Breathing


I’ve known for a long time that I don’t do well with extended aerobic exercise. I get intensely overwarm, to the point of nausea. I get lightheaded and have trouble thinking. I take a long time to recover, and frequently end up with a headache. I cough for hours afterward.

That last one, I knew was exercise-induced asthma. I didn’t know it when it started, in junior high track. I was given to believe I was malingering instead, that the problem was somehow shameful. But I figured it out some years later on my own.

I’ve mentioned it to doctors in intake interviews. None of them ever followed up. There were no questions about managing the condition, no tests to measure how impaired my breathing was, no suggestions even that I should have a rescue inhaler. They probably assumed that it was mild rather than self-diagnosed.

I didn’t have any way to gauge the severity of the problem either. I knew I couldn’t sustain activity that required me to breathe heavily, but I also knew the asthma kept me from training. I knew I coughed afterward, but I’d always done that without my breathing feeling particularly impaired.

Then I started my new job this summer.
Where a one-and-a-half mile walk to my last job downtown was comfortable, the two-and-a-half mile walk to the new job involved more time than I wanted to spend on my commute on a regular basis. I ordered a token for the city’s Nice Ride bike-sharing program to test how I felt about biking to work.

I hadn’t been on a bike in more than 20 years. The first morning was embarrassing. While it may be true that you never forget how to ride a bike, that doesn’t mean you never forget how to get the damned thing going, particularly for someone with balance issues like I have. Still, I rode it about two miles to the coffee shop nearest work.

Then I sat on a curb for fifteen minutes wondering whether I was going to pass out.

I didn’t, but I didn’t get coffee either. Sitting and breathing took up all the time I’d left for that. I wasn’t in great shape for walking the last half mile to work either. Crossing the busy road my building is on felt extra dangerous, because I was only able to focus very narrowly.

I wondered how I’d managed to get that far out of shape, since I could walk the whole way with just a bit of cough to show for it, and I determined to get better after giving myself a recovery day or two. A route change and some more biking did keep me from being completely incapacitated by the ride, but I still had to budget time for recovery on the work end. And I still showed up for work beet red, which is always fun.

I knew I wasn’t in good enough shape to tackle the hill just up the road from work, so I didn’t try riding home. I walked or took the bus, depending on my schedule, until the day I noticed there was a bike rack right next to the shop past the hill where I had to stop that evening. So I tried it.

I live on local high ground. It’s quite nice during our summer thunderstorms, less nice for biking. There were no other big hills after the one I skipped on my route home, but the near constant, gentle upward grade was still enough that I was in danger of passing out again by the time I got home.

This time, at least I could lie on the couch to recover. That was great, except for the part where I still felt near to passing out about an hour later. That’s when I went to go find my husband’s rescue inhaler. It was upstairs, which was minor torture, but it worked some.

Due to con crud, it wasn’t until this week that I got back to biking even semi-regularly. This time, I’ve been using the rescue inhaler for prophylaxis.

And I’ve discovered what exercise is supposed to feel like. I don’t mean endorphin rushes. I mean the ability not to worry whether I’ll reach my destination before I run out of steam. I mean 10- to 20-minute recovery times instead of dragging for a couple of hours. I mean still feeling clear-headed when I’m done (though some of that may the stimulant effect of the inhaler).

I finally understand that when people talk about torturing themselves with exercise, they don’t mean it literally. I always thought they did. This? It’s still work, but it’s not torture. I don’t have to pick and choose days that I can manage this safely. I don’t have to hold off on days I have to be sharp at the other end of my ride. This I can do any day that isn’t absurdly hot or rainy. As I’m getting used to it again, this isn’t even hard.

Who knew?

So now that I understand just how pathological my body’s response to aerobic exercise was, it’s time to make a doctor’s appointment to get it properly taken care of. Get it measured. Get it under control. Also, I’m still coughing after my rides.

I’ve been talking about this a little bit on Facebook and Twitter. I’m finding other people who have had undiagnosed or untreated asthma for much of their adult lives. I know other friends have been in the same boat. That’s a bunch of us limping along for years, not understanding that we had a significant barrier to getting—and enjoying—exercise.

So now I’m putting this here to tell all of you as well. Is intense aerobic exercise torture for you? Do you not recover for hours after you’re done? Do you ignore signs of asthma when you exercise because “It’s just a little cough”?

Stop ignoring them. Stop letting your doctor ignore them. Breathing is such a good thing.

Comments

  1. says

    I had exercise-induced asthma as a kid, but haven’t given it much thought except when I get respiratory infections as an adult. I’ll look into it – thanks for posting.

  2. says

    I have exercise induced asthma, but I’m lucky, unless I have a cold or the air is cold I’m usually fine. Also been treated with steroid and relief inhalers since I was a kid. Although I only use the steroid one when I have a cold as I don’t like the idea of taking it constantly when the asthma is intermittent. Its no fun and as a kid who was undiagnosed I just didn’t do long distance running etc. Short distance stuff that required a short burst of power was fine, but as you say a long recovery afterwards! Hope you get it sorted, drugs are pretty good for it these days.

  3. Great American Satan says

    There are other reasons to be unable to exercise. I know of people who have those inward-angled knees who start getting joint pain within a few minutes of running, people who have a blood sugar crash leading to weird terrors, depression, and/or anger when exercise actually starts to work.

    Think I might have to give it a go someday for cardiac health, since I’m luckily not disabled in any particular ways & won’t fuck myself up in the process. But I’ve never seen it go well for the few people I know who have earnestly tried it, and it’s rather demotivating.

  4. Bruce Martin says

    Of course, doctors who specialize will tend to look at things in terms of their specialty.
    My regular doctor told me that if you want to get diagnosed with any condition, then just go see a specialist in it and they’ll do that.
    But maybe the converse also applies? Maybe doctors who are not specialists have an unconscious presumption that no specialist is needed or justified, unless it is obvious?
    If this happens to be true, then it might not be so surprising that a series of non specialist doctors could overlook something of real concern.
    We want all doctors to use evidence in diagnosis, and I’m sure most do, most of the time. But they’re human, so their reason can be overwhelmed by nonscientific cultural presumptions, such as may have occurred here.
    I don’t mean to criticize any doctors. But people might need to follow Stephanie’s lead here and be more proactive sometimes in forcing doctors to deal with issues. That may mean telling a doc to do or refer one for a test, even if it’s not clear in advance that it would be covered by insurance. If it says nothing, one has more peace. And if it says something, then it’s better to know sooner that it’s an issue that needs attention.

  5. Menyambal says

    Huh. Reading this, I wonder if I might have exercise-induced asthma, but not know it. I exercise at easy rates pretty well, but have never been able to go at high levels. I just learned to not push it, to avoid the effects, and have been living with that so long that I don’t even know what the effects are anymore.

    I will look into it further.

    Thanks for sharing this. Please continue to get even better.

  6. says

    Great American Satan, yeah, there are plenty of other issues besides breathing that have to work. I can’t run because of deformed kneecaps, but luckily for me, biking is good for exactly the muscles I need to manage that.

  7. MadHatter says

    I definitely have exercise-induced asthma, but unless the air is really cold or I push myself for too long I’m fine. What I learned a while ago is that I work up to aerobic exercise very slowly and my lungs get stronger so I go longer and longer before having trouble. So for the immediate period, I get off the bike and walk when my breathing gets difficult, or when I decided to start running I would do the interval thing and just make sure my breathing was normal before each running interval.

    My sister has it much worse than I do, but she discovered the same thing. Both of us prefer things like weight lifting where we can get our heart rate up without driving our lungs too hard though. It took a while to get over that hump with exercise though.

    I did get tested, multiple times and it was always inconclusive, though doctors will give me a rescue inhaler anyhow.

  8. Great American Satan says

    The main person I know with the knees does just fine walking – it’s only the shock of running that’s trouble. Can you walk pretty well, asthma issues aside? Just curious.

  9. angharad says

    I’m fairly sure I don’t have asthma of any kind, but oh boy can I relate to the red in the face part. I think I must have thick skin. I don’t feel the cold much, but if I get warm I feel like all the blood in my body is trying to get into my cheeks.

  10. badgersdaughter says

    I have always had trouble exercising because I just get overtired so quickly. I have good breathing, but small red blood cells. The doctor told me I was anemic. I also have insulin resistance, though it is not full diabetes. Two extended-release Metformin tablets and two one-a-day vitamins per day seem to help. My thyroid was checked and is apparently normal, but for what values of “normal” I don’t know.

  11. Shari says

    Badgersdaughter, i overtire quickly in hard cardio… Hate running (feet and lung and cardio hate) hate stair-steppers (lung and cardio hate) and I also have very low blood pressure – so when i yank it up with running I feel HORRIBLE. I started yoga and get a hell of a workout, and I am hoping to get my body used to the exertion, so i can maybe do harder swimming, or at least not feel faint if i do bike (no love there either). I feel ridiculous to be 45 and only NOW figuring out what actually feels…..good, for exercise. Chasing my kids doesn’t provide the workout it used to, that’s for sure!!! Good to hear about others who are facing our barriers to being healthier :-)

  12. kthondragon says

    I’ve known for a long time I had exercise induced asthma. I used to joke with my doctors that I treated it by not exercising. They never found that funny for some reason.

    Recently I was talking to a sleep/pulmonary doctor and she asked if I wanted to do a full pulmonary workup. She had me walk up and down a hall at a normal pace with an O2 meter attached to my finger. In 9 laps, I dropped from 99% to 89%… she said if I had dropped below 89, they would have been legally obligated to put me on oxygen. So I had the full workup and learned that I have terrible small lung function. Nothing that could have been repaired by exercise or weight loss or anything.. it’s just how it is.

    That explains my exercise induced asthma. It also explains why I always wanted to just DIE after exercising. I couldn’t breathe, I was light-headed, I felt like crap. I never understood how people could enjoy exercise, with how it makes you feel like you just want to keel over dead.

    I’ve since been given an albuterol inhaler(to use “as needed”.) I should probably get around to actually exercising and seeing if it changes, but my whole life I’ve been avoiding exercising and have this ingrained aversion to it that is hard to work past.

  13. Crimson Clupeidae says

    I’m probably atypical. I’m 46, and I bike 11 miles each way to work almost every day, 12 months of the year. It does taper off in the winter, as I have a lower threshold, more over concerns of black ice and falling than actual cold, although I hate cold weather.

    Eventually, I want to get a trike like this for winter riding, or possibly a full velomobile like a Rotovelo Trisled. I would then pretty much only need my SUV for towing and hauling really large things. :)

    If you have balance issues, you might look into trying out a trike. Depending on where you live, the shops will usually let you try some out. They are both fun, good exercise, and have lots of options for making a commute comfortable (like small electric motors to assist on hills/short rides).

    I ride a recumbent bicycle as my commuter.

  14. says

    I have this intermittently. It took me some time to identify it, though, as you always think of asthma attacks as gasping for air, all dramatic, when what I get is just a constant tickle that coughing won’t alleviate. I trained for my first marathon this year and did fine until I hit the 20 mile training run. About an hour after I finished I got the tickle, and god DAMN it’s annoying–for me and the people around me. With the race only a few weeks away I panicked a bit and went to my doctor. He, bless him, immediately recognized what I was describing and prescribed an inhaler and told me how to use it in conjunction with my running.

  15. D. C. Sessions says

    Asthma? Me? Nope.

    The boys, now … Yeah. Real bad. Hospitalization bad. Spending nights managing their nebulizer and juggling their breathing vs. their heart rate increases bad. All night.

    The good news for them is that they outgrew most of it, and what’s left is responsive to training so the rescue inhalers tend to die of old age rather than use (and damn those things have gotten expensive. Is there a patent on the propellant they use now or something?) Which won’t be good news for you.

    As your doc will tell you when you see her, rescue inhalers are just that: for jumping on an attack before it gets worse. Not really for prophylaxis. Inhaled corticosteroids are much better (much lower side effect profile, for instance) for regular prophylaxis. And then the conditioning can kick in.

    Other tips (that your doc should be telling you too): respiratory irritation is cumulative. Exercise, pollution, particulates, infections, … it all adds up. Tobacco smoke is nasty but most of us tolerate it even if we don’t like it. An asthmatic should be (if you’ll pardon the expression) religious about not inhaling even third-hand smoke (furniture, clothing, like that.) If you get air quality alerts, take them very seriously. If you have seasonal allergies, jump on them aggressively. “It’s just a cold” never applies in your case.

    Stuff like that.

    One last thing: get yourself a pulse oximeter. Dandy little things that you can slip on your fingertip and it’ll record both your pulse rate and your blood oxygen saturation. They cost about $40 or less at all sorts of places now. That saturation number is you early warning so you don’t have to start getting tunnel vision.

  16. says

    I’ve had the same symptoms too. Luckily(?), I brought it up with my primary care doc a few years ago. And, oh my goodness, did it explain why I hated those mile runs in full football pads during two-a-days practices in high school (and why other people were still standing while I was doubled over almost ready to pass out), and also why I continually avoided any sort of heavy aerobic exercise.

    Without my albuterol inhaler, it’s sort of a craps shoot whether I’ll take a long time to recover or still feel mentally “there” when finishing (probably something to do with the respiratory allergies). And even with it, it depends on what I’m doing. If I’m swimming (not a great swimmer anyhow) even my legs will, almost literally, burn for ~20 minutes after even a relatively short swim. My ankles have forced me to give up running, but it was hard to find a breathing rhythm so I could sustain the run. On the bike, though, it seems like I can concentrate on taking deeper, more consistent breaths, at least to the point where I can crest an initial wave of exhaustion and get to sort of an exercise high.

    On the bike front, getting/renting/borrowing a decent road/hybrid bike (something with a bit less weight/friction than a cruiser or mountain style bike) can help a lot with a commute. My current bike is just a Costco special, which is an order of magnitude cheaper than the several thousand dollar bikes folks around here* think is “basic”, and it’s actually fun to ride. Much better than my 20 year old rusty mountain bike in any case. :o)

    *Silicon Valley

  17. fork says

    I’m fine during exercise, the coughing kicks in after, although I might have something different as the cough doesn’t impair my ability to exercise.

    I developed a persistent cough after working in an environment where chemical fumes were not vented properly. It took me nine years to get treatment. I would bring it up every time I changed doctors. Highlights were the doctor who said, after a description of the cough I’d had for about two years, “Come back and see me if it persists”, and the ear, nose, and throat specialist who told me to just stop coughing and I would stop coughing.

    It finally became intolerable during my third pregnancy – I spent my hour or two of sleep a night with a towel between my legs. When I mentioned it to my doctor, it turned out I had forgotten to bring it up when I first came to see her. She promptly prescribed an inhaler.

    It still makes me so angry that it took that long.

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