Monthly Archives: December 2013

Running and Asthma

[I hope this is obvious, but just to be a thorough and responsible blogger, I will point out that I am not writing about asthma from any position of medical or scientific authority, so please do not take my word as such. I have been as faithful to facts and science as possible, and if I have made any errors, I welcome corrections. However, as with all things, it is perhaps better to approach my opinions here with a healthy dose of caution and skepticism rather than blind acceptance. As I tell my composition students, I am not infallible, so please question everything, even what I am telling you, and even if you already believe it.]

There seemed to be a good bit of discussion during and after the London Olympics about asthma, athletes, and performance. Alex Hutchinson, a columnist for Runner’s World, has written several articles on the subject. I’m not going to evaluate the relationship between asthma (or taking asthma meds) and performance, because I don’t think I could do a better job than Hutchinson or those far more qualified to discuss matters of pathology and human physiology than I. But I do know a lot about dealing with asthma and sports, as a life-long asthmatic, and a life-long athlete. The strategies I’ve come to rely on to manage my asthma — strategies that allow me to continue running — are supported by these (kind of) recent studies about asthma and exercise-induced bronchoconstriction, which is pretty encouraging.

One of the most important things about asthma and exercise, which Hutchinson points out, is that the traditional idea that people with asthma should avoid physical exercise is not necessarily the best advice:

More generally, a recent article in the British Journal of Medicine reported that “regular, moderate exercise can improve your asthma and also your immune system, which can also help avoid asthma attacks.”

This marks a shift from outdated advice in which asthmatics were warned to avoid exercise – and is probably the most important message to emerge from the flurry of research sparked by fears of performance-enhancing puffers. Sensitive airways may be an occupational hazard for Olympic endurance athletes, but for most of us – even those with asthma – exercise remains a crucial way to keep your lungs and airways working properly.

This idea seems follow other asthma-management philosophies (however unofficial they may be) that don’t rely on complete isolation from potential triggers. My allergies triggered by dogs and cats, including asthma attacks, have always been much less severe when I’ve been regularly in contact with, if not surrounded by, pets. Thankfully, my parents didn’t take my childhood asthma diagnosis as an unalterable decree to banish any animals from our home. As a toddler, I took naps curled up with our family’s Labrador, Winnie. My mom took in a stray cat one very cold winter, a beautiful tortoiseshell we named Marmalade. I helped train our second lab, Oboe, when I was a sixth-grader. Our family also included a rabbit (who I innocently named Woody), and many and various fish, lizards, and frogs. I know that consistent exposure to animals helped to build up tolerance to the allergens they brought, and, while my asthma is genetic, science backs having a dog around to help develop infants’ immune systems and reduce the likelihood of developing allergic responses and diseases like asthma and eczema.

bidda&oboesm

young pup Oboe and sixth-grade me (already growing out of my shin guards)

Similarly, being active helps bolster your immune system and can improve asthma symptoms, rather than just exacerbate them. Just as they didn’t prevent me from being around animals, my parents allowed and encouraged me to play sports (and whatever sports I wanted, except ice hockey, which made me sad because I really wanted to be like The Mighty Ducks). Being active helped (and still helps) my body better “cope” with asthma, strengthening it against too-frequent attacks, and making symptoms less severe when they did arise. Still, I wouldn’t be able to be as active (or be the animal lover that I am) without a steady stockpile of rescue inhalers, allergy pills, and steroid/bronchodilator preventatives.

asthmameds

the rescue squad

I’ve always been of the opinion that far from improving or enhancing my athletic performance, the drugs I take to control and prevent asthma attacks act more as a leveler, allowing me to run, cycle, or ski just like all the non-asthmatics. Environment, weather, and altitude have all tended to affect whether I have an attack or not. Living at altitude, in Boulder during college and later in Tahoe for a winter, proved a significant challenge for my lungs. I experienced frequent asthma symptoms while working as a ski instructor in Tahoe, from a combination of the altitude, cold and dry mountain air, and admittedly, not being in the best aerobic shape. In Boulder, once I got over the altitude-hangover and began to increase my aerobic endurance far beyond what I was capable of in high school, EIB attacks became a common — and seriously annoying — obstacle.

I first experienced exercise-induced bronchoconstriction during my senior year of high school, while playing field hockey. I was in good shape; I was one of the stronger runners, and usually had a lot of playing time per game. I hadn’t had much trouble with asthma for so long that my doctors had even suggested I may “grow out of it.” Because of this, and because I was a stubborn teenager, I didn’t realize or consider that my sudden shortness of breath and chronic tiredness were a result of just plain old not getting enough air. I had assumed that I was breathing hard after running because I wasn’t quite in shape enough, and that I was tired all the time because I was working so hard. When the school nurse had me breathe into a peak flow meter to measure how well my lungs were working, I was shocked at how weak they were. How on earth could I be running around everyday, with lungs that crappy? The immediate effect of this little incident was that I had to sit out a game, which was devastating, of course. (I started bawling in the trainer’s room, which I think seriously scared my coach. Not even her yelling at me as a silly and clueless freshman had ever reduced me to such uncontrollable sobbing, and yet there I was, amidst training tape and ice packs, hyperventilating and thoroughly soaking my uniform with a mixture of tears and snot. Ah, high school, where every moment seems like the absolute most important thing ever of your whole life.)

The more lasting and more significant effect of this episode was my realization that if I wanted to be successful as an athlete, at any level, I would need to pay much closer attention to my body, including the particular pathology of my asthma. I also began to realize that there was a difference, in terms of symptoms, triggers, and consequences, of asthma attacks related to allergic reactions, and asthma attacks related to exercise, though I would not know about EIB until many years later, while perusing medical journal articles on the subject.

Rather than having a full-on, wheezing asthma attack, what I normally experience while running is exercise-induced bronchoconstriction (EIB), which essentially makes me feel like my lungs have suddenly shrunk to half their size, if not disappeared entirely. My breathing becomes very heavy, and very shallow, almost as if I’m hyperventilating. This usually happens if I’m pushing hard at the end of a faster-paced run or race; I’ve finished several 5k’s so short of breath, I’m sure a few fellow runners were wondering what on earth was going on with me. I’ve also experienced EIB during spin classes, especially after an intense, fast-paced “race” interval. Traditional asthma attacks — the wheezing variety — are generally triggered by allergens like dust, pollens, cats, cigarette smoke, or mold. As long as I keep taking my allergy pills and preventative inhaler, though, these attacks are not very common, thankfully.

To avoid EIB attacks while running, I try to always include a decent warm-up of about 20 to 30 minutes, with several high-intensity intervals, before any major run or workout. Some days I measure by time, others by distance, but it will usually be something like five minutes of easy jogging, followed by four to six 30-second intervals at slightly faster than 5k pace with 60-second recoveries, and another five minutes of easy running around 10k pace, leading into whatever workout I have planned. I will usually take a puff or two from my albuterol inhaler just after finishing the last 30-second interval, which seems to deter EIB occurrences during my regular workout more effectively than taking it before I start running altogether.

Medical studies support the idea that this kind of warm-up can effectively prevent EIB episodes during exercise. A 2006 study, published in the International Journal of Sports Medicine, concluded that “repeated high-intensity warm-ups can lessen the bronchoconstrictor response to exercise,” and that “combining the interval warm-up with salbutamol [like Ventolin] prior to exercise resulted in substantial bronchodilation and conferred a greater protective effect against developing EIB than either treatment alone.” Part of the reason for this, according to the authors, is due to the “refractory period,” in which subsequent attacks of EIB after a first occurrence are less intense, usually within a four hour window:

various training schedules and pre-exercise warm-up periods have been proposed to attenuate the bronchoconstrictor response to exercise in asthmatic subjects…if an asthmatic subject repeats an exercise challenge within 4 hours, the resulting EIB will often be considerably less severe than that experienced during the first exercise challenge…some degree of exercise refractoriness exists in almost all subjects with EIB (28 out of 29 subjects).

The authors note that this phenomenon leads to the idea that “some asthmatic athletes can ‘run through’ their asthma.” While I would love to appear so superhuman, the way someone like me can get their body to do this is a bit more of the earth. Essentially, what this study and others like it are saying is that if you create a warm-up that will trigger a bronchoconstrictor-response, your lungs will (more likely) be primed against an episode of EIB during your main workout or race.

The present study has shown that asthmatic athletes can use a bronchoconstriction-triggering warm-up prior to training and/or competition as an effective prophylaxis for EIB…[and] employing a high-intensity warm-up could lead to less reliance on the need for pharmacological medication before exercise.

Personally, I find all the science behind this fascinating (it wasn’t based on a completely misguided notion that I was a pre-med biology major for two years of college). But if all this makes your head swim, Hutchinson explains a warm-up strategy with less of the science-geek stuff. Also, bear in mind the importance of discussing these strategies with your doctor, and/or doing a bit of research and reading on the subject yourself; what works for me may not necessarily work for you.

Mickleborough, T.D. et al. “Comparative Effects of a High-Intensity Interval Warm-Up and Salbutamol on the Bronchoconstrictor Response to Exercise in Asthmatic Athletes.” Int J Sports Med 2007; 28: 456-462. <http://www.ncbi.nlm.nih.gov/pubmed/17111314>

Finn’s Peanut Butter and Sweet Potato Cookies (for good dogs)

sand

There are many things in my life for which I give thanks, but this little guy is something special. Finn was abandoned in rural Arkansas, along with his mom and litter mates, when he was only a few weeks old. Just a few months later, he had become a true Rhode Island dog, discovering the joys of rolling around in washed-up seaweed, the satisfaction of a hard day spent attacking garden hoses, and the benefits of hanging out around the grill when salmon is on the menu. He isn’t the bravest of lions: thunder, fireworks, garbage trucks, balloons, computer power cords, and men with large beards are all good reasons to hide under the bed. He’s really more of a Boo Radley than a Huckleberry Finn, but what he lacks in courage he makes up for many times over in sweetness, silliness, and a sometimes exasperating degree of cleverness.

If you’re lucky enough to be some dog’s special human, you probably know what I’m talking about. We dog people could go on forever about our slobbery companions; I am not ashamed to admit that I have way more photos of Finn that I do of myself (he is much more photogenic). But this post isn’t just about me gushing over what an awesome dog I have (he is awesome though). This is about thanking Finn, and all the other pups of this world, for being the best carbon-based life forms ever. Whatever we human beings manage to achieve during our existence on this planet of ours, we will never be as awesome as dogs are. We’re so lucky they like hanging out with us so much.

(This is also, admittedly, a bit of an apology on my part, for not bringing home any Thanksgiving turkey leftovers for this poor dog. Alas, there were none left to take; graduate students had pilfered it all already.)

When you’re being thankful for all the good things in your life — family, friends, not being run over by holiday shoppers on various missions to conquer Black Friday like it’s the elusive superboss of Consumerism: The Game — don’t forget about the pup! Bake your little scoundrel some of these treats, and they’ll probably forgive you for spending all of Saturday in line at Target instead of spelunking through the neighborhood’s leaf piles with them.

Finn’s Peanut Butter and Sweet Potato Cookies

(Though I’ve changed it substantially, the original recipe for these treats is from Yvette Van Boven’s Home Made, a fantastic cookbook that everyone should have. There is a section dedicated to planning the ultimate hangover meal. What more could you want?)

cookbooks

Van Boven’s very well organized book; my not so organized notes.

Finn has never done too well with foods and treats filled with grain, which most conventional dog foods use. He is just such a sensitive kid. Luckily, it’s pretty easy to find alternatives to wheat flour and other grain-based ingredients that are typically used in most dog treat recipes. I substituted the whole-wheat flour with potato flour (Bob’s Red Mill makes a good one, available in most health food stores) and the cornstarch with potato starch. If your dog doesn’t have a problem digesting grain, then go ahead and use regular flour and cornstarch. Sweet potatoes take the place of chicken in my version, since I don’t ever buy or cook it. I also used unrefined, virgin coconut oil instead of butter. Coconut oil, when unrefined, has a lot of good stuff in it for humans and dogs alike. I put a tablespoon in Finn’s food at night to help with his itchy, dandruffy skin, and apply it directly to his paw pads when all the hot pavement and salt water starts cracking and irritating his sensitive little feet (the poor guy had mange when his was little, and it was the most persistent on his paws).

doughball

The Ingredients:

1 Tbsp. virgin, unrefined coconut oil

1/3 cup salt-free chicken stock (homemade is best; avoid onions and don’t add any salt. Plain old water could also work here.)

1 medium sweet potato, peeled and chopped.

2 Tbsp. creamy peanut butter (no salt, no sugar added)

2/3 cup potato flour

1/3 cup potato starch

Preheat oven to 340 degrees F. Grind the sweet potatoes in a food processor with the coconut oil and chicken stock or water until mostly smooth (minimal chunks). Add the peanut butter and mix a bit more, then transfer into a mixing bowl. Add the potato flour and potato starch, and mix the dough with a wooden spoon until it is Play-Doh like in texture. Form dough into a big ball, dust a clean and dry counter with some flour, and roll out the dough until it is about a centimeter thick. Cut dough into fanciful, outlandish, or completely customary shapes, as your heart desires. Channel your inner child who always liked clay best out of all art class activities. If you feel like it, taste test the dough to make sure it’s “safe.”

finncookies

done

I highly recommend lining a baking sheet with some parchment paper. It keeps the treats from sticking without using butter or sprays, and makes cleanup a lot easier, especially if you are dishwasher-less, like me. Bake for 20 minutes, then check to see how the treats are doing. I ended up leaving mine in another 10 minutes; they should be a golden-brown when they are about done. Allow them to cool before tossing one to your impatient and drooling friend, and store in an airtight container.

thegent

creative inspiration and credit goes entirely to Van Boven and Verschuren’s photography work for this one.

Since this batch did have chicken stock in it, I have no idea what they taste like, but Finn immediately brought his first cookie over to his bagel bed, dug out a safe hole in the bedding, circled around two or three times, and then devoured it. So that’s a good sign.