Asthma – Breathing is a good thing!

Well, it has been awhile since my last posting. Sorry for that. First, I would like to give a hand to the resurgence of race promoters and solid local group of trail maintenance workers. For those that don’t know me, I was a MTB racer for 10 years and a regular at the Dan Comber racers. When he folded up shop, I started racing road and cross, and drifted away from the trails. Over the past year I have been getting out on the trails again and have seen the calendar for races. Way to go folks. Thanks for keeping fat tire rides alive and well.

Oh, the irony, I was just reviewing my section on colds as I sit here fighting one myself. With my asthma flare along with the cold, I thought I would do a little bit on asthma, especially since it becomes a lot more common in the winter.

Do you find yourself coughing in the winter on those cold rides, and it goes away when you warm back up? You probably have cold air and possibly exercise induced asthma.

What is asthma?

Asthma is defined as reversible airway disease with inflammation and bronchospasm. What this means is that 1) it can be treated 2) there are two problems that occur in asthma. Asthma is different in everyone. All asthmatics have their own triggers. Pollen, mold, animals, and smoke are some of the ones most people think of. Heat, cold, and even exercise can be triggers as well. When someone who is susceptible comes into contact with these irritants, the lungs start to undergo a change. The airways get ticked off and start tightening up. When this happens, your ability to take in air diminishes. Some folks are really sensitive and the tightening can be extreme, sudden, and life threatening. A large number of people don’t even know they have it though. I have been with lots of riders and runners who start coughing on a cold day and they say “Oh, its nothing, I always do this.” Well, it probably is not going to be life threatening, but you wouldn’t see them carrying an extra 20 lbs. When you can’t fill your lungs, it is the same thing. Less oxygen, less energy, decreased performance. They often don’t recognize it as asthma because they expect wheezing. In med school, the first rule in pulmonary medicine was “Not all asthma wheezes, and not all wheezing is asthma.” People with exercise induced asthma are more likely to cough in my experience as well. So what do you do. Well, for most mild exercise induced asthma (EIA), you don’t have to do anything. But why not treat it? Would you let your brakes rub for an entire ride if you knew about them? Treating the asthma takes less time than adjusting your brakes. The mainstay of EIA treatment is albuterol. This is often seen in a little white inhaler. One or two puffs of this, and your lungs are great in less than a minute. It should be used prior to riding, but could be used at any time to open up the lungs. The biggest side effect for some though is that it can cause the heart to race. If this happens, there is one called Xopenex which doesn’t cause nearly the heart racing but costs a bit more. The albuterol helps the spasm in the lungs and if you only need this a couple of times a week then albuterol is probably all you need. If you need this more than a 3or 4 times a week then you may want to use something to treat the inflammation as well. There are 2 main meds used for this. Inhaled steroids and a pill called Singulair. The inhaled steroids won’t bulk you up so don’t worry about that, but they work great for most all asthmatics. The singulair is a leukotriene inhibitor – say what – basically it is like an antihistamine for your lungs. It doesn’t work for everyone, but if it does work, it’s simple and safe. Daily use of these can actually prevent the need for albuterol. The steroids or singulair should be used daily though through the “season.” If winter is the only time you have asthma, then it is ok to stop your daily meds when the weather warms up. EIA can be tough to diagnose in an office since you are warm and not exercising. This is why I diagnose it more on group rides. However if someone comes into the office and gives the right story, I will give them an albuterol inhaler to try. If it helps, the diagnosis is made, and the patient has already started the treatment. If it doesn’t help then more testing is needed.

Well, that is more than you might have wanted to know, but asthma is something that any family physician or internist should feel comfortable diagnosing and treating so go ask your doc if this sounds like you, and see how your winter riding improves.