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peak flow meter

Asthma and marathon swimming – Part 2

Part 1.

Continuing on from the previous article on the subject, I’ve made a point now of completely abandoning the pool during the summer, allowing my lungs a break from chlorine. I have to try to remember this as it would be easy for me to go back to the pool especially if I want to do some speed work before a race. (I can’t seem to do much speed work in open water by myself). During the summer, without discussing it with my GP, I also stop using the Serevent Asthma Preventer, as I continue to be concerned with long-term use of a by now more powerful beta-agonist.

This is a personal decision, I’m certainly not advocating it.

Before I continue on this a brief digression into asthma and chlorine is warranted: Chlorine in pools is not in itself the problem. Chlorine interacts with organic compounds (such as urine, sweat, shampoo, soap, perfume, deodorants) to form tri-halo-methane gas. This is an odourless, colourless heavy gas, which can inhibit  or damage respiratory function and sits on the surface of the water and may be the cause of increased asthma amongst swimmers, and those who swim the most, children and elite swimmers, are those most affected. It why you should ALWAYS shower before swimming, and so should everyone else, and why pools make note of this important point.

I also, like most asthmatics, make a point of having access to a Ventolin or Salamol Reliever pretty quickly. This means there is always an Inhaler in my car, one in my swimming box, one in my pool swimming kit-bag, and two in the Loneswimmer Castle, one downstairs, and upstairs in the South Tower. Contrary to what you see on TV, using an asthma inhaler doesn’t lead to instant relief.  And I also rarely have to rely on any of these.

Next in my process is having a Peak Flow metre. When I remember to do so, I use one like the one on the left here.

You’ll notice that one has coloured bands. A peak flow meter measures the person’s ability to inhale (through measuring quick exhalation). A reading from 50 to 250 litres per min, under the red line, is dangerous. 300 to 600 is amber, and above 600 is normal.

All one does is exhale quickly and hard three times, and look at the maximum of the three for the reading. Since everybody’s aerobic capacity drops at night, one does this in the morning. If one use a peak flow meter daily, as is recommended, one charts one’s daily morning reading on a simple one page chart. You agree with your General Practitioner the reading which is the trigger for concern and a possible Doctor’s visit. I don’t want anything to mistakenly think this is something you can pick up from me, so I won’t tell you what my trigger is, except that if it occurs three days in row, I should visit my GP.

Here’s the interesting thing for most of you:

As a distance swimmer, who trains regularly and hard, my usual reading is 600 litres per minute or just under.

I am on the border between below average and the very low-end of normal. I just took it now, for this article, a couple of weeks after returning to pool training, and I measured 550 l/min. At my best, I will dip into the very low-end of normal. I put that to you as a positive if you are an asthma sufferer. If I can do it…so can you.

Now, I’ll also be honest and tell you I often get completely out of the habit of using my Peak Flow metre and forget about it for months on end. But being back in the pool, with winter coming on hard, I try to start using it again.

Wait, I’m not finished. I also use heart rate monitoring to monitor my fitness, if I’m getting enough sleep and as an additional asthma check.

Again recently, but before I returned to VO2 max and anaerobic and more strenuous training, in fact after a few weeks of low mileage and taking it easy in the sea, I had a medical which included an ECG. I had had coffee that morning, which raises heart rate.

My heart rate was 54 bpm. Not bad considering I wasn’t in great shape. In fact the nurse said I was bracycardic, i.e. that I had a lower than normal for my age heart rate, until I explained I was a swimmer, and that was normal for me, and would go lower with training.

Now, years of exercise have told me I’m not naturally bracycardic, like Dee, and in fact my heart rate before that lifetime of exercise was probably slightly higher than normal. (I always find it funny how men and teenagers particularly like to compare heat rates and boast).

I have a laminate page beside my bed, which I don’t notice over 95% of the time, but when I do, I check my heart rate before I get up in the morning, again the best time to check. An HR of 60 or above will tell me I’m tired, overtrained, not getting enough sleep or have some cold or illness coming on. I’m not regimented at this, but it is a really useful tool and I know 60 is my upper level.

I also use this free Android heart rate app on my phone. And in a effort to validate its accuracy, I used it immediately after my recent ECG, and the difference was 1bpm lower, within the margin of error. But a simple pulse check with your fingers will work once you get used to doing it.

I have to be very careful about illness. I now get the influenza vaccine every year, I only started in 2008 when I was training for the English Channel relay, and I have to say it’s been a great aid.

The normal problem I encounter though is get a cold, which will ALWAYS lead to a chest infection for me, which will then precipitate an asthma attack. So as soon as I detect any hint of infection (morning cough, sniffles) I visit my GP within 24 hours, and get an antibiotic to reduce the impact.

Here I have to say though, swimming in cold water year round, I am less prone to these colds for the past six years. While I can’t quantify that, it is the same immune system improvement many open water swimmers report.

Extreme emotional stress which comes on suddenly, at least for me, is also an asthma trigger, but of course there’s little any of us can do about this.

Testing with Clare off Orca and Helvick Head

For two hour pool swims I use an inhaler before and for my longest swims, 4 hour plus pool training swims, 5 hour plus sea swims, I use an inhaler beforehand and during the swim. During the English Channel I had scheduled in two inhaler stops with my feeds, and Clare and I had tested using the Inhaler on an offshore swim off Helvick Head in choppy-ish conditions (test everything remember).

For very long pool swims in chlorinated pools, everything becomes more critical. For the 24 miles in 24 hours swim, I chose Kilkenny Pool because of its ozone-based water treatment approach, not just for myself, but for all the swimmers.

Recap:

  • Monitor and chart lung capacity daily with a peak flow meter. Know your own reading. Don’t worry about anyone else.
  • Use a daily Asthma Preventer. Agree the best option with your own GP (MD). Discuss your trigger and action points.
  • Monitor your heart rate.
  • Use an Asthma Reliever (salamol etc) before long pool swims. Learn to use it for marathon swims. If you do suffer asthma, make sure your crew understand your requirements.
  • Keep a close eye on any respiratory illnesses. Understand your own health cycle and take ownership of it.
  • Be proactive instead of reactive, as with everything else in marathon swimming…be prepared, this is yet another aspect of open water safety.
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.