Self Observations: Severe Asthma and Endurance walking

Ive been doing endurance walks now for about 10 years, and because of the severity of my lung disease, I often experience significant symptom exacerbations afterwards. Well something quite unexpected and encouraging has happened recently during the peak of this current training cycle, or should I say…didn’t happen!

On 3 separate occasions over a 4 week period, I did NOT suffer a significant flare up following a long training walk. This is big news, because it’s never happened before, especially after doing multiple long walks in a row. It could be just the natural ebb and flow of the disease or the cycling of good and bad days if you will, but I think it has more to do with the way Ive been dealing with my symptoms after these long walks. I believe I may have finally found a way to minimize the onset and/or severity of asthma symptoms triggered by prolonged physical workouts.

Following my most recent training walks(a 13, 17 and 21 mile walk, each one week apart), I experimented by doing multiple double-dose neb treatments at a frequency of 1 to 2 hours for the first 6 hours. In other words, I nebulized 2 unit doses of albuterol/atrovent at a time and then repeated that at least twice over a 4 hour period, regardless of how I was feeling. For the remainder of the day I continued to neb with a normal dose every 2 to 4 hours, depending how tight and /or short of breath I felt.

The reason I do those initial neb treatments “regardless” of how Im “feeling” after a long workout, is because many times there will be a delay in symptoms of several hours, sometimes a day or more, before my lungs start to react negatively. Additionally, I don’t always accurately perceive my own symptoms. I can be tight as a drum and not even sense it. It’s just a theory of mine, but I believe that circulating endorphins, which have been shown to alter the perception of breathlessness, as well catecholamines that have a bronchodilating effect on the lungs, remain in the body for a while after the exercise ceases. This might partially account for the delay of symptoms. I also believe that lactic acid (the by-product of muscle breakdown) has an effect on already damaged and/or sensitive airways causing bronchospasm. And as with other forms of exercised induced asthma, air quality, including irritants in the air, the temperature of the air, and the humidity levels all can have an impact on asthmatic airways. For those with more severe disease, increased air-trapping caused my breathing faster probably play a role in worsening symptoms as well.

It remains to be seen if I can keep these exercise induced exacerbations at bay for an entire 3 month, 300+ mile training cycle. Probably not, as a non exercise induced triggers set me off about every 2 months anyway.Still, this little experiment gives me hope that I can work out hard on occasion without the constant fear that I might make myself dangerously ill. I think also helps ease the concerns of those in my life who would prefer I not train for marathons at all.

**It’s important note here that the type of exercise induced asthma Im referring too, is different than the more widely used definition of the term “Exercise Induced Asthma“, also known as (EIA), in that the symptoms dont generally occur until well after the exercise activity has stopped, as opposed to “during” or shortly after the activity. This type of delayed response is more common in people with chronic lung disease.
Also, Im not encouraging anyone to overdose themselves on nebulized bronchodilators (which btw,is difficult to do) just to be able to exercise, Im just saying that it works for me. After 50+ years of using these drugs, I have a very high tolerance.

Here are a couple non-respiratory related observations Ive made as well during these training walks:

Frequent Blisters: Probably a combination of an altered gate (I dont racewalk anymore , so Im landing on my feet differently), poor fitting shoes and soft skin . On a positive note, Ive had very few problems with calf and legs cramps after my walks this season, again, because Im using different muscle groups.

Dehydration: What else is new. Plain and simple, I don’t drink enough, as evidenced by post walk nausea and tachycardia. I started my walk with a HR of 58 ( my normal resting HR) and a full 4 hours after completing the walk my HR was 108!

Sun Burn: That’s a no-brainer, but you’d be surprised at my lack of common sense sometimes.

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