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Exercise induced asthma? or?
nsfdff137 posted:
Don't know where to turn. I'm 50, I used to smoke (+13 yrs since last) now frequent exercise and compete: Run, Ski, Bicycle. At times, I get a nagging, productive cough, some mild dyspnea, after extended exercise or race effort that usually clears after 3 days or so. I've never had any issue with short breath while competing. I've been tested several times and told no asthma. But never been checked while having symptoms or right after triggering event. Inhalers freely given, no real help. Have gone to ED to try and have it seen at time, but they just give inhaler and refer to specialist. Symbicort is latest attempt with little to no relief. Although this usually has happened when competing, lately it has been happening at times while working out for extended periods (ran 8 miles 4 days ago ... suffering the result now). Cough and hack since, less each day. Did use inhaler (Symbicort after the fact, but no relief) Not sure where to turn. Can't find a Dr or clinic pt enough to see me WHEN it is happening. Always the same thing, have episode, try to make appointment, get told to wait a week or more. Voila! No more S/Sx. Have tried to time it for after an event, but out of 14-16 races I do a summer, I only have the issue on 75% or so. Seems to be the events with higher effort closer to LT but that is unpredictable as each race dictates its own pace.
Any ideas or different direction would be most appreciated.
Aqua14 responded:

I do know there are allergists out there that do in-office testing for exercise induced asthma -- my allergist has a treadmill in his office and does do the testing. You might call around and find one so that they can make you exercise and see if they can provoke your symptoms in the office.

Have you taken Symbicort prior to engaging in exercise? Symbicort contains a long-acting bronchodilator which usually takes effect within 15 minutes, and will last for 12 hours thereafter. I used to use Symbicort (to control asthma) and the long-acting bronchodilator worked well for me.

When you say that the inhalers were of no real help, how often were you taking them, and when? (I assume those were albuterol inhalers.)

Here's something to try (discuss with your doctor first) -- take Symbicort (2 puffs) a half hour before going out to exercise. If you are exercising in cold, get something over your mouth/nose to warm and humidify the air. I usually use a fleece neck gaiter or balaclava, but you could use a scarf or a mask. Then, after exercise, take 2 puffs of the albuterol inhaler every 4 hours until your symptoms go away. The combo of the before and after treatment should lessen the duration and severity of your symptoms.

Also, have your doctor check your inhaler technique. When you haven't used an inhaler before it can be tough to get the inhale coordinated with the inhaler, which can result in the med staying in your mouth and not getting to your lungs. Using a spacer attached to the inhaler (albuterol or Symbicort) could help.

There is something else that comes to mind apart from EIA, and that is that strenuous exercise can cause acid reflux. You can Google and read more about that. Stomach acid can be refluxed far enough up the esophagus that you aspirate it, which of course irritates the lungs and causes asthma-like symptoms. I haven't read a lot on this but it appears there are various tips you could try to reduce reflux, from diet/timing of eating before exercise all the way up to using reflux meds.

Hope these thoughts help you explore other options. Take care & good luck. Judy (long-distance biker with asthma)
Aqua14 replied to Aqua14's response:
P.S. I forgot to add -- if you are indeed refluxing during exercise, know that using Symbicort in particular will promote that.

Bronchodilators, especially the long-acting ones, tend to relax the lower esophageal sphincter (LES), which makes it easier for stomach acid to reflux. To some extent short-acting bronchodilators like albuterol also promote relaxation of the LES, but not as badly as the long-acting bronchodilators unless albuterol is used often.
nsfdff137 replied to Aqua14's response:
Thx for the reply and generally good response however ... I am on Symbicort now. No help. I've used as described and technique isn't the issue. I have also had a full nuclear stress test and the doctor had to have me run for a while to get my heart rate high enough for that test, but it is not an effort that would trigger a problem. I can run and bike basically all I want until I push my limits of Lactate Threshold or VO2 max effort for extended periods, as in, during a competition or extended training. I enjoy trail running and have triggered when running in our kettles terrain as the hills can be rather aggressive. Heat and cold are not factors as this typically happened during summer months. I actually don't recall it ever happening in cool or colder weather. I have no real seasonal allergies I'm aware of and do use protection from dust (most of the time) during events as all of my racing is off-road MTB. My doctor and Insurance tell me if I can't reproduce effect, they can't fix. I cannot get them to see me when it is happening ... and I am against going to an E.D. when it isn't emergent and they certainly aren't going to test it. grrr frustrating. My first race is April 14th ... maybe I can get it to happen again and get seen. I dunno.
amcate replied to nsfdff137's response:
You could try urgent care instead of the ED or perhaps get a cardiac workup from a cardiologist, or consult with a primary care physician who may have a generalist background where they could give you feedback of where to go. Other than that, I don't know. Normally when I have issues it doesn't spontaneously go away and when it gets bad I need prednsione.
Aqua14 replied to nsfdff137's response:
Well, then consider checking out the acid reflux idea. There are some meds you could take to minimize or avoid reflux -- from Tums all the way to omeprazole (generic Prilosec) or Zegerid (both which suppress acid in the stomach). Just another idea for you to pursue if you wish. Here's a WebMD article to get you started:

Take care & good luck. Judy
nsfdff137 replied to Aqua14's response:
Thx Judy and amcate - As I previously stated I HAD a full nuclear stress test workup - all good. Also had echo done and no problems. I also was checked for GERD only because I had an esophageal spasm a couple years ago, but that test was clear. I rarely get heartburn and never have had it while working out or competing. Urgent care is not an option in our clinic system (Aurora Health Care) as same problem prevails ... to be seen by a specialist, one must make an appointment and then go. The Uregent care center will just give a scrip for an inhaler and make the appointment, usually it is staffed by a PA or NPc, rarely a doc. If it is emergent, they send ya to ER ...
I do not wish to sound ungrateful, but I am hoping a professional will reply. I posted my same question quite some time ago thru WebMD's contact form for professional reply ~ so far no one has replied. I'm just gonna move on. This place is going nowhere IMHO.
Thanks again, I know you all mean well and give best advice you know. peace
amcate replied to nsfdff137's response:
Best of luck to you. I read you had a stress test done, but I didn't realize you had seen a cardiologist...sorry.
amcate replied to nsfdff137's response:
Just so you know, the urgent care system works differently where I live. Normally, you'll end up seeing an MD who is certified in emergency medicine within 30 min of arriving. You pay more, but you get better service. The emergency medicine doctors normally know how to evaluate for asthma exacerbations and urgent care normally takes more time to thoroughly investigate things than the ER in my area. So, I thought it would be a way to see a professional when your symptoms are happening and have them do more than just giving inhaler without doing much of a workup. Urgent care in my area is notably a higher level of service than the ER, but you pay more.

Anyway, I hear your fustration and I hope you find your answers.
gargoyle responded:
Symbicort is a long term inhaler. It will not help you when you are having trouble breathing. You need a short term inhaler that has albuterol in it.
nsfdff137 replied to gargoyle's response:
Had em, done that. Been there. All Albuterol does is make me all janky. I still hack and cough. I have finally found a Dr that is sure it is a form of Exercise Asthma ... he is stumped on how to treat tho

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