Exercise Induced Asthma?

[sagelily]

DD is 15 and has been dealing with exercise induced asthma for a few years. She has an inhaler and only uses it for high intensity exercises such as mountain biking and distance running. She does not need it for long hikes even if there is elevation gain. The issue seems to be getting worse instead of better and it is now impacting her ability to finish rides and runs. We will be going to back to the doctor but today was probably the worst experience she has ever had and it is now starting to affect her emotionally not just physically. For anyone else that has experienced this personally or with their kids, are there alternatives that have helped? Thanks in advance.

[mccallister84]

Does she take it proactively? I would take two puffs before I started exercising and that seemed to stave off most issues.

My daughter has regular asthma and the doctor always says there’s no harm in giving her the inhaler (as long as I’m not over dosing her) when I express concern about knowing whether or not to use it (we’ve been dealing with it since she was 2ish so well before she could articulate that she needs it).

[penguingrrl]

I would talk to her doctor. If taking albuterol prior to exercise is no longer adequate to reduce her symptoms I would guess it might be time to try a maintenance inhaler. I progressed to needing one and no longer need to take albuterol before running, and actually can go over a year without needing it.

[ellipses84]

I do, but I went my whole life into my 40s not knowing it and not understanding why I hated exercise, running and cardio in particular, because couldn’t breathe! I only use an albuterol inhaler prior to exercise, 2 puffs. Once exercise taxes my lungs too much it’s really hard to recover so it’s best to be proactive. If that isn’t enough for her, I would think a daily maintenance inhaler might be what she needs, in addition to one before exercise and in an emergency. Could there be anything exacerbating it, like air quality or allergies, seasonal or otherwise?

[sagelily]

Thank you all for your thoughts. Yes, she takes two puffs about 15-20 minutes before exercise. She used to only have a problem if she forgot or took it immediately before starting but now she never forgets to do it in advance and she is needing to pause the first 15-20 minutes in to use the inhaler again. Today she did not finish a race because even with using the inhaler before and during activity, she could not get the wheezing under control until she stopped. Fortunately it does not continue once she stops exercising.

She does have severe seasonal allergies but she takes medication for those. I have been reading more today and some articles said dry air can cause more problems but this is a situation where the humidity is high.

[awkwardpenguin]

I have both mild asthma that is mostly exercise induced, and something called vocal cord dysfunction, which causes your vocal cords to spasm and cause breathing issues (more with inhalation than exhalation) and is often triggered by exercise or emotional stress. I was so discouraged because my inhaler was not controlling my symptoms anymore and it turns out that it was the VCD. Basically the VCD was caused by me trying to overcompensate for the exercise induced asthma. It's almost always a learned pattern of breathing (although it's usually subconscious).

Basically sometime in my early 20s after a lot of failed asthma treatment I was diagnosed with the VCD. You can sometimes see the difference between them on spirometry, but diagnosis took a while because I had both the asthma and the VCD.

I went to speech therapy for the VCD to learn to relax my vocal cords and between that and just knowing that my breathing troubles were caused by VCD I basically recovered fully. I do still need inhaled albuterol before intense exercise during allergy season or if I'm sick, and I have to be extra careful with general anesthesia (another asthma trigger for me) but it's a very minor problem in my life.

[intheden]

DD (15) also has exercise induced asthma. She takes Symbicort (inhaler) twice daily and then uses her Albuterol (rescue inhaler) when necessary. It has helped her tremendously 

[sagelily]

Sept 28, 2024 16:23:19 GMT -5 awkwardpenguin said:

I have both mild asthma that is mostly exercise induced, and something called vocal cord dysfunction, which causes your vocal cords to spasm and cause breathing issues (more with inhalation than exhalation) and is often triggered by exercise or emotional stress. I was so discouraged because my inhaler was not controlling my symptoms anymore and it turns out that it was the VCD. Basically the VCD was caused by me trying to overcompensate for the exercise induced asthma. It's almost always a learned pattern of breathing (although it's usually subconscious).

Basically sometime in my early 20s after a lot of failed asthma treatment I was diagnosed with the VCD. You can sometimes see the difference between them on spirometry, but diagnosis took a while because I had both the asthma and the VCD.

I went to speech therapy for the VCD to learn to relax my vocal cords and between that and just knowing that my breathing troubles were caused by VCD I basically recovered fully. I do still need inhaled albuterol before intense exercise during allergy season or if I'm sick, and I have to be extra careful with general anesthesia (another asthma trigger for me) but it's a very minor problem in my life.

Thank you so much for explaining this. I will definitely ask the doctor about it.

[sagelily]

Sept 29, 2024 10:37:23 GMT -5 intheden said:

DD (15) also has exercise induced asthma. She takes Symbicort (inhaler) twice daily and then uses her Albuterol (rescue inhaler) when necessary. It has helped her tremendously 

Thanks for letting me know! Does she take the Symbicort twice daily throughout the whole year?

[devonpow]

DS1 has allergy induced asthma that is also affected by exercise - this is all new-ish. He always has bad allergies but the asthma just started/was diagnosed last year. They think his first round of covid triggered it (I guess viral infections can do that? I don’t know). He runs XC and track so it’s been tough on him. He’s on symbicort inhaler twice daily, albuterol for rescue and pre exercise, singulair, a nasal spray I can’t recall the name of daily, and Allegra daily. Also lots of things like air purifiers, dust mite protection on mattresses and pillows, etc etc etc. He’s going for a lung function test in a few weeks to see how things are. None of these things have proven incredibly effective unfortunately. I’m really hoping the new specialist we are seeing can figure things out.

[meanie]

I had asthma as a kid really bad, I am a lot better as an adult but it flares up when I am sick, in cold weather, or after doing cardio.

Do menthol cough drops help her at all? I use them while working out if I have a lingering cough that will trigger a bigger episode.

As a kid I did daily breathing treatments - like a nebulizer but with extra oxygen, and used a dry powder inhaler every morning for years. I'm not sure if these are even a thing anymore, but around 7 I did have a big improvement and went from frequent ER visits to not having any attacks. 

[intheden]

Sept 29, 2024 12:26:53 GMT -5 sagelily said:

Sept 29, 2024 10:37:23 GMT -5 intheden said:

DD (15) also has exercise induced asthma. She takes Symbicort (inhaler) twice daily and then uses her Albuterol (rescue inhaler) when necessary. It has helped her tremendously 

Thanks for letting me know! Does she take the Symbicort twice daily throughout the whole year?

Yes, all year, she does indoor soccer and tennis in the off seasons, so she still needs it! Good luck, I hope you find a solution that works!

[madringal]

My 16 year old has been dealing with it for about 3 years now. She is a swimmer, and it always gets bad at the start of each season. We recently added a Singular and it was really helped. Also, when she does have a flare up, just laying flat seems to help the best until it passes.

[ksun]

I've had it since I was a child and so has DD; the inhaler is all that has helped.

[dontlook]

Sept 29, 2024 10:37:23 GMT -5 intheden said:

DD (15) also has exercise induced asthma. She takes Symbicort (inhaler) twice daily and then uses her Albuterol (rescue inhaler) when necessary. It has helped her tremendously 

Same for my DD (13). A game changer for her.

[laurack]

I have allergy (and exercise) induced asthma and in spring time when it’s the worst I was using albuterol far too much and my doctor added an advair inhaler and it was a game changer. Instead of waking up gasping for breath every night and using albuterol around the clock I felt mostly fine and had only sporadic albuterol use.

So I’d suggest you try a daily inhaler which is long acting (keeps the airway open) and that should reduce reliance on the rescue inhaler.

[picksthemusic]

I have it. I need to take it pre-emptively before workouts (like treadmill walks, hiking in the cold which is a huge trigger) or I'm a mess afterwards and it will take longer for the albuterol to work.

I have Qvar for when I'm sick or having more frequent symptoms. It's a daily long-acting inhaler (I've also taken Advair before with success) and it helped tremendously when I was having more frequent symptoms.

[bugandbibs]

So there is a lot changing in how we manage asthma in the adolescents right now. I definitely recommend you speak to her health care provider. Combined medication inhalers are becoming the new standard, especially if there are allergies. Albuterol is a regular short acting beta agonist that can lead to tolerance in the airways when used daily as the primary asthma treatment causing reduced effectiveness and increased airway hyperresponsiveness. The main issue as always is the FDA catching up to the science and insurance covering prescriptions.

If she isn't already, I would highly recommend that she use her inhaler via a spacing chamber to maximize the amount of medicine that gets in her lungs.

One thing to note, evidence is showing that some inhalers have a shorter life span than previously thought. The expiration date is more reflective of an unopened/non-used inhaler and that once its been used other factors (like moisture) can effect its efficacy.

[sparty04]

My son has asthma that is triggered by cold symptoms and seasonal allergies. He's been on singular and a daily nebulizer steroid (and albuterol as needed) until this past spring. We finally saw an asthma specialist after non stop flare up's, and he was switched to a twice a day powder inhaler (Wixela but only because our insurance doesn't cover Symbiacort). He's currently experiencing an asthma flare up but it's milder than in the past, thankfully.

Is it ok for her to be doing so much albuterol in a short period of time? It's been drilled into my head that treatments should be about 4 hours apart.

Also ditto the spacer. Our doctor told my son he needed to be using it again (we had stopped once he was able to take a deep breath while inhaling).

[sagelily]

Sept 28, 2024 16:23:19 GMT -5 awkwardpenguin said:

I have both mild asthma that is mostly exercise induced, and something called vocal cord dysfunction, which causes your vocal cords to spasm and cause breathing issues (more with inhalation than exhalation) and is often triggered by exercise or emotional stress. I was so discouraged because my inhaler was not controlling my symptoms anymore and it turns out that it was the VCD. Basically the VCD was caused by me trying to overcompensate for the exercise induced asthma. It's almost always a learned pattern of breathing (although it's usually subconscious).

Basically sometime in my early 20s after a lot of failed asthma treatment I was diagnosed with the VCD. You can sometimes see the difference between them on spirometry, but diagnosis took a while because I had both the asthma and the VCD.

I went to speech therapy for the VCD to learn to relax my vocal cords and between that and just knowing that my breathing troubles were caused by VCD I basically recovered fully. I do still need inhaled albuterol before intense exercise during allergy season or if I'm sick, and I have to be extra careful with general anesthesia (another asthma trigger for me) but it's a very minor problem in my life.

Thank you so much mentioning VCD. Based on her breathing test result when we saw an allergy and asthma specialist, they think this is part of her issue so we are getting a referral to a ENT to talk about next steps. I had read about it after your post so I felt better prepared to ask preliminary questions when the doctor raised it.

[sagelily]

Thank you all for sharing experiences. We have been able to see her pediatrician and also an allergy doctor since I originally posted. The only available allergy appointment before February meant she missed PSATs but the good news is she is now taking Symbicort morning and night while using the spacing chamber. We were also referred to an ENT because someone upthread mentioned vocal cord dysfunction and her breathing test showed that was a possible contributing factor. The Symbicort is new as of Friday so it is too soon to tell how much it will help but I appreciate everyone’s help.

[bittybomb]

I had this. It helped if I used my inhaler 1/2 hour before any strenuous activity. My doctor also put me on singular and Advair, which also helped tremendously on cutting down on attacks.

[awkwardpenguin]

Oct 13, 2024 10:28:32 GMT -5 sagelily said:

Sept 28, 2024 16:23:19 GMT -5 awkwardpenguin said:

I have both mild asthma that is mostly exercise induced, and something called vocal cord dysfunction, which causes your vocal cords to spasm and cause breathing issues (more with inhalation than exhalation) and is often triggered by exercise or emotional stress. I was so discouraged because my inhaler was not controlling my symptoms anymore and it turns out that it was the VCD. Basically the VCD was caused by me trying to overcompensate for the exercise induced asthma. It's almost always a learned pattern of breathing (although it's usually subconscious).

Basically sometime in my early 20s after a lot of failed asthma treatment I was diagnosed with the VCD. You can sometimes see the difference between them on spirometry, but diagnosis took a while because I had both the asthma and the VCD.

I went to speech therapy for the VCD to learn to relax my vocal cords and between that and just knowing that my breathing troubles were caused by VCD I basically recovered fully. I do still need inhaled albuterol before intense exercise during allergy season or if I'm sick, and I have to be extra careful with general anesthesia (another asthma trigger for me) but it's a very minor problem in my life.

Thank you so much mentioning VCD. Based on her breathing test result when we saw an allergy and asthma specialist, they think this is part of her issue so we are getting a referral to a ENT to talk about next steps. I had read about it after your post so I felt better prepared to ask preliminary questions when the doctor raised it.

I’m glad it was helpful and it’s great you have a direction to go in now.