Running With Asthma

Funny that it took me this long to write a blog post on this topic -- I think that's what happens when you get so used to something.

I was diagnosed with asthma when I was eighteen months old. From what I am told this whole period was an absolutely terrifying time for my parents. In addition to having extremely scary large-scale attacks a few times a year that lasted for days, I also grew up having exercise-induced attacks. It didn't happen all the time, but sometimes a single lap around the schoolyard was all it took before I was gasping for breathe and fighting to stay upright.

Pretty early-on I was put on an albuterol rescue inhaler plus any number of preventatives (there must have been dozens), but in spite of all of this, I still continued having attacks, both exercise- and mystery-induced, four or five times a day (and night) for somewhere in the neighborhood of fifteen years.

You can imagine how this complicates things for a runner / gymnast / equestrian.

I basically grew up clutching my inhaler the way other kids clutched a favorite toy. My inhaler was my safety object, quite literally. I carried it with me everywhere I went. I kept one by my bed, one in my locker, one in my backpack, one in the school office, and any number of backups in our kitchen cabinet at home. Realizing I had somehow left home without it or didn't know where it was could send me into utter panic. I ran all my track workouts and races holding it in my hand, knowing that as soon as I was across the finish I would need it desperately. (Forget running more than two miles at a time; I wouldn't be able to breathe long enough to finish.) Twice I was hospitalized for week.

Once when I was sixteen and at the doctor for something different, he asked about my asthma and was horrified to hear how much albuterol I was taking.

(Me, totally deadpan: "What?"
Doctor, bug-eyed: "I'm not actually sure why you haven't had a stroke yet.")

So he put me on a new medicine, which changed my life. Suddenly I could go weeks without needing my inhaler, with the exception of running, where I still needed it pretty much every workout. On the plus side, I stopped waking up in the middle of the night unable to breathe and didn't have a panic attack if I realized I'd left home without it. This was all AWESOME.

But I still really wanted to run longer distances. And two miles was still about the farthest I could go before I was gasping for air.

When I went to college, I discovered swimming. I'd never been much of a swimmer before (that is, I could probably avoid drowning in most situations, but I didn't really know how to properly swim). I was really curious to see how swimming affected my asthma, and interestingly, it didn't affect it at all. I could swim 200 repeats for half an hour, and even though I was breathing hard, I never had an attack.

It occurred to me to wonder if this could have something to do with my breathing -- how, when you swim, your breathing is pretty much regulated for you. Short of swimming faster or slower, you can't really change how fast you breathe. Not long after, I started trying something similar with running. For the first time, I started paying close attention to my breathing, and on slower, easier run, I tried to breathe in for six steps and out for six steps. It wasn't easy to learn to do, but for the first time in my life, I found that I was able to run more than just a couple of miles without an asthma attack.

To this day, I am still incredibly mindful of my breathing when I'm running. I don't have regular attacks anymore, I don't have to take a billion preventatives, and think nothing of leaving my inhaler at home fairly often. Most of the time I do use my albuterol 5-10 minutes before a run, which is supposed to prevent acute attacks, and seems to most of the time. Very occasionally, though, I do still have small ones while I'm out running. I've learned that running too hard or too fast, too soon without a proper warm-up will sometimes do it, or sometimes larger differences in air temperature inside and outside.

While this isn't super-fun, I've also figured out how to run through attacks. It's not pretty and usually means breathing as slowly and deeply as I can, cutting my effort back and still running a pace about a minute slower than that effort level would normally result in, not to mention fighting tension in my shoulders and arms and upper body. Not a ton of fun (it happened this morning), but at least I know I'll make it home and won't need to call an ambulance because of it.

When people ask me for advice about running with asthma, here is what I tell them:

• Don't let anyone tell you you can't run with asthma until you've tried every single, solitary option open to you (for very broad definitions of "every," "option," and "open").
  
• See your doctor and be very clear and specific about what you can do now and what you want to be able to do. There are a billion possible combinations of preventative and rescue medications out there and it's unlikely that none of them will help you. If you feel like your doctor isn't giving you many options or is being a Debbie Downer about it, see a different doctor, potentially a sports medicine doctor who specializes in (or at least has experience with) respiratory conditions in athletes.
  
• Once you're on a treatment plan, be fanatical about sticking to it. There's no reason to expect it to help you if you can't commit to taking & doing everything on time, getting any prescriptions refilled on time, etc. If you don't think you can stick to the plan your doctor is suggesting, speak up.
  
• When you run, make sure you give your body at least half a mile to a mile of really easy jogging to warm up. For me, I think that this is also important because it means I breathe pretty slowly for the first 5-10 minutes I'm outside, which gives my respiratory system time to acclimate to the air temperature and anything else that's weird about it (humidity, dust, pollen, etc.).
  
• Try to breathe in through your nose while you're warming up, and as you run faster, try to avoid breathing in ONLY through your mouth. Because the passage from your nose to your lungs is longer than that from your mouth to your lungs, breathing in through your nose gives the air time to warm up to your body temperature, which is less likely to irritate respiratory tissue and cause an attack.
  
• Even when you run fast, breathe as slowly and deeply as you can (of course, 'slow' and 'deep' are relative, depending on your pace). Try to stick to breathing in a specific rhythm if possible (four steps in / four steps out / whatever). I do this even when I'm racing. In the last half mile or so of a fast race I may be less great about it, but I still do it as much as I can -- it's pretty much automatic for me now.
  
• Try to breathe low in your body -- feel your stomach area expanding, while your chest and shoulders remain still. This is something all runners should should practice, but it's especially important for those of us with EIA.
  

So yeah. Those are my tips for running with asthma. Properly controlled, it can be just one in another long list of potential minor challenges you face as a runner, right up there with chafing and early alarms. Hope it's helpful. :)