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Breathing Fire

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Joined: 03 Oct 2012
Posts: 12

PostPosted: Mon Aug 19, 2013 10:12 am GMT +0000    Post subject: Breathing Fire Reply with quote

Dear Bike Doc,

Twice I have experienced what can only be described as fire in my lungs. Each was after/during dusty races, Blazzing Saddles and the Waco races this year. My rescue inhaler does little to help, not really wheezing anyways. What concerns me is that I can not take a deep breathe with out incurring an unbearable amount of pain in my lungs. It feels as though I am standing directly over a camp fire and taking huge lung filling breathes of smoke. Is there something I can do short of just not racing when conditions produce a lot of dust?

Thanks a bunch.
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The Bike Doc

Joined: 08 May 2003
Posts: 1398
Location: Corpus Christi and Warda, Texas

PostPosted: Mon Sep 02, 2013 9:51 am GMT +0000    Post subject: Reply with quote


Something that you can do immediately is to wear a NIOSH N95 face mask when racing in dusty conditions. This type of mask can be gotten through hardware and paint stores. You will want the disposable kind with two elastic retention straps to get a good fit. If you have a full beard, you will not get a good fit and you will still inhale dust around the sides of the mask.

Something you should do expeditiously is to visit with an adult Pulmonologist to have an evaluation and pulmonary function tests done to help answer your question. If you require a rescue inhaler before exercise, you likely have asthma. I no longer use the term "exercise induced asthma" as the underlining pathology is airway inflammation in asthma whether or not the asthma symptoms are only exercise induced. Elite athletes who only have intense exercise induced bronchospasms have been shown to have as much airway inflammation as individuals who have severe persistent asthma. That inflammation can be effectively suppressed using inhaled corticosteroids (NCAA, International Olympic Committee and WADA approved use for individuals diagnosed with asthma who compete). The "exercise induced asthma" patient often does not get placed on a long term asthma preventer (controller medication) to suppress the inflammation in the lungs. The irrational for this is the exercise induced asthma patient “only” has asthma when they exercise, which is wrong. Asthma is a chronic inflammatory disease of the airway characterized by airway hyperresponsiveness to various stimuli. Inhaled corticosteroids are the most effective anti-inflammatory medications for this chronic airway inflammation and they do not cause long term systemic steroids side effects like prednisone or steroid injections.

35% of US winter Olympic athletes have asthma which is a reflection of the actual prevalence of the disease in the US adult population. There coaches don’t tell them not to compete when it is cold. Their asthma is controlled and they go for the gold!

Asthma, unfortunately, is underdiagnosed and under managed by most primary care providers. Seek out an evaluation by a Pulmonologist.

A little bit about my background if you do not know.
1. I have asthma and have experienced similar respiratory symptoms you describe before I had optimal asthma control.
2. Maximizing my asthma control with appropriate doses of inhaled corticosteroids combined with long acting bronchodilators dramatically reduced my airway tightness I would experience when I raced.
3. I raced mountain bikes for several years in the Texas and found wearing the face mask protection helped on those dusty back of the pack finishes. Training harder and always finishing first to avoid the dust just wasn’t in my genepool or my time allotments. I work to ride my bike, ride my bike to work but cannot work by riding my bike exclusively.
4. I spent 17 years as a combined Internist (adult medicine doctor) and Pediatrician (children’s doctor) with several years of ER medicine mixed in, before I became a full time Pediatric Pulmonologist for the last 10 years.

Paul K. Nolan, MD
AKA: The Bike Doc
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