Wednesday, 15 September 2010

Difficult to breathe while training? Could it be EIB?

Yes, I'm an asthmatic guy since I was born. In my childhood I've had some pretty bad moments but with a 3h train everyday in the competitive class at the swimming pool, my asthma almost disappeared during my teenage years.

2 years ago (the 1st moment I can recall is the National Long Distance Championships in 2009) I started to have a strange feeling while running at high intensity. I had the distressing and anxious feeling that the air couldn't reach my lungs, something completely different from the asthma that I could recall.

Since January 2010 it got pretty intensive. I've talked with my Immunoalergologist and she told me that "it wasn't anything special" (after all, I could run anyway and she had tougher cases to solve than me). Moreover, my lungs started to burn after track sessions... and in the second half of the season, even if I did 13 training sessions a week, I worsened (a lot) all my track and race times. I was desperate!

Last friday it was supposed to be my 1st track session of the season: 4x1000. I started well but, suddenly, after the 1st serie I had to quit and rest in a bench and it got really difficult to breathe. I thought that this couldn't be normal and immersed myself in abstracts and books...

... and found this:

Exercise-induced bronchospasm (EIB) is an often-undiagnosed but common problem affecting both recreational and elite athletes. Although Exercise can trigger exacerbation of chronic asthma, EIB should not be confused with the chronic inflammatory disease. While in the past, athletes were forced out of competition because of exercise-induced bronchospasm, today they can frequently get back in the stride with their peers.

EIB is defined as the transient constriction of the airways as a consequence of vigorous exertion. It occurs in about 12% to 15% of the US general population. Of patients with chronic asthma, 70% to 90% have an exercise component to their disease. As many as 40% of patients with allergic rhinitis also have EIB. However, between 5% and 10% of patients with EIB have no concomitant respiratory or allergic disease.

Olympians have been studied to quantify the incidence of EIB among elite athletes. About 11% of US Olympians who participated in the 1984 Olympic Summer Games met the criteria for EIB.These athletes won 41 medals, a testament to EIB's prevalent but controllable nature. Of the US Olympians who participated in the 1998 Olympic Winter Games, 17% admitted the need for medication for their exercise-induced symptoms.The incidence of EIB in a recent study involving US Army recruits6 was about 7%, but it had no effect on physical performance during basic training.

Clinical Symptoms
EIB presents in various ways, and patients report both obvious and vague complaints.
Symptoms during or following exercise include the following :
Chest tightness or pain
Cough
Shortness of breath
Wheezing
Underperformance or poor performance on the field of play
Fatigue
Prolonged recovery time

Symptom onset usually occurs 5 to 10 minutes after the start of exercise but may take longer in a conditioned athlete. Chest pain rarely indicates cardiac disease in children. In a study by Wiens and colleagues,16 up to 72% of children with chest pain met the criteria for EIB. Adults present with wheezing and dyspnea more often than do children. A patient's inability to keep up with his or her peers is an important detail in history taking in pediatric and adolescent athletes. (...)
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Yesterday I've started a new anti-inflammatory medication (not doping) and I can't remember ever breathing so well. I'm really enthusiastic with this and can't wait for testing myself again (and check if it was a placebo).

...and can't understand why Salbutamol (the classic asthmatic inhaler) is still prohibited by WADA:

There appears to be no justification to prohibit inhaled beta(2)-agonists from the point of view of the ergogenic effects.
Do inhaled beta(2)-agonists have an ergogenic potential in non-asthmatic competitive athletes?
Kindermann W. Institute of Sports and Preventive Medicine, University of Saarland, Saarbrücken, Germany

We concluded that no ergogenic effects were attributable to salbutamol, which should therefore remain a legitimate drug for the management of athletes with asthma participating in international sporting events.
Is Salbutamol Ergogenic?: the Effects of Salbutamol on Physical Performance in High-Performance Nonasthmatic Athletes

Inhaled salbutamol, even in a high dose, did not have a significant effect on endurance performance in non-asthmatic athletes
Effects of inhaled salbutamol in exercising non-asthmatic athletes.
Goubault C, Perault MC, Leleu E, Bouquet S, Legros P, Vandel B, Denjean A.

In conclusion, inhaled formoterol did not improve endurance performance compared to placebo.
Can asthma treatment in sports be doping? The effect of the rapid onset, long-acting inhaled beta2-agonist formoterol upon endurance performance in healthy well-trained athletes.
Carlsen KH, Hem E, Stensrud T, Held T, Herland K, Mowinckel P.

1 comment:

september said...

Olá Miguel! Por acaso já tinha lido algumas coisas sobre o broncospasmo induzido pelo esforço e nunca tinha associado ao que dizias que te acontecia em alguns treinos. fantástico! (o mecanismo e a terapeutica!! ;) beijinho e bons treinos