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    How Does Asthma Affect Running?
    choo_chu posted:
    I had asthma as a child, then it went away for a while and came back while I was in the Army. When I wasn't having problems with asthma, I could run pretty fast over long distances. Now, I'm not so fast...I'm pretty much a turtle, though I can run for long distances. I don't seem to be getting much faster, even though I have a solid training plan. Does anyone know whether asthma can affect running performance even if there are no obvious breathing problems? If it helps any, I take Symbicort everyday, and add Singulair for a while if I start having problems. I use albuterol 10-15 minutes before each run.

    Thank you.
    choo_chu responded:
    I guess there must not be many runners out there. I've learned that asthma really doesn't go away, it just changes severity. So, for a few years, it was mild, then became moderate again for whatever reason.

    Anyway, I think the reason I'm not progressing very much is that I try to run through the times when I'm having breathing issues. That causes me to have to slow down or walk, so my training isn't as effective as it could be. If I just took the time to use my rescue inhaler, I'd be able to run at my normal pace, which would increase the effect of my training. I know that seems obvious, but my thinking was that if I tried to run through it, I'd become better at running. That isn't proving to be the case.
    amcate replied to choo_chu's response:
    I still have low numbers on lung function (compared to my personal best) even without obvious asthma symptoms. So, yes, asthma can be operating even without obvious symptoms.

    Also, sometimes asthmatics get used to the symptoms such that they don't register they are having symptoms (ie, feeling of tightness in the lungs, etc.).

    You may want to also talk to your doctor about increasing your controller medicines so you only have to do the initial albuterol dose.

    Good luck.
    choo_chu replied to amcate's response:
    I think you're right about symptoms not registering. Not too long ago, I did a little experiment. I took a peak flow reading and my usual dose of albuterol before I went running. Then I took peak flow readings at 5 and 10 minutes after I got back. I was surprised because my peak flow reading dropped about 20%, putting me in my yellow zone, and I had no obvious symptoms.

    As far as talking to my doctor, I did that the other day. They told me I have a sinus infection, which is why I've been waking up at night and having problems running. They gave me medicine and said it should clear up in 2-3 weeks. They kept my controller medicines the same, and said if it doesn't clear up, they'll make changes. In the meantime, it's ok for me to use a little more albuterol before I run.
    amcate replied to choo_chu's response:
    I think the symptoms not registering is one reason why doctors will give out peak flow meters. I know I get used to the lungs being congested and I really notice a difference after a prednisone burst.
    choo_chu replied to amcate's response:
    I think you're right about peak flow meters. Regular asthma medications work pretty well for me, so I don't need prednisone very often. If I get to the point that I need prednisone, my asthma symptoms are really obvious. You're right, though, it works like a charm.

    I've read some of your other posts, and you mentioned that you think some other medical condition is aggravating your asthma. I had problems with GERD and it really messed with my asthma. So, I know what you're saying about other medical conditions affecting your asthma. I hope you figured out what's going on.
    amcate replied to choo_chu's response:
    The first allergist I saw when I lived in Texas referred me for testing for GERD. She also referred me to ENT to rule out sinusitis.

    Unfortunately, where I live right now, the doctors are not good at differential diagnosis. I know of a lady who it took 2 years to get the diagnosis of multiple sclerosis (MS) because doctors kept saying she had a psych issue. MS can cause mood differences, but it's due to the MS. Last time I checked the Diagnostic and Statistical Manual (the hallmark of psychiatric diagnosis in the USA), it says to rule out general medical conditions first. They don't always do that here.

    I know of another person who lost half her vision before going to the Mayo clinic where they diagnosed her with macular degeneration.

    A colleague of mine had a brother who repeatedly went to the doctor complaining of abdominal pain, but the doctor didn't listen. They pushed it, and a CT scan of the abdomen was done, but it was too late...he had cancer everywhere.

    Another colleague of mine had a friend who had a family history of a rare lung cancer. She went to a local pulmonologist, who said it was allergies and did nothing to rule out this cancer even though the friend asked the doctor to rule it out. She dead in a year from the very cancer she was trying to get the doctor to rule out.

    In general, doctors here don't do a good job listening to the patient. They are not good at recognizing anything outside the box or neurological conditions, like MS. However, anything inside the box, the more typical and common things, they are very good at. They tend to ascribe symptoms to psych problems before adequately ruling out medical conditions such that the medical condition goes untreated and could put the patient at risk.

    What I am doing is gradually ruling other things out as a result of my own research as I'm able to afford it. My PCP and I have already done the free tests and screens that are available in my area. I convinced my pulmonology PA to give me a letter recommending National Jewish. I've been researching mycoplasma and different types of pneumonia. Turns out, mycoplasma infection would have been ruled out by the CT scan and there is one type of pneumonia that can't be ruled out by CT scan and is hard to kill. It is detected by blood work. I may ask my allergist next time I'm in if they can order the blood work.

    So, that's where it stands. Thanks for your wishes.
    amcate replied to choo_chu's response:
    Just to clarify-I'm don't know that another medical condition is aggravating the asthma. I've done all I can and so has the allergist to decrease the amount of prednisone I take. Although the amount has decreased, it's still higher than my allergist likes. So, the only other thing I know to do is to rule out other medical conditions that may be aggravating the asthma. It is possible that I may just have really severe asthma.
    choo_chu replied to amcate's response:
    I think the approach you're taking makes sense. I don't know whether you've always had this many problems with your asthma, but I've noticed that my asthma fluctuates. So many things can affect my asthma control. I've had issues with GERD, pneumonia and sinus infections that really messed with my asthma and made it hard to control. Allergies were a big problem for me when I moved down to TX. I started getting allergy shots, and that tamed my asthma to a controllable level. I have to use controller medicines, but my asthma responds to them pretty well now. My thoughts are that if your level of asthma control has changed, there's probably a reason for it. If it's always been like this, that's a different story.
    amcate replied to choo_chu's response:
    My asthma was mild for a few years, but turned into moderate to severe persistent asthma when I was about 28. So, it's been like this for about 13 or 14 years. It's actually better now than it was when it first got worse due to me lessening exposure to triggers. Still, I take too much prednisone according to my allergist.

    I realize my above posts have some misspellings. Oh, well. It is possible it's just really bad asthma, but I don't know what else to do but to rule out other medical conditions that can aggravate asthma, like sleep apnea. It's the only other thing I can think of to lower the prednisone amounts further.

    I couldn't tolerate the allergy shots....always sent me into attacks.
    choo_chu replied to amcate's response:
    I did rush immunotherapy and after my first regular shot I had an anaphylactic reaction. For a year or so I had to use Benadryl and albuterol before my shots. Now I don't have to use any extra medication before my shots. If you have perennial allergies (cats, dogs, dust mites, etc), it's sometimes hard to avoid those things and allergy medication only does so much to help the associated asthma. At least that's been my experience.

    This might sound kind of stupid and you might already do it, but do you keep some sort of asthma diary? Like if you have an asthma attack, write down the circumstances surrounding it. For example, "I woke up last night at 4am coughing and my peak flow was 345. I used albuterol and my peak flow went up to 390. I used albuterol again 15 minutes later and it was 445. My nose was plugged up and my cat was sleeping right next to my head." Or, "My husband was cleaning the toilet with bleach. I started coughing violently and had to run outside. When I went back inside, my peak flow was 390. I used some albuterol and it went up to 445." You get the idea. When I was having a lot of problem with asthma control, my doctor had me do something similar to that. From that, we were able to identify a number of triggers that we didn't suspect, and they decided a nebulizer would help me. If you already do something like this, I hope it's helping you identify more of your triggers. If you aren't, it's worth a try. You can share your log with your doctor, and perhaps it'll give them some insight as to why your asthma is hard to control.
    amcate replied to choo_chu's response:
    Actually, I don't think your suggestion is stupid at all. When my asthma first got worse I did write things down (the year of using 4,000 mg of prednisone). I also tracked the levels of air pollution in Houston, the city I lived in at the time. I was able to establish a correlation between levels of pollutants and the asthma attacks as well as that 1/2 the attacks occurred while I was in the car driving on the freeway, where there are a lot of diesel engines. So, I moved from Houston based on that, and in fact the peak flows increased by 20% in the first 30 days and I've maintained improved lung function ever since (as compared to when I was in Houston).

    Right now, though, I don't really write things down. I usually think back to determine the trigger or I experiment with conditions to see what will bring me out of the exacerbation. For example, last April it was infection. I work in healthcare, but it's difficult to wear a mask more often than the standard precautions because you get professionally isolated and it can become difficult to get a job. I considered not working in healthcare, but then I would lose the ability to work on call, which is essential for me surviving economically due to the exacerbations. Also, working in healthcare I can take a travel assignment to rural areas where the air is clean if I have to.

    This last time, it was probably due to me not doing a good job taking my controller for about 5 days due to stress (a person I love very much dying, etc.).

    Basically, I no longer write things down, but I have spent a lot of time trying to work out by memory the possible triggers. I do know that if I wear a mask whenever I'm outside of my apartment, the amounts of prednisone go down as well-to about 600 mg a year and I get over exacerbations much quicker. The problem with that is then I end up being socially isolated, so it's a quality of life versus quantity of life issue. Unfortunately, most people don't understand moderate to severe persistent asthma and I guess I'd rather not be socially isolated. I take about 1000 mg to 1500 mg of prednisone a year currently. I've also considered experimenting with my diet to see if that is contributing.
    choo_chu replied to amcate's response:
    I'm glad you've been able to identify some of your triggers. Have you found any seasonal fluctuations in your symptoms?

    When I moved to TX, my first two years were a living nightmare. My husband's family, several of whom have asthma, couldn't comprehend the level to which my asthma was affecting my quality of life. My nocturnal asthma is severe. If I don't take my controller medicines, I'll wake up 7 or so times in a night, every night, of every week, of every month. I'll wake up, use albuterol and it'll only last 1-2 hours before I wake up again. I was so sleep-deprived that I couldn't function and hold a job. I spent my days lying on the couch coughing and complaining that I couldn't breathe. My husdand's family claimed, "We know asthma and what you describe isn't asthma. You need to see a different doctor for that (a psychiatrist)." When my doctor gave me a controller medicine with a long-acting bronchodilator, my episodes of waking up decreased to about 1-2 per night. When they added Singulair, they went away completely. I had to give asthma education to my husband's family. It was so stupid because they have asthma! I don't know what kind of asthma they have, but I'm guessing it's mild intermittent or something.

    I'm fortunate because, except if I get sick or something, my asthma is pretty well-controlled with controller medicines and allergy shots/medicine. I haven't had to use prednisone for 2 years now. But I know there are a lot of ignorant people in the world who don't understand what's it's like to have uncontrolled asthma. I hope you're able to stick it out and figure out what's going on. I'm pretty sure you'll have to give some asthma education to people (even healthcare workers) along the way.
    amcate replied to choo_chu's response:
    Sometimes my asthma is seasonal, and sometimes it's not...depending on where I'm living. I normally can get exacerbations that require prednisone any time of the year, but in some locations they are much more frequent during certain times of the year.

    For example, where I currently live, the summer months are more difficult. It's not that hard to figure out why since I would look out my window and see smoke from nearby forest fires. Summertime is the fire season. I had a swamp cooler. I did some research, and discovered that refrigerated air works better at keeping the smoke out. So, I switched apartments to refrigerated air and away from the swamp cooler. Now when fire season comes, my asthma stays much more stable.

    The triggers I've identified are ones that load heavily on the variable of asthma exacerbations. The problem is, assuming there are no other medical conditions present, in identifying the triggers that don't load heavily on the variable of asthma exacerbations. This is because for those triggers, no one by itself would cause problems, but it would when combined with others. It would be like throwing a 1,000 small pebbles at a window and then the window breaks from the cumulative effect. So, I could theoretically have an exacerbation due to several minor triggers over several weeks such that a few weeks could pass by before an exacerbation starts from the time of first exposure to a minor trigger. Those that load heavily are so much easier to identify because the effect is much more immediate.

    I used to have night time flares when I first got asthma...when I lived in Houston. The asthma was the best in the morning. I don't know why, but over the years it's the same at night and during the day.

    Thanks for your support when you were talking about your family. I've experienced the same thing. Those who have only experienced mild, intermittent asthma oftentimes assume that is the only way it presents....or some will somehow blame those with more severe forms. I try to educate people, but I've not been able to get people to listen to me. You are correct in that some healthcare workers also need education. I've had asthma interfere with having a full time job. I'm surprised your family wouldn't suggest ruling out sleep apnea if they didn't think it was asthma....but actually nighttime flares are common with asthma. General medical conditions should be ruled out before assuming a psychiatric diagnosis. Anyway, thanks for your support. I do the best I can and I appreciate your support very much.
    choo_chu replied to amcate's response:
    I'm sorry you've actually had to go to the extent of moving to new locations to help deal with your asthma. I've had to move around a lot, usually due to my job or my husband's job. I don't really have a choice where I move to, but I've learned that some places are better than others. Places with temperate climates, like the NW work best for me. Not too humid, not too dry. Not too hot, not too cold. It's possible that we'll need to move to Atlanta in the next 6 months. Atlanta is the ninth worst asthma city in the country, and I thought TX was some sort of asthma capital! We're hobby farmers, so the live-near-work/short-commute versus live-far-from-work/long-commute is an easy decision for us. We tend to migrate to smaller towns, where we can have a little land for planting and animals.

    Usually when I'm confused why I'm having symptoms, it's either an insidious sinus infection, or the result of multiple triggers, as you mentioned. I'm not good at sifting through multiple triggers and assigning a weight value to each one. I end up blaming it on the trigger that made the most sense to me. You probably use a lot of controller medicines, and have been through most of the ones that are available. Have you tried Dulera? My doctor mentioned it as an alternative to Symbicort if my late night wake-up calls don't go away. I was just curious whether you have any experience with it. I assume your asthma action plan has a step-up protocol for when you first begin experiencing an increase in symptoms, before you reach the point of needing prednisone? I don't even know why I asked that. I'm sure you have all your bases covered.

    Interesting you mentioned sleep apnea. My husband has a history of sleep apnea, so he made me go to a sleep clinic to get tested. I didn't have one apnea episode, but there were a few times when my oxygen saturation dropped below their threshold, and they woke me up. That made me realize that the severity of my nocturnal asthma was related to something in my immediate environment.

    It's hard dealing with something that impacts your everyday life. People don't really get it unless they've been there. Asthma is pretty common, but, as you've mentioned, it presents differently in each person. My mom has asthma, but it's very mild intermittent. She doesn't need a controller and she goes for years at a time without having to use albuterol. But I have moderate persistent asthma. It's weird like that.

    I'm always here, if you need support. You can even email me at my public email account,, at any time.

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