“Who do you think you are?” said the inhaler. “You can’t even leave your home let alone cycle anywhere without me in your pocket!”
Hello to you, Dear Reader, thank you for stopping in, and welcome along! Are you a cyclist with asthma? Do you ever wish you could just get shot of it altogether? I wished that too. I made it happen. You can too. I hope to explain what worked for me.
So I don’t take my inhaler out on a road ride. Not any more. Not religiously like I had to do before. And I’m glad. Well, you know, it never fitted particularly well in my pockets. It fitted even less well down my sock as it was for me back in days of old, lol.
Sadly, since I no longer take the inhaler with me, I haven’t noticed any discernible saving in drag. Nor have I noticed any aero benefit from not having to have my Ventolin in my ankle sock. Socks weren’t as tall up the calf then as they’ve got now! And sadder still, I could say the same for weight-saving. With your average Salbutamol-filled puffer averaging between 40g full (yeah, like when were they ever full!) down to 20g when you could feel nothing but a tiny splashing around inside the aerosol, losing one inhaler is never going to add up in watts of output! So sad… Kidding!
I know you know I’m joking. Those of us riding with asthma know too well that isn’t the point. We know the benefit isn’t in tangible things. Though hands up, I’m sure I’ve tried to save 20g on QR skewers before, you got me! But no, the benefit from not carrying my inhaler on road rides is in immeasurable peace of mind. There’s an assurance, possibly a healthful self-assurance that even my negative automatic thoughts about the whole I-Can’t-Breathe situation can’t perturb.
The joys of cortisol
Cortisol, the stress hormone, at least when not utilized for the fight/flight/freeze response, can have a habit of causing us to replay negative or unpleasant memories when we’re under duress. Cortisol pops out at every fearful moment. If you’re asthmatic, you’ll have had your share of those I’m sure! It’s the catalyst as it were that makes us worse when we’re already in a bad place. Oh the irony that cycling, like any exercise can diminish cortisol levels! But when first venturing out without my inhaler – by that stage my asthma was improved markedly – still my little brainhole pushed up clear on the screen of my mind the memories of me heaving my lungs on a cold winter afternoon.
I’d gone nowhere further than lapping the local park. My asthma didn’t allow me to. And in panicked disbelief at finding my inhaler once, twice, three times of zero utility and then feeling the impending shroud of dark constriction set in. I unclipped, from toeclips and straps as it would’ve been, dropping my bike on the ground, falling to my elbows and knees, probably in some mixture of plaintive grovelling, and not-even-slightly-believed self-reassurance, and in my hysteria, blasted with images of me dying right there from this suffocation. A nice memory. Good ol’ cortisol.
I’d occasionally still get those thoughts and doubts. Self-doubt. “Who do you think you are?” Said the inhaler. “You can’t even leave your home let alone cycle anywhere without me in your pocket!” But that’s not true. I’d like to share my experiences of how road cycling played the major part in helping me lose the inhaler. Well, more or less!
I love cycling. I always cycle! I’d cycle everywhere for utility or for fun. I couldn’t foresee me not cycling. But the cycling without doubt induced asthma in me. And therein was the problem. The problem was that need to cycle, to be a cyclist coupled to the fact that cycling was my exercise-induced form of asthma. That was the problem. The more I tried, the more of a struggle the asthma made it for me. And if the weather was worse so too was the asthma. The cold, the fog and the frost were dreadful precursors. Living in Ireland, not always too practical to avoid those as a cyclist though.
Like finding oneself suddenly suspended on a tightrope over Grand Canyon with zero experience of tightrope walking at all!
It meant I couldn’t ride where I wanted. Because where it was that I wanted, I could rarely get there. I used to congratulate myself for getting a certain distance along the route I always rode when I was younger before needing the inhaler. But then I’d be equally hard on myself for needing that inhaler at all. I’d hate having to turn around when the cold was too much. I’d hate struggling for breath even on descents. And worse, the absolute delirium of panic at realising I’d forgotten the damn inhaler! You left the house without it! How could you? You idiot! Oh my, I’ll bet you know that left-your-inhaler-at-home feeling, like finding oneself suddenly suspended on a tightrope over Grand Canyon with zero experience of tightrope walking at all!
Personally I was just always going to be a cyclist. That wasn’t for changing, nor will it be. He said, defiantly. And that’s just how my cycling went during those years. I took pleasure from small victories: a wee bit further, a climb slightly higher or steeper in gradient. But small victories they remained. Still, it was that very defiance I think that broke me free from the shackles of asthma.
I had asthma for around 27 years before I got to the point where I couldn’t take its relentlessness any more
As a case background
I picked up asthma as a teenager. We got a dog. I’m allergic to dust mite droppings or something. And to dog dander it turns out. And doggie licks too as I realized on the day we got our puppy home! I loved that doggie. I don’t know if that was a trigger, but it might have precipitated the asthma. But I’d calculate I had asthma for around 27 years before I got to the point where I couldn’t take its relentlessness any more. I had a bunch of asthma attacks, none of which required hospitalization. Several of which were while cycling.
But what I couldn’t take was my utter dependency on this little blue puffer – and it’s brown steroid preventative counterpart. I was sick of being reliant. I was sick of feeling at the beck-and-call of these drugs.Towards the end of my asthma I was taking the reliever anywhere from 15 – 20 times daily, not just on bad days, every single day! And it continued all through the night. My sleeping was so badly disturbed wakening with a gorilla squeezing my chest to grab for my bedside inhaler. It was having so little effect too. I was also bruised along the arms from the weakened capillaries from the steroids, both oral and inhaled. I was having other unpleasant and unwanted and worrying side-effects that had me busily reading up too on the potential effects of adrenal atrophy due to the high dosage corticosteroids. It got to the point where I felt completely helpless and impotent in the face of this asthma.
My doc had tried many options, mostly variants. But in fairness he’d also tried me on pycnogenol supplements. As an asthmatic himself, he was always interested in the alternatives, as was I. Some things helped. Some things gave relief. For me relief was measured by the length of time between having to take the Ventolin. At the end, that came down to sometimes less than an hour. I felt like a addict, helpless at the hands of this drug that wasn’t in the end bringing me a whole lot of benefit but certainly was making me feel like a victim of my own helplessness.
As I write today, I’d class myself as free of asthma. I’d dare anyone to disprove that. I don’t have any Ventolin available to me at home at all now. I do have a specific kind of inhaler though, and I do on occasion use it. Particularly in chest-infection season in the depths of winter. I never take it riding though. I just don’t need to, no matter how cold, no matter how hard I push, no matter if I’m in VO2Max up a 33%. I don’t need it. Not now. And were it at all possible, I’d like the same to be true for you too!
About that inhaler…
Okay so this is about freeing yourself of being hostage to asthma and its minion inhalers. But, as an aside, as a first step in eliminating your asthma, and but just if you’re interested (what a lengthy caveat!), well just because as inhalers go, this one was the last one my doc prescribed. I wouldn’t say it had a pivotal role in eliminating asthma, but it was a temporary crutch while that was happening. It’s an inhaler brand called Symbicort, I have the turbohaler version which is a combination all-in-one of the preventer and reliever, budesonide and formoterol. Again, brand names tend to differ from jurisdiction to jurisdiction but if you can’t get this, you may find something similar. One unit gives 120 actuations. My last one, still half-full, actually I checked and, oopsie, it expired 05-2015 (it’s 08-2018 as I type!) so okay it hasn’t gone away but half full so 60 uses in 4-5 years, that averages one use per month. So I’d say the asthma was as good as gone, in remission at least!
But FAR more importantly, I can ride where I want, for as long as I want, saddle soreness and ischial tuberosity pain permitting, and in whatever conditions the local climate throws my way. It’s nice to ride free. If you fight with your asthma while riding, maybe what worked for me can help you too. That’d be awesome to think!
Eliminating your asthma. As a sentiment, how does that feel?
Just to get your brainhole in gear, I wonder, how does it feel if we talk about eliminating your asthma through riding your road bike? Eliminating your asthma. As a sentiment, how does that feel? Great? Or a wee bit weird? Do you think you feel as if your asthma is part of you? Does the idea of eliminating it, while being liberating, sound odd? Could it even give you some trepidation? Perhaps not. But I could certainly understand if that were the case. Some of us, we have these conditions for so long that we almost assimilate them into ourselves as part of our being. We might be inclined to even claim ownership of them. Is the asthma that you have, ‘your asthma’ ? I think mine was. I think I owned it. I was defiant enough to know it didn’t belong in me though.
Did your asthma ever gain traction once you started focusing on it?
My experience has led me to believe the severity of my asthma attacks and episodes was mediated by my thinking; by my thoughts on the situation. But regardless of being a CBT counsellor, I’m sure is common knowledge to many, that those thoughts are frequently predicated upon our prior, often negative, experiences, in this case of the symptoms and effects of the asthma when it’s hit hard previously. I mean, did you ever feel your asthma episode wasn’t helped, and perhaps even gained traction once you began focusing on it? It’s like if you’re ever hot, flustered and confined in a situation. Focusing on being hot and flustered rarely helps. That being true, what do you think might happen if you began catastrophizing the asthma episode? How likely then would it actually be that that episode would ease off? I’d often ask myself: If asthma is 100% physiological, how can that be?
Conversely, has your asthma ever dissipated when you’ve been too engaged or immersed in something else, some other experience to the point of “forgetting” the burgeoning tight-chestedness? Have you ever been helped by an inhaler that you were sure was spent, empty or done? Again, how can that be?
Don’t get me wrong, I’m not saying asthma is somehow psychosomatic. Rather, there’s an acknowledged effect from catastrophizing an asthma episode that leads to a vicious cycle of cortisol and other stress hormone dumps, precipitating panic, further catastrophizing and further panic, all of which exacerbate the severity and symptoms of the episode. Maybe, like me, you’ve experienced that for yourself too? -I’d love to hear in the comments if that’s been the case or not- But if that’s true, why wouldn’t it be possible through this little plan-of-action to begin to feel less loss of bodily control to asthma and to regain that self-control, and to therein diminish the asthma symptoms? Maybe we could dare to talk then of eradication and inhaler-less cycling. It worked for me.
How tolerant of your asthma are you?
I imagine owing to the differing predispositions we all have, that this is going to take differing timescales to achieve. For me, I had the motivation to get rid of asthma. I was sick of it spoiling my cycling, ruining my sleep and of being hostage to it. For you, I don’t know? Are you happy in your asthma? You’ve read to this point so that might suggest not.
But maybe tolerant is a better word? How tolerant are you of the asthma that bestows upon you these symptoms? Can you put up with it, muddle through, soldier on? How do you like if your asthma dictates to you how far you can ride? How do you rationalize your asthma deciding whether you can or can’t take that hill rather than your ride fitness? Is your asthma a disability you’re prepared to live with? I know sometimes it’s easy to submit to it. It’s the simplest thing to take the drug, acquiesce. I get it. I did that too. I did that many times for years. But if your tolerance for asthma symptoms is high in that regard, I suggest this may be protracted and/or may appear not to work, you may inadvertently block its utility without knowing, or it simply won’t work at all. But again, if you try this and it doesn’t work, I’m genuinely interested to know. I’m interested to know what you’re trying. What’s your plan to gain back your freedom to ride as you’d like? It’d be helpful for other readers of that I have no doubt 🙂
On the other hand, if your tolerance for the damage asthma, and asthma meds can do long term is low and if you’re motivated to change that, then there’s no reason that the route to the goal won’t be nice and short.
Cycling Questions Multi-Pronged Plan for Riding Free of Asthma
Ooh, that must be important, I’ve capitalized each word! Get me! 😛
What I did PRIOR to doing the plan:
- Address the stress. I mean this in a couple of ways. I’m one of those folk that can often go for a while oblivious to the fact that what I call my “baseline stress level” is too high. I usually only realise that when I’ll get a nervous tic in my eyelid! So I’d advocate for checking in with yourself that your baseline stress level is where you’re happy with it before you start.
I’m sure you don’t need me to tell you high stress irrespective of whether -like me- you’re coping with it, will work against any of your attempts to alleviate asthma. That’s a given, right?
But secondly, and more pertinently, I’m referring to addressing the stress that happens in the time leading up to taking a reliever inhaler. I won’t spend too much time reiterating, but I found that visualising calmness, whatever that is for you, shallowing my breathing, and giving my body permission to relax at that point did work – and I know you’ll know this – to mitigate the speed of onset of asthma symptoms, delay them, or allow them to pass you right by.
- Eliminating Your Asthma Triggers. Naturally some of these aren’t possible or practical to eliminate. However there are steps for each that we can take to again mitigate the magnitude of their effect. For me, the cold weather asthma trigger was reduced by wearing a neck-tube or buff across my nose and mouth, similarly with smog or environmental pollutants. I suspected what I was eating (or maybe the volume of food!) was increasing mucus production – that frog-in-the-throat feeling. I did a short-term food elimination plan to pinpoint what were the worst offenders. In my case that was dairy. And sugar. Any sugars right down to certain fruits.
This was terrible for me, someone with a very sweet tooth! But priorities prevail. In that case, the priority was doing away with the asthma.
Supporting yourself DURING this plan:
- Mind your Meds. I would never suggest you adjust your meds at all. Especially since you know your adrenal function diminishes when on long-term steroids and can need a period of adjustment in which to reduce the intake of the steroids. Obviously consult with your doc about what’s good for you. Having said that, it’d be hypocritical if I didn’t admit that I just dumped mine. I went “cold turkey” I was so sick of them. Reckless or not, you know I can’t advise that for anyone.
- On that note, your inhaler(s) work for you don’t they? If not, could you consider trying for more effective alternatives, for example like the one I mentioned above that worked well for me? As long as you know your medication works for you or there’s one that you can get to work effectively for you before trying to eliminate the asthma. This isn’t an exhortation to continue deferring your own health to external agencies (your doc, your meds). This is just a temporary ‘crutch’ while you’re getting unhitched from the asthma.
- Correctly Using Inhalers. I think it goes without saying, but I’ve been guilty of this so I’ll say it anyway. You do take your inhaler correctly don’t you? You often see it in the media, movies, TV shows. The poor asthmatic – often no more than a euphemism for a weakling – they reach for their inhaler, puff and start talking before it’s had any chance to work. They don’t hold the breath nor did they try to calm the breathing as much as possible before inhaling. Surely they’re aware, these asthmatic TV weaklings that β2 adrenergic agonists used as bronchodilators do need get right to the source of the problem ie. in their airways if they’re to relieve constriction and do their job, right? Yes, I’m being glib. I just hope when you take it, you do it right, calm your breathing to the extent you’re able beforehand. Breathe as deep as you’re able. Hold your breath for as long as possible to allow the bronchodilating agent to work. Breathe out slowly. Take slow breaths within your ability afterward.
The multi-pronged asthma-eliminating road cycling plan that I used:
- Nose-Breathing. I worked up to completing full rides while nose breathing only. Funnily this did take a few rides before I was able to manage it. In many cases I did have to lower my effort to make it happen. But happen it did. Since getting shot of the asthma I’m fine to go over threshold with my mouth open, it does no harm. But back then when I was ditching the asthma, I worked hard at consciously keeping my mouth shut and nose-breathing for the full duration of the ride. I would advocate for this as the first step. Nose breathing not only gently heats the air passing into the lungs but also calms the respiratory rate and heart rate too. I find it’s a great technique for climbing too, but that’s for another day! As mentioned, I use a buff or neck tube across my nose and mouth to help preheat the air on colder days. These are horrible in very wet rides though – it’s like some kind of awful waterboarding thing!
There’s a beneficial aside to nose-breathing when riding. I found that consciously reminding myself that I was going to keep my mouth shut during the night while sleeping improved my sleeping too! I think all of these steps here worked in synergy to help bring the cure about 🙂
- Very Gradual Warm Ups. This is simply to reduce the incidence of exercise induced asthma on the ride. It can still happen, but a VERY gradual warm up of 40-60min from super low zone 1 incrementing cadence by 5rpm every five minutes up to 120-130rpm. That’s how I did it. No cheating. For me, often the warm up WAS the ride. I wasn’t training for anything. I was working to rid myself of asthma. So I’d suggest warm up possibly for longer than usual, particularly in colder weather.
- Remain Below Threshold. I’m sure this is self-explanatory. Again, if you’re training for something, you might have a bunch of hills on your rides and so it might not be practical. I understand that. For me, and I’m sure for you too, you notice your breathing change once you hit your threshold zone, right? I mean it’s noticeable. And that makes sense due to the muscles’ demands for oxygen at that power output. But it’s the increased workload on the lungs at threshold and above that I wanted to avoid. So I did. And that’s what I’m suggesting here. I live in the middle of a hill. It didn’t matter which direction I rode from home, either I hit the hill right out of the gate, or I hit it on my cooldown. Either way, it is possible to do a ride under threshold. Look on it like a high spin session! 🙂
- The Interesting But Controversial Book. Again, such was my desperation to regain the health that I felt was mine out of the prison of asthma, I did many hours of research and accidentally stumbled upon a book. I’m not going to do any sales pitch. You can check it for yourself if you’re inclined. It was called “Eradicate Asthma Now – with Water: An ABC Guide to Curing Asthma, Allergies and Lupus”. Written by a doc with the surname of Batmanghelidj. You can still get it on Amazon or anywhere else, probably used on eBay too I’m sure. What can I say about this book. It’s controversial. For me, I like to believe I have an open mind and that my thinking around health and the body is pragmatic – whatever works is my motto! I’m not one for permitting medical orthodoxy to lead me by the nose. If you’re anything like that, this book should make sense. And if not, it might be irksome! It isn’t “woo” or anything, it’s just unorthodox. As I recall, he advocates simply using water. And salt. That’s it. Again, I’m not selling it, I’ll leave that to your discretion. The author explains far better than I could as a lay person. All I can say is, in conjunction with these other steps here, it worked for me. From where I was in the bleakness of inhaler captivity and tiny bike rides, believe me, that’s something. I can’t ask that you trust me. That’s a dumb thing to say. Trust must be earned not asked for. The thing is, this might be of zero benefit to you. All I’m saying is, for me, it was just the trick. Maybe it was a trick. This next step, definitely was that. But again, it worked.
- Buteyko Method. For me, this was the most revelatory aspect of my asthma campaign. Again, I’ll leave the details to your googling discretion. Essentially it’s a programme of breathing techniques. I think there’s a decent bit of information out there on it now. While the above book addressed our dealing with asthma in a physiological way, this for me at least is quite psychological. And in my opinion, as I’ve stated, the effects of asthma can be influenced by our thinking, specially at those gorilla-squeezing panic moments! But this Buteyko method uses shallow breathing. It wasn’t an easy technique for me to get the hang of at that time. Gasping for air was more my thing. But that can be so damaging to our already raw lungwork, right? Again, it’s not for me to expound on this method. If you’re interested, I’d highly recommend it. This, in conjunction with the aforementioned book were what I used to shake off my asthma.
- Step off the Vicious Cycle. I think the above prongs can allow us as road cyclists to step on a more virtuous cycle as it were. As our symptoms diminish, we realize it’s us that have been in control all along. Asthma removes our perception of that control; persuades us IT has control and we do what it commands. That sense of having control over the simple freedom of breathing easily at any training zone, is a revelation. I wish that for you as I’ve experienced it. However, asthma, being devious as it is, can always throw a spanner in our spokes. If you’re at the stage where your use of relievers is noticeably dropping, you’ve gained confidence in your chest and lungs, still there can be a moment. It can be due to perhaps overdoing it on a hill, due to an inbound upper respiratory infection or whatever. But those moments where you’d get drawn back to the bad days of, “oh my, I’ve left my inhaler at home!” And we know how that exacerbates and magnifies even minor passing symptoms and tries to catastrophize them. This only throws us right back into the waiting grip of asthma. Instead of allowing yourself back into this vicious cycle, just remember the Buteyko techniques, rein in your gasping, calm the breathing. If you’ve got to this stage in the program, you’ll already be conversant with that kind of self-assurance around your breathing. Just stay on that virtuous cycle. I guarantee no cycle is more aero 😀
How long does this all take?
As I’ve said, I believe this is to some degree dependent upon your own mindset. When I did this multipronged attack, I envisioned it every step as though I were on the offensive against the asthma. For me the whole thing was surprisingly short. Without ever wanting to set you up for disappointment, noticeable changes happened for me within a matter of days. But again, the severity of the asthma naturally differs from rider to rider. All I know is that I was singleminded in my determination to get myself clear of asthma. I can’t see the harm in adopting that stance.
The first thing I noticed was my very first full night’s undisturbed sleep in so many years. I can remember the shock of it. I can remember thinking, nah, that can’t be right. I must just not remember wakening to pay homage to my blue aerosol master. But I’d done it. I can remember it almost felt like a cause for celebration on its own. The rides were tentative at first. Mind you, my rides are always weirdly tentative too after I fix a puncture, so I’m not sure that’s saying much.
I don’t recall my doc ever seeing this as any kind of medical miracle. Probably too many patients on the register to have noticed. Actually he retired. I haven’t been to the doc’s in around 8 years I think. I’ve never met the new doc lol. I don’t know that that’s anything to do with anything. But all I’m hoping is that something here might help you as a road rider to get shot of any asthma that dares to try to hold you back from your riding enjoyment and success. Let me know in the comments if you’ve experiences to share. I’d totally appreciate hearing. It all helps build a wider picture of how we riders are handling asthma.
I wish you well. Ride safe, and have fun on the Virtuous Cycle! David.