asthma

Asthma and marathon swimming – Part 1

This post and the subsequent Part Two post should not be construed as medical advice.

This is another example of how I deal with something related to swimming, in which I have made mistakes and learned and adapted and which may be instructive or useful as advice or warning. Throughout the two articles I will reference my G.P. (M.D.) who has a key part in the discussion.

You know the disclaimer of “seek medical advice” and how it can be annoying? It’s still valid, but at least you have some context here. It is also probable that what I write here, relating to my current stable situation is possible or even likely to change in the future, and that I will have to adapt again.

I have asthma. Like quite a lot of swimmers.

In my case the two are not causally linked, because I developed it as Adult-Onset asthma, during my competitive cycling years. There is a feeling amongst cyclists, at least in Ireland, that those two sports are also linked, possibly due to what seems to be a high rate of chest infections developed by cyclists, which we, regardless of any scientific evidence put down to constant exposure to cold and damp conditions, along with crud and literally crap thrown up off the roads. It’s completely common for cyclists here to cycle wet roads with cow dung spraying up from cars and trucks.

Asthma tends to divide into childhood and adult-onset. Childhood asthma often clears in the late teenage years whereas adult-onset asthma rarely clears. Asthma is a shut-down of the bronchials in the lungs, usually due to mucus, stopping your ability to inhale sufficient oxygen.

It actually took a couple of years to diagnose as asthma, during which time I suffered some really bad asthma attacks. Some attacks early on were so severe I was unable to climb a simple flight of stairs.  I discovered personal triggers in smoking, house dust, some chemicals. Nothing unusual. Other people react to animal hairs (I don’t, luckily given the three doglets and cat), pollen

(And as you can imagine, smoker’s claims they are now being discriminated against hold little validity for me).

Once I was diagnosed, I made a few decisions. I would try to control it via exercise. I would not take the daily steroid Preventer, due to a dislike of the idea of taking daily medication.

I had by them stopped competitive cycling and without racing I lost my interest in the long training hours. Within a year I was no longing cycling, so I took up running, which I also needed to address the damage done to my knees during my cycling years.

I would get a few bad asthma attacks a year, using my reliever and get through them. I would get a chest infection of two, which would clear and an asthma attack would follow.
Asthma attacks are pretty nasty. You never have enough air, you feel like you are slowly drowning, (and as swimmers that is a sensation we all think about, and is not an ideal description), and you would give anything for one clear lungful of air. I used to have to try to sleep sitting up a few nights a year.

As I figured out triggers and reacted more quickly, things improved very gradually. Attacks became more rare and less severe.

By then I was swimming regularly. This whole process was over ten years since the first symptoms, through diagnosis. I didn’t think about a link between swimming and asthma. I was in the sea for months during the summer, mainly the pool during the winter.

In 2009 winter Channel training, I started to get more asthma attacks. They would manifest by a gradual feeling of wanting to clear my throat by coughing. This would usually not occur until a few thousand metres into a session and gradually get worse, until I could no longer swim. The Ventolin reliever had no effect and I used 100 to 200μg. The next day I might be fine or I might get another attack. This continued for about a month on and off and I was really getting worried, I couldn’t predict attacks and they continued to occur.

One thing I realised, about which I could do nothing, was that the previous summer I had swam much more in the pool and less in the sea, not taking my usual extended break from the pool.

I had finally started using the daily steroid Preventer (Becotide, 250μg of beclometasone dipropionate), for the first time ever. There was a slight but not sufficient improvement. By February, I was looking at not being able to train at all or attempt the Channel.

I was visiting my GP regularly.

I was worried about having developed Exercise Induced Asthma, from the constant pool and chlorine exposure, but my GP said this was highly unlikely as Exercise Induced Asthma usually occurred within the first 10 to 15 minutes of exercise. (My GP was very interested and supportive of my swimming by the way).

A typical inhaler, of Serevent (salmeterol)
Image via Wikipedia

After three or four visits, antibiotics and decongestants, we changed the Daily Preventer to Serevent, 25μg salmeterol, which is a beta-agonist like beclometasone, but as I understood it, combined a stronger steroid with a bronchial vaso-dilator, and the salmeterol lasting longer than beclometasone, and used for more chronic asthma It took about two weeks to take effect but it worked. At the same time I started using two puffs standard Ventolin (100μg salbutamol) about an hour before training.

The combined result was a success and normal training resumed. I was still on my training target, because any day that I could train, I made every effort to make up for the missing hours or metres, but it was a very, very tough six-week or so period.

Now that I’m back pool training, I find myself remembering this and trying (and so far regularly failing) to remember to take my reliever (now Salamol, still 100μg of salbutamol but CFC-free) before pool training.  In the next part I’ll write a bit more about the practical effects and control in my training and life.

Part Two.

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