AUK - Light at the end of the tunnel!! Thank you

Just spoke with the AUK nurses, they suggested that my leg cramps on a night could be down to the LABA in Seretide. And my 'loss of power' and 'lack of air in lungs' after about 15mins of running, could be another asthma symptom. So along with the fact the Fostair has made my symptoms so much worse, I'm back off to the nurse next week.

The AUK nurse suggested

(A) separating the steroid and LABA, then reducing the LABA portion to reduce the cramps, but increasing the steroid to regain control even when exercising.

(B)Or trying without LABA.

(C)as A but try slightly less steroid and adding Intal for the EIA

Anyone have any experience of doing any of the above? Any other suggestions?

I know I keep going on but I dont want to stop running, but the GP seems not to care that I can't do it without breathing problems. As the AUK nurse said, your asthma should be controlled to a level where you carry on with normal activities without symptoms, if this includes running, you should have enough control to do it. OK, some people can't get enough control to do this, but there's more avenues to investigate for me yet!! Just frustrating that up until ~6 months ago even my EIA was controlled on the Seretide ;-(

10 Replies

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  • Have I misunderstood or can you really, actually, run for 15 mins? That's amazing! I don't think your GP doesn't care, he just probably hasn't come across many asthmatics who can do that. You must have great control, well done x

  • Maybe your GP was having a bad day.

    Dont give up though - if you want to run, make them listen so you can. Im an athlete and I know how frustrating it is when I cant do things if my asthma is playing up due to whatever triggers going on.

    PM if you ever wanna rant

    Take care xx

  • Polly - Yes I can run for 15 minutes, before, when I was under control I could run for an hour tho with no problems at the end of it, so its frustrating. Typical symptoms of EIA don't appear until 10-15 minutes of activity tho, and sometime after activity has stopped, so the fact I'm struggling suggests I don't have control. And running with asthma is commonly possible, Paula Radcliffe is a sufferer.

    Little.sporty.julie - The GP probably does care to be fair, just every time I see him I seem to go on about not being able to run and he can never suggest anything that could help and brushes over the fact. Other than this I actually find him really helpful!! Guess as you say, its just me getting frustrated! And I probably will take you up on the offer of PMing you for a rant, it'll be nice to chat with someone who has similar experiences/frustrations

  • I was on intal when younger as was one of the few of the few permited asthma drugs allowed in competitive swimming in order to pass frequent drugs testing done during competitions. To be honest did not really control the asthma when in the pool...

  • Hey hey!

    I would go for the 1st option of separating the steroid and LABA, then you can try lowering the LABA, till you stop getting cramp. Has your GP ever suggested trying quinine tablets for the cramp? taking these for a couple of weeks may stop the cramp reoccurring.

    Don't give up on the running, it's so good for us and defiantly will be helping your lung function and general health and in turn asthma. Polly -I have difficult asthma and I still run/swim whenever I can as their are so many benefits for it. As a medical student we get lectured and lectured on the importance of a good health style, especially for those with chronic conditions, so September your GP should be taking note!

    September, do you have another GP in the practice that has more of an interest in sport? It might be a good idea to go and see him/her instead to see if he/she can provide you with more advice?

    Ally

  • Hi September,

    There's also a plan D - trying Singulair (montelukast) which sometimes works well for EIA. It's possible to develop some degree of tolerance to LABAs (* see link below) and this could be one reason why Seretide isn't so effective now.

    As Ally suggests Plan A seems to be the sensible one to try first. If the asthma was better controlled on Seretide 250, perhaps match the steroid strength in that inhaler and try reducing the LABA. 1000 mcg/day of flucticasone is quite a high dose though, so your asthma nurse might be reluctant to increase the steroid further if you're otherwise well controlled.

    Then if that doesn't provide enough control, try adding Singulair or Intal.

    I use Intal and it can work to prevent EIA including the ""second dip"" that happens after several hours. There are two ways to take it:

    (i) Pre-exercise only

    Take usual amount of reliever and 2-4 puffs of Intal 10-15 minutes before exercise.

    nationalasthma.org.au/conte...

    (ii) As a regular preventer

    This involves taking it up to 4 times a day and before exercise if needed, so it might be sensible to see if pre-exercise only works first.

    A slow warm up routine before exercise can also help, as can wearing a buff when running in cold weather. One interesting thing about exercise induced asthma is that some people have a refractory period after the initial symptoms have subsided and during this period it's possible to exercise (for roughly an hour) without experiencing further symptoms. I think this might be the reason why a slow warm up helps. The warm up isn't intense enough to provoke full blown EIA but a mild dip might be followed by a refractory period when you can exercise properly.

    Hope that helps,

    Ginny

    * Page 50, BTS Guideline on the Management of Asthma 2011

    brit-thoracic.org.uk/guidel...

    4.7.2 Exercise Induced Asthma

    ... ""Long-acting β2 agonists and leukotriene antagonists provide more prolonged protection than short-acting β2 agonists, but a degree of tolerance develops with LABA particularly with respect to duration of action. No tolerance has been demonstrated with leukotriene receptor antagonists.

  • Ginny - Thanks for your advice and suggestions.

    I am already on Singulair but thanks for the suggestion, its what eventually brought me under control last year - until everything went haywire this year!

    I think plan A is making most sense, that way I can play about (with GP's help of course) with different combinations and find a happy level of each component. Then of course I can try Intal if no luck with the EIA

    In terms of warm up, we always do a 5-10 min warm up inside before a run and as daft as I look, I always run with a buff in cold weather!!

  • Hey ally18 - Thank you for your reply to my post. GP just suggested putting up with leg cramps or trying Fostair, wouldn't even check my bloods!! But I could ask him to try quinine - I've found sometimes you need to go in and suggest things to them sometimes!!

    I'm glad its not just me who thinks its good to keep running!! We're constantly reminded we should be fit & eat healthily so GP's should be helping. I have lost 2 stone in weight this year - I have no intention of putting it back on because I stopped running!!

    Yes there are other GP's in the practise but I think this one is the best, the GP who specializes in asthma is so rude, he answers his phone while you're talking to him and all sorts! There is one lady doctor who I haven't seen though so perhaps its worth trying to get in with her. I also have an appt with the asthma nurse next week to discuss different options with her.

  • run while only breathing through your nose

    Hi September,

    If you slow down your run so that you can manage to maintain nasal breathing throughout then you will avoid much of your EIA problems. Although this seems to slow you too much at the start, it is vital to start at that point and build up just like any other resistance training.

    As mentioned by others, a warm up is vital as when you breathe excessively (lungs have just realised that you are increasing your effort levels) your lungs can go into spasm and restrict your breathing.

    By nasal breathing you will also reduce the reliance on a buff as your nose can warm air from 6degrees to 37 degrees prior to entry into the lungs (also adds moisture and filters air).

    Over the longer term,by switching to correct breathing (always through the nose, in and out) and at teh correct volume you can retrain your breathing to a new normal.

    While not a runner, i do regular exercise and will do my first triathlon this weekend very much as a beginner. In my cycles and my few runs to date i can see the large difference between my breathing and others who mouth breathe, and the effect on lactic acid and recovery (i work aerobically for longer thus less lactic acid). Swimming i do mouth breathe and am aware of the ease of overbreathing through the mouth.

    By regulating your own breathing, you will suffer less cramps ( i used to cramp almost every night to the extent that i couldnt sleep in a bed with a footboard...that changed completely when i retrained my breathing - no more leg cramps (had also been on seretide but has cramps pre-seretide too).

    The logic behind it is that your body, muscles and cells are better oxygenated with correct breathing through the Bohr effect where haemoglobin is stickier with reduced CO2 levels - when you breathe at a more optimal volume the O2 passes more easily into your cells/muscles from your blood - less lactic build up in the first place and then oxygenated again afterwards more easily.

    I learned buteyko from an instructor and believe that it is vital to learn from a practitioner/instructor to ensure that you do the exercises correctly and have support through the process. Some exercises are also not suitable to all asthmatics. Although the exercises are relatively straightforward, they are also very easy to do incorrectly and make your breathing worse rather than better.

    best regards

    Buteyko'd

  • one thing that springs to mind and one that we're all told, but it's really not needed is to take ventolin before exercise, this is false economy and you're teaching your body that it need this to exercise. Wonder if you've been doing that. The trouble is you get resistant to it and also serevent component of seretide no longer works. It's going to take a while to get back, but do the nasal breathing to readjust your body that you don't need so much oxygen, infact you need more CO2 as it's a natural muscle relaxant. in the short term, try intal or atrovent, but upping the steroids to over 1000mg a day really isn't likely to be of any benefit, you reach a point where the higher doses have less and less of and improvement and you've reached that.

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