Exercise Induced Bronchoconstriction (EIB)

Coach Chad talks about this issue here:

I’m wondering if anyone else has experience with this, and additional tips on dealing with it. Thanks!

where is the time index?

1:01:00 :+1:

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I had this very bad last winter. I did a 3 hour fat bike race in Canmore AB in -35. About 10 days to recover from it.

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Thanks Bryce - thought my link jumped right to the topic.

Haven’t listened to this one yet – or I don’t recall listening to it…I thought I had covered them all! :wink:

With that being said, I struggled with this up until the last couple years – riding for long durations (2+ hours) in cool/dry air seemed to trigger it. While I would feel it the last part of the ride, it didn’t really get bad until I stopped riding all together when a nasty, persistent cough that was tough to shake. One time it was so bad that I started coughing up bits of blood. Sometimes my lungs felt sore the next day.

I never really got it treated – although I spoke to my doctor about it, and he was confused by something that only affected me after 2+ hours of strenuous exercise. I had a precautionary chest x-ray because of it (as he said to me, “Anyone who comes in here and has coughed up blood gets a chest x-ray…”)

I did, however, stop riding more than 90 minutes outdoors when the temperature was below 50F. Using first Zwift and then TrainerRoad kinda eliminated the need for me to be outdoors to train in cold weather.

Here is an article to check out: https://acaai.org/asthma/types-asthma/exercise-induced-bronchoconstriction-eib

It really depends on how bad your case is. Mine wasn’t that bad…although it was alarming when it occurred.

Good luck.

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I developed EIB a few years while commuting to work during the winter. Once onset, I would have it for months and could at times be almost debilitating (not being able to climb a flight of stairs).

It’s the cold (<5C) and humidity which sets it off. Last year it was a really foggy day in October which led to months of grief. It probably developed because I used to really hammer my commutes, basically red light to red light all-out sprints all the way.

After years of the Dr. repeatedly saying it’s seasonal asthma – even after I went for an asthma test which came back negative (I actually got better numbers as the test progressed!) – I decided to really look into it. That’s when I came across EIB.

The reason Dr. adamantly diagnosed it as asthmas (and subsequently prescribed asthma inhalers, which were useless except for the side-effects), is because EIA and EIB have the same triggers and the same symptoms and thus are lumped together as the same thing by the medical community. They are treated as being the same, yet the underlying condition which is triggered is different in each case, which is why asthma meds don’t work in treating EIB.

Research is still light concerning EIB, but I read that one symptom of EIB is that is really ramps up the production of histamines in the body. So I thought I’d give anti-histamines a try. I started taking regular allergy meds once a day (10mg I think) and supplementing that with a straight anti-histamine (25mg) before more intense workouts (Threshold and above). It seems to be doing the trick.

I have also stopped sprinting my way to work on the commutes, as well as wearing a mouth covering at all times during the winter months = lower intensity and warmer air.

Good luck!! :+1:

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Was out on my TT bike dialing in my fit and I thought it was warm - 55 or so and I forgot my knee warmers and just my jacket. Anyway, I got a cold from that and then it lasted forever. Couldn’t breathe at night, coughing all through the night. Was diagnosed with that, then switched to asthma.
Basically if i’s going to be cold, I layer up more than I think I should. Can always shed. Covering the ears and a neck warmer. It happened again just before my A race and that sucked. Anytime I get a cold or sick, my lungs can’t stay healthy. I’ve been on prednisone in the past.
Now I have my rescue inhaler I use before anything hard and I have a my daily inhaler. But that’s getting expensive, but I use it 3-5 days a week in the morning.

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It’s my teen son that is suffering from this. We have had him in for asthma testing, and for about a year thought that it was asthma. Like you, better testing (and a better Dr.) came back that it was not asthma. Which made scenes as the inhaler and the allergy meds were not helping. He does the mouth cover, this helps. What really gets him is the short warm-up and then jumping right into high intensity efforts. Air temp doesn’t make a huge difference. He ended up in an ambulance last summer 10 min after a race start in 80 degree weather. Were going to try extending and lowering the intensity of his warm-ups (tough for a kid). When his EIB kicks in, its completely debilitating. The only thing he can do is sit and breath thru it.

What ant-histamine are you using?
Thanks Captain!

I take Reactine Extra Strength (Cetirizibe Hydrochloride 10mg) 1/day — not sure if brand is avail in the US. This type of AH is non-drowsy (does not work on the brain)

For higher intensity workouts I take one generic brand 25mg Diphenhydramine Hydrochloride. This type of AH can cause drowsiness because it does work on the brain; however it doesn’t really seem to affect me, esp during workouts.

I have not explored food related histamine issues but that might be worth something if you aren’t into popping pills every day (I’m not but it’s better than not breathing!).

And yes, I do extra time for warm-ups as well. Maybe 10min or so before hitting the ‘Load Workout’ button, and then doing that warm-up too.

As for triggers, I think mine is almost all humidity, the cold just amplifies the issue. I’ve been to Hawaii and within hours of stepping off the plane I was flat on my back in bed struggling for air. So scary. Took a good 24-hours to calm things down. Even walking into a poorly ventilated house that someone has been cooking in can affect the condition, but not severely.

I’ll try to dig up the research papers I’ve read on the topic, if you think those would be of any help.

:+1:

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Yes, I’ve experienced mild EIB for the last few years. Like others I find it strongly correlated to colder and drier air. Typically hits me gradually after around 90 mins of tempo+ riding, and symptoms are tightness in upper chest, and dry coughing, especially if I deliberately try to breathe really deeply.
It settles down after 20 mins or so rest (great reason for a cafe stop), and after a long ride (5 hrs+) the cough can last a day or so.
I try to avoid it by inhaling through the nose as much as is practically possible (which is often not much!) and keeping hydrated, but have not found a complete solution. My doctor is not concerned, and since it’s mostly seasonal and not severe, I can live with it. BTW, I’m 59 and ride for fitness & pleasure, not racing :grinning:

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I have both of those AH’s - I think we’ll try the Cetirizibe if the extra 10 min warm-up does not help. thx!

I’m a little riddled on the timing of when EIB symptoms start. Most of what I’m reading is the constriction starts up fairly deep into a ride, maybe hours. And recovery can take days. For my kid - his starts up right away, 10-15 min into a ride. He’ll recover in about 30-60 min. This makes me wonder if indeed EIB is what he’s dealing with.

If the starting intensity is high enough I think symptoms will start right away. Like mine did when I used to sprint/commute to work. The recovery time sounds similar to what I’ve read in med pubs (which I will look for!). Is his recovery time once activity has stopped? These things can be really tricky to figure out and very frustrating in the mean time!

Recovery time depends on how bad the constriction was. If he’s going moderately hard and feels the symptoms coming on, he can back off and recover while still riding (maybe 5-10 min recovery). If its a bad reaction, he needs to completely stop riding, recovery time will be 30-60 min. The worst reaction he had took about 2 hours of recovery, but he felt “off” for a couple days. Yeah - this is completely frustrating…

I got an inhaler for it. I’ve had it my whole life while competing in running races without knowing. It’s been rather life changing for cycling workouts and works wonders for me on hard efforts.

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What’s the substance in the inhaler?

Ventolin HFA, an albuterol formulation for EIB. https://www.ventolin.com/

I have had EIB without knowing it since I was a teen though at anything above moderate intensity. In races, teammates knew when I was coming because they could hear my coughing. It was like breathing through one of this stupid oxygen restricting masks.

The first time I tried the inhaler before a hard workout, when the intensity got up there, I started hyperventilating because I was used to having to work so hard to inhale and exhale and now my breath was just rushing in and out. I adapted quickly. But my oxygen was so restricting my performance, I didn’t realize it. I ran 5ish minute miles as a teen barely able to breathe compared to now. I used to be confused by TR talking about lactic acid buildup and burning in your legs, because I never got that. I’d always run out of air first, body parts would tingle from lack of oxygen but no lactic acid burn. Now I’m having to learn how to adapt to the discomfort of lactic acid buildup, which compared to not being able to take in adequate levels of oxygen is a minor discomfort but it’s one I’m not used to so even though it doesn’t hurt that badly my brain is throwing out “OMG WE ARE DYING!” signals from stimulus I haven’t experienced before.

After retraining with it for a year, I’m finally able to get my heart rate near max again. I can’t do FTP comparisons as my old trainer probably read 50+ watts high so I appear less fit now but I can tell I’m significantly stronger regardless. Kind of wondering what my limits are now that I can actually breathe.

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My son was on Albuterol - I can’t say for sure what kind but it was a form of Ventolin. We took him off it and all asthma meds after he passed a methacholine test.

Interesting side note, about 10 years ago when I was first getting into running/biking a had 2 fairly serious allergic reactions after runs (hives, swollen face etc). I was diagnosed with “exercise induced anaphylactic shock”. Had a to carry an epi pen when running/biking. Could there be some hereditary thing I gave to him?

The mainstay of treatment remains the use of short-acting β-adrenergic agonists [=Ventolin].

Warm-up routines consisting of submaximal work loads and sprints reduce the symptoms or EIB for subsequent exercise.6Short bursts of vigorous exercise (wind sprints) may extinguish EIB and induce short-term resistance to EIB, particularly if EIB is due to an endogenous release of prostaglandins.10,22

Warming and humidifying of the air may help decrease the symptoms of EIB.

Masks and nasal breathing have been found to be helpful but are not always obtainable.

Avoiding exposure to cold, pollutants, and irritants can be helpful in some circumstances, but environmental conditions are often dictated by the sport.

Diet may also influence the symptoms of EIB.

Low-salt diets and those high in antioxidants and fish oils may decrease the frequency and severity of symptoms.15

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