy" around here anymore. Or maybe my experience at Cal was highly influenced by how much time I spent on the bike.

     
  6. 2wheeldiesel

    2wheeldiesel New Member

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    I have asthma…I’m now 45 and have grown up as an asthmatic. Exercise can bring on symptoms as can changing weather. I race competitively and I coach both road and mtb.



    I have had some very frustrating rides relating to asthma for various reasons. I started taking Advair about 18 months ago. I also use an albuterol Inhaler when needed. For me Advair has been the magic built, and I now don’t use a 1/3 of the albuterol I once did. You name it I have tried it, but Advair seems to work for me. I do stop taking advair in the mid summer, and here is why…I find that hot dry weather –which we get - Advair seems to aggravate my throat. This could also be a form of acid reflex. Recent studies have found a relationship between acid reflex and asthma. Still, I find my best solution is to stop taking Advair during the summer months…mid June through August. Once the weather starts to change I’m back on Advair on a daily basis. Excursion in cold dry air has a negative effect on my air ways, leaving me feeling as though I have lost fitness even through I know that my training has been good. Advair combats this feeling.



    Things that help me, as mentioned during the difficult weather seasons, be consistent with your medication. –find what works for you-



    Always get a good warm-up, the shorter the race the longer the warm-up.

    (you may even try this) –Try this on a training ride first- exert yourself to the point where you cause mild asthma symptoms. Use your albuterol inhaler to recover, take a ride and see how you feel. I have heard of this working well for people.



    Be attuned to what works and what does not work for you. Manage your asthma so it does not manage you. The classic mistake we all make…only reacting, to our asthma when we have problems. This often causes over medication and more issues.
     
  7. kslim

    kslim New Member

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    If you're serious about controlling your asthma/RAD and improving your performance, first get to a good doctor. There are a number of steps to asthma management.

    If you wanted to do this objectively, you should probably be getting regular spirometry readings while on regular treatment (inhaled corticosteroid +/- long acting brohcnodilator) until you have achieved your max lung function (which may or may not be the max predicted). Regular Peak Flows are an acceptible (but not as reproducible) alternative The next step is maintaining this - your meds can be back titrated to the level required to keep your readings at their best. It is possible to self manage using a home Peak Flow meter, but talk to your doctor about this.

    I had a similar experience after a bad cold, where I found I was down to grinding away on my lowest gears on hills I would otherwise be able to spin up. My FEV1 and FVC dropped about 20%. A few weeks back on inhaled corticosteroids made a world of difference.
     
  8. ozelise

    ozelise New Member

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    All good advice. I would make the following points:

    - Your asthma is suboptimally controlled when you "feel normal" yet your peak flows improve with short acting bronchodilators

    - Spirometry is more accurate than peak flows at judging airflow limitation. Get this done and get advice on what is predicted for your age and height

    - Combination long acting bronchodilators / steroids are excellent at controlling airways responsiveness. However another medication your doctor may want to consider, particularly for exercise induced symptoms are leukotriene antagonists (montelukast/singulair or zafirlukast/accolate). These have no steroidal adverse reactions and are particularly useful in young athletes.
     
  9. roadcyclist

    roadcyclist New Member

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    Thank you for help. When I was first diagnosed, I did the Spirometry twice; once when I first started having the symptoms and once after couple of months of Flovent/Albutral. Comparing the graphical results, the Pulmonlogist told me that I have some sort of (bronchitis induced) asthma and RAD. My understanding is that the two results did not allow him to distinguish between the two-like the lift was not high enough or something to that extent. He prescribed Advare and he said he I should use that for couple of months. He suggested I use Albutral when I feel like I need it. For Advare/Flovent, etc. he suggested seeing a doctor when my symptoms re-appear. To date, he has been the only Doc that has prescribed Advare to me and the only Pulmonlogist that I have seen. The rest (general/sports MDs) seem to prefer to prescribe Flovent/Albutral.



    So last week I tired to see a Pulmonlogist and no one would see me without a referal! They ones around here seems to have their "union" as they all work in the same Pulmonlogy clinic and if one says no, it means everyone says no-kind of a monopoly in my opinion. So I saw a nurse practitioner at my (new) general doc's office. She gave me the same Fovent/Albutral combo and I've been on it for a week. I've been getting a little better but still have the tight/cold /somewhat painful chest feeling and the dry cough. I know that it takes time for the meds to kick in. I've also been riding a lot so I don't know if that helps/hurts.



    So thanks for reading the long story but my question now is, knowing this history, should I insist to be referred to see a Pulmonlogist AND/OR do Spirometry again. Do I need to explain anything specific about cycling, training, performance, racing, etc to them? I certainly let them know how much I ride and that I compete and everything but anything specific?



    And another question, anyway to deal with the jittery feeling that Albutral gives you after you take it? I hate to take if because of that feeling. That + excitement of racing ( + some caffeine) isn’t the best feeling when riding in a pack/racing.
     
  10. matagi

    matagi Well-Known Member

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    Yes, you should have another spirometry done and you should see a respiratory physician.

    If you are still having symptoms on the Flovent/Albuterol combination then you either need a dosage adjustment or a change of medication.

    And yes, you should make sure they understand how important cycling is to you and how seriously you take it.

    As for the jittery feeling - it is a side-effect of the medication, if you can avoid combining it with caffeine, then it might not be so bad.
     
  11. kslim

    kslim New Member

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    I'm afraid the diagnostic and treatment pathways are not always clearcut. Sometimes the internet is not the best place to get good advice. Seems to me there are three things on your mind (correct me if I have misinterpreted) -

    1. Is the diagnosis really Asthma/Reversible Airways Disease ...
    2. What is the best treatment,
    3. How best to follow this up.

    At the risk of being boring, there are a few points to make.

    Asthma is a diagnosis based on history, examination and supportive investigations (spirometry is the best easily accessible test for most of us - but there are others). Spirometry by itself may not give you a diagnosis, and may in fact be completely normal in between attacks in mild asthmatics.

    Mild asthmatics can have exacerbations.

    Your history is highly suggestive of Asthma.

    Management of asthma is guided by certain well established guidelines. Have a look at [size=-1]www.nationalasthma.org.au

    [/size][size=-1]My next comments [/size][size=-1]need to be taken in the context that I'm from Australia, and not that knowledgable about the hierarchy in the US health system. I would have thought that your local doctor/Family Physician/General Practitioner (whatever the terminology is there) would be your first port of call. Only a small proportion of asthmatics in Australia need to be managed by Pulmonologists/Respiratory Physicians.
    [/size]
    Flovent/Fluticasone would be considered a very reasonable initial treatment option for mild persistent asthma, with the use of combination therapies (Advair) reserved for Moderate Persistent asthma. (Remember - there are still some reservations on side effects of some medications)

    What's the bottom line ? See a good physician (from what I understand of the American system - your local Doc should be OK), by all means get another spirometry (if you still have symptoms currently you probably SHOULD). The spirometry will help to establish severity of the condition as well as be a guide in treatment response. If you are not improving - there are a number of reasons why this may be the case - dose and medication type are only two of many. Your doctor should be able to look at the other reasons.

    Sorry for the long reply. Unfortunately there is not always an easy answer.
     
  12. roadcyclist

    roadcyclist New Member

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    Thank you for taking some time to explain this. I hope others can find this thread helpfull too.
     
  13. roadcyclist

    roadcyclist New Member

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    I don't mean to personalize this thread but for the sake of sharing the info I'll continue here and continually appreciate feedback/professional opinion or your experience in this area.



    So I saw the doctor today and did Spriometery twice, once before and once after getting a breathing treatment. So the Spirometery results showed that I am not doing as well as I should be-both the exhale/inhale graphs were shallower that normal and also the initial strength of exhale /inhale and the length of each. The breathing treatment improved my breathing but I was still noticeably below where I should be.



    This was all after 12 days of being on Flovent (first 2puffs2day, then 3puffs2day) so with the doctor's recommendation I'll be switching to ADVAIR 100/50 and see how this works out. I'll see him in a month and insist on doing Spirometery again and see where I am then.
     
  14. kslim

    kslim New Member

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    Always interesting to hear progress reports. That's how we all learn. Sounds like you're on the right track.
     
  15. brusheda

    brusheda New Member

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    I use to get bronchitis all the time. My whole body used to be screwed up, but a homeopathic doc helped me to get more normal. He had a fancy machine that used radiant heat to help my body to get rid of the bronchitis- in the early stages. I learned that if I put heat on my chest and back with a heating pad when I feel a cold start moving to my chest I can stop it in its path. The heat increases blood flow to the area, which means more of the good guys are there to fight the bad guys. I don't know if that will help you, I just know I was estatic the first time I was able to beat bronchitis w/out antibiotics.
     
  16. Mikebike125

    Mikebike125 New Member

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    Not such a good idea. I have had asthma forever and over the years have discovered that if you take a breath of an albuterol inhaler BEFORE your ride it will pretty much stop any attack from happening during the ride. If you wait until you have the attack it will take more albuterol and more energy out of you.

    One or two puffs before is worth many puffs after. Try this method and I bet you will like the results.
     
  17. roadcyclist

    roadcyclist New Member

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    Thanks for the advice and input; I hope this has been/will be as much resource to others as it has been to me.



    A quick update: I’ve been on 100/50 Advaire for about a month now. It seems to be controlling my asthma. I can breathe better and have no chest tightness and riding has been good. But I still don’t feel 100%, still feel my lungs a bit and there is a cold/pressure spot right in the center of my chest (I cannot explain it any other way). I also have this dry/deep cough that is painful-this is rather recent.

    So I saw the doctor today and we decided to up the dosage and I’ll be using the 250/50 for the next 6/8 weeks and see him again. I suggested doing spirometry but he said it will probably not going to give any info that will change anything since he was going to give me the higher dosage anyways. It made sense; we are going to do it in a month or two; I am hoping for no symptoms and normal results then.


    So just to pose a question, are there any long term side effects and/or disadvantages of using Corticosteroid and/or long-acting beta2-agonist, components ofAdvaire?

    How about the effects of coricosteroids on training and recovering? I rememebr hearing about the negative effects of them on recovery before-with seems a bit strange-steroids, recovery :)


    I know about the mouth infection of course-do rinse my mouth after using it!



    Just read about Salmeterol-an ingredient in Advaire:



    http://www.webmd.com/content/article/119/113391.htm



    Happy riding!

    Thanks!
     
  18. kslim

    kslim New Member

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    Sounds like you are doing the right thing so far. Regular review, optimise lung function, then maintain best lung function and avoid triggers - are probably the main steps in asthma treatment.

    With respect to side-effects/problems with inhaled corticosteroids and lon acting beta-agonists - very good question, and unfortunately very BIG question.

    Suggest looking at http://www.nationalasthma.org.au/html/home/index.asp for some answers.

    Couple of quick points though. Yes there can be problems with long term inhaled corticosteroids - mostly dose related, and generally VERY low probability. These have to be weighed up against the complications of inadequately controlled asthma.

    The warning on Salmetrol is largely based on studies where Salmetrol was used WITHOUT corticosteroids (not quite sure why you would do this given the nature of the condition, but there you go...) Using it WITH inhaled corticosteroids probably does not cause the same problems, but it is still generally considered an add on drug to inhaled corticosteroids for the reasons you have discovered in your link. I note that you are on combination treatment, so I probably wouldn't be overly concerned about that warning. There is a law of diminishing returns for inhaled corticosteroids where most benefit is obtained at the lower doses, and higher doses do not lead to a linear improvement, so there comes a point where adding something like salmetrol is better than increasing the steroid dose.

    Good luck. No symptoms, (and good riding) is the goal of treatment.
     
  19. ehirsch83

    ehirsch83 New Member

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    As for the jittery feeling - it is a side-effect of the medication, if you can avoid combining it with caffeine, then it might not be so bad.[/QUOTE]
    I went to my internist and a really good pulmonologist and they both kept me on albuteral. But last week I went to see an asthma/allergist specialist to figure out why I have bronchitis so often, which causes me to always be around 65% lung capacity and she switched me to a different relief inhalfer and it isn't supposed to make you so jittery! Ask your Dr. about Xopenex MDI. I was also put on Asmanex once a day b/c the Advair wasn't really working. So there are oother options out there.(I have been prescribed albuteral and advair for 4 or 5 years by different drs, this is the first to ever prescribe something different!)

    Also, go to the health food store and get Quercetin. http://en.wikipedia.org/wiki/Quercetin

    It is a natural anti-inflammatory and if taken daily can help reduce your asthma and bronchitis problems.
     
  20. Mikebike125

    Mikebike125 New Member

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    I have been taking the Asthmanex for about 2 months now. It works REALLY well. I love the counter on the bottle
     
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