Cold-induced asthma symptoms - athletes

[skimomma]

14 yo dd exercises and competes outdoors daily in very cold temperatures.

 

She recently had a bad cold.  It may have even been the flu.  Dd has a history of hanging onto dry, non-productive coughs for weeks after a cold/flu.  She is currently coughing occasionally but otherwise feels fine after two weeks of recovery time.  

 

One week into recovery, she was competing on a very cold day (-18F) and partway through had "breathing problems" and had to slow down.  This resulted in a slower-than-expected time and much disappointment.  I assumed it was a one-time perfect storm of illness recovery, very cold weather, and race day jitters.  She described the problem as having sudden, much-reduced lung capacity.

 

One week later, last night, it happened again during drills at practice.  It was again, very cold (-10F).  This was a first time she was pushing herself as her other practices were post-race recovery practices.  

 

I talked to her coaches and googled.  It appears to be a classic case of viral-induced and/or cold-induced asthma.  Her history of hanging on the coughs after illness is a key clue.

 

Anyone deal with this?  Can you give any advice?  Can we expect it to clear up on its own and if so, how long?  Her coaches said some athletes need rescue inhalers that they use when needed or pre-race when it is super cold.  I am not 100% against it, but getting into her doctor is difficult so it will take some time.  She races every weekend for the next two months.  And these races are important to dd because they are used as qualifying races for something she very much wants to do.  The issues she is having, if they continue, will knock her out of the running.

[MysteryJen]

This happened to my ds3. He now has exercise-induced asthma and uses an inhaler. Your dd needs to get in to the doctor ASAP, because in our experience, this didn’t get better.

 

For ds3, his breathing issues are much, much worse in the cold and can flare up with allergies or even a small cold.

[skimomma]

This happened to my ds3. He now has exercise-induced asthma and uses an inhaler. Your dd needs to get in to the doctor ASAP, because in our experience, this didn’t get better.

 

 

 

Is it your opinion that dd could have avoided this by avoiding super cold weather exercise while recovering?  I am even contemplating keeping her home from practice today (another very cold day) if there is any chance it will do permanent damage.

[lexi]

My hubby has exercise induced asthma. When he exercises strenuously he has breathing problems. Cold air does seem to make it worse. He uses an inhaler before exercising and has no problems. See a dr to discuss inhalers.

My hubby’s is easily controlled with the right meds and with being cautious.

My daughter has breathing issues when she does certain activities- like running. She’s a swimmer and swimming gives her no issues. But we have inhalers just in case.

So they both seem to have exercise induced asthma. Whenever either one are sick the breathing problems get so much worse. If they have a cold or respiratory infection they cannot exercise. They have a hard time breathing.

[almondbutterandjelly]

If it were me, I would keep her home.  My understanding is that every asthma attack scars the lungs a little bit.  That's why being preventative is so important.  You might be able to call the doctor and ask for a rescue inhaler prescription until you can get an appointment.  If you explained the situation, I suspect they would do that.

[MysteryJen]

The first asthma attack was in cold weather, though not as cold as the weather you are describing. It did get progressively worse until he used an inhaler on a regular basis. He now warms up very carefully, breathing into a scarf or hood to get warm, moist air at the beginning of his workout.

 

I would have your dd stay home and get to a doctor or urgent care today.

[Selkie]

This happened to my ds3. He now has exercise-induced asthma and uses an inhaler. Your dd needs to get in to the doctor ASAP, because in our experience, this didn’t get better.

 

For ds3, his breathing issues are much, much worse in the cold and can flare up with allergies or even a small cold.

 

This is the same experience we've had with our ds.

 

OP, you should keep your dd home and take her to the doctor right away. I would not risk having her out in those cold temps again without an inhaler.

 

One thing our doctor always stressed is that when you're out in the cold, make sure to keep the inhaler in a warm pocket. If the inhaler gets too cold, it won't work properly.

[skimomma]

Thanks everyone.  

 

I called her doctor's office in a ridiculous hope they had an opening this morning.  We have a severe doctor shortage in our area and they not only had no openings today but cannot get her in for three weeks!  The flu is going around and the receptionist told me, after I was on hold for 17 minutes(!), that they are drowning and I might be better off going to the ER (we have no urgent care).  Hmmmm.  I asked if we could get an inhaler before the appointment but she said the doctor will not consider it without an exam first.  I scheduled the appointment and asked to be on their call list if they have a cancellation, to which the receptionist snorted.  I'm not holding out much hope there.  Temps are supposed to be higher starting tomorrow and her next race is forecasted for temps in the 20s, which is 40 degrees warmer than the last race..  Should I hold out for the appointment I made or.....?  I don't see any other options.

[almondbutterandjelly]

Sometimes receptionists are staunch gatekeepers.  To get past them, you have to ask to leave a message for the doctor or nurse.  Sometimes this is even an option on the automated voicemail.  If so, pick it, and explain the situation and ask for a rescue inhaler prescription.  

[flyingaway]

I'm sorry. This happened to my daughter, too. But for her it just kept getting worse and worse and having a coach who tried more than once to convince her asthma was a mind game didn't help the situation any. I would go to the ER.

[PeterPan]

The ped just gave my dd an inhaler for the mild, intermittent asthma and it was really no biggee. No, an ER or Urgent Care will not give you the scrip necessarily. First UC I went in to with severe pneumonia did, but 2nd referred me to a pulmonologist. So with nothing going on right them and no relationship, fat chance.

 

Can you drive farther and get into a doc? Or call a hospital in a larger city and get a referral from their nurse line? In our small town the wait for a pulmonologist was 6 months, but in the neighboring, much bigger city, the nurse line got me a referral and in in a week. You aren't even needing a pulmonologist, just a ped. Around here family practice docs are hard to get into, but probably the nurse line could get you SOMEONE. 

 

When you get the inhaler, get a spacer as well. It's way more effective. Who would be holding it while she competes? If she has to hold it, then she won't want to carry the spacer. However if someone will be on the side to give it to her, the spacer will be good. It makes it 7X more effective and is just WAY better. I gave my dd my spacer when she left for college and am getting another one today, pronto.

 

Definitely keep calling around to try to get the inhaler. Now the bummer about an inhaler, just so you know, is it's a muscle relaxant. She needs to do what she needs to do, but if you don't use it very often it can sometimes leave you feeling jittery as the tissues relax. People do it before exercising, and maybe for some people it's a nothing. For me, I'm kinda cautious about that because it's a weird feeling. It passes, but it's a weird feeling. She would be wise to be in similar conditions while training, have it occur, use it in the training, and know what it does and how she feels. She might find the pattern and decide to use her inhaler a half hour *before* the race to let the wobbles pass. And it might be a nothing, but it's just something to work out. Definitely get it though. 

[skimomma]

I'm sorry. This happened to my daughter, too. But for her it just kept getting worse and worse and having a coach who tried more than once to convince her asthma was a mind game didn't help the situation any. I would go to the ER.

 

That's terrible!

 

Dd's coaches are taking it very seriously.  According to her head coach, more than half of her team struggles with it.  It is, according to him, very common in this particular sport.

[skimomma]

The ped just gave my dd an inhaler for the mild, intermittent asthma and it was really no biggee. No, an ER or Urgent Care will not give you the scrip necessarily. First UC I went in to with severe pneumonia did, but 2nd referred me to a pulmonologist. So with nothing going on right them and no relationship, fat chance.

 

Can you drive farther and get into a doc? Or call a hospital in a larger city and get a referral from their nurse line? In our small town the wait for a pulmonologist was 6 months, but in the neighboring, much bigger city, the nurse line got me a referral and in in a week. You aren't even needing a pulmonologist, just a ped. Around here family practice docs are hard to get into, but probably the nurse line could get you SOMEONE. 

 

When you get the inhaler, get a spacer as well. It's way more effective. Who would be holding it while she competes? If she has to hold it, then she won't want to carry the spacer. However if someone will be on the side to give it to her, the spacer will be good. It makes it 7X more effective and is just WAY better. I gave my dd my spacer when she left for college and am getting another one today, pronto.

 

Definitely keep calling around to try to get the inhaler. Now the bummer about an inhaler, just so you know, is it's a muscle relaxant. She needs to do what she needs to do, but if you don't use it very often it can sometimes leave you feeling jittery as the tissues relax. People do it before exercising, and maybe for some people it's a nothing. For me, I'm kinda cautious about that because it's a weird feeling. It passes, but it's a weird feeling. She would be wise to be in similar conditions while training, have it occur, use it in the training, and know what it does and how she feels. She might find the pattern and decide to use her inhaler a half hour *before* the race to let the wobbles pass. And it might be a nothing, but it's just something to work out. Definitely get it though. 

 

Thanks for the tips!  I had to look up what a spacer is.  I don't think she could carry it with her during races but someone close by could.  I'll have to ask around because I now know that several of her team members use these so they must have some sort of system.  She could certainly carry during training. 

 

We are in a very isolated area, which is partially why we have such a severe a doctor shortage.  We would be looking at a minimum two hour drive to the next "city" (which also has a doctor shortage) and at least four for a "big city."  I am not unwilling to go there but I also think there is a possibility that it will clear up as she continues to recover and also suspect we would be looking at even longer wait times to get into someone cold.  Sigh.  Not sure how to proceed.  The doctor office is now closed until Monday but I did send an email directly to her doctor in hopes that she might consider writing a script before we can get in.  

[wintermom]

Thanks everyone.  

 

I called her doctor's office in a ridiculous hope they had an opening this morning.  We have a severe doctor shortage in our area and they not only had no openings today but cannot get her in for three weeks!  The flu is going around and the receptionist told me, after I was on hold for 17 minutes(!), that they are drowning and I might be better off going to the ER (we have no urgent care).  Hmmmm.  I asked if we could get an inhaler before the appointment but she said the doctor will not consider it without an exam first.  I scheduled the appointment and asked to be on their call list if they have a cancellation, to which the receptionist snorted.  I'm not holding out much hope there.  Temps are supposed to be higher starting tomorrow and her next race is forecasted for temps in the 20s, which is 40 degrees warmer than the last race..  Should I hold out for the appointment I made or.....?  I don't see any other options.

 

You could try going to a pharmacy and talk to a pharmacists to see what over-the-counter meds there may be available to help. My dh just got some great stuff to help out his cold-induced cough. Who knows? It's worth a try at this stage.

Edited January 13, 2018 by wintermom

[lexi]

Someone posted about inhalers making you feel

Jittery. My daughter finds that xopenex does not make her feel as jittery as an albuterol inhaler. Xopenex is levalbuterol.

Of course my Insurance will no longer pay for xopenex. Ugh!

We use pro-air and it has worked well. And I agree that you need an inhaler. My daughter keeps a pencil case type bag hooked to a caribener on her swim bag. It’s kept poolside every time she swims. And when she golfs I hook it to her golf bag. It also holds her Audi-Q too.

I do urge you to get her in somewhere or get a script for an inhaler. My hubby tried some over the counter inhaler things years ago and they did not work. He ended up uncomscious in the ER. I’m fairly certain that the ER dr gave us a script for a more appropriate inhaler and referred us to another dr to follow up.

 

*and I’m on my phone trying to wrangle a toddler so sorry for typos!

[PeterPan]

The dry cough is from drainage down the back of her throat, or at least that's what the ped said it was with my dd. No, I wouldn't assume the two are connected. if she's not bringing up phlegm, then her reaction during the running is from the mild/intermittent asthma and not being caused by the cold (virus). They're two separate things.

 

If you let it go, then down the road, as she ages, she'll continue to have symptoms, begin to have them more frequently (at a pace that is dependent on her body and exposures to things she reacts to) and will eventually have enough that she'll compel herself to get in. There's really no advantage to waiting and it's not going away.

 

The inhaler is a nothing. It's not going to give her health problems or be addictive or be a sustained thing. It's just making sure she has airflow during the occasional, few times a year, situations. It's making sure that she has access to it in an *emergency*. Frankly, you don't want to know how bad it could be. She could be fine, at this low/occasional level, and then get into something and BAM get really scary. I'm at that mild/intermittent level where I maybe need an inhaler once a month, once every other month, but I've had that happen. And in those situations you'd MUCH rather have the inhaler and NOT need it than to wish you had it. Much safer.

 

So I can see why you're frustrated with the drive. I drive 2 hours each way weekly for therapy for my ds, so I get it. Maybe try calling the nurse line in the 2 hour distant community, seeing what you can make happen, and then doing the 4 hour if the 2 hour can't work?

 

Yeah, I've never tried different inhalers. What I use is the pro-air with an Aerochamber spacer. If you want, you can get an inexpensive ($16, really cheap) peak flow meter from amazon. I'm crazy for mine. Then she'd have data to make her decisions. When I started, my peak flow (while sick) was pretty close to averages for my age and height, which actually left me wondering why I was having so many problems. As I got better, my peak flow went up. Turns out I have close to DOUBLE the peak flow for my age/height when my asthma is really controlled. And weight lifting bumped it another 10%. As an athlete, she may have a very large lung capacity and high peak flow. And people are like ooo cool, but actually i wonder if it's a disadvantage because you NEED that capacity and need it to WORK and really FEEL it when it's down 10%. So like me, I really don't like how it feels 10% down, even if the flow would be really good compared to somebody else. I need that oxygen and that air flow to have energy for my muscles, kwim? 

 

She sounds very self-aware, but that's just a way to give data to it to help her quantify what is happening and whether she needs it or not. If I'm 10-20% down and my numbers are bouncing around, I use the inhaler. If my numbers are stable but less than 10% down, I hold. Some people go by how they feel, but I like to use the meter. And if she just tests herself during the day (when she's exercising, when she's at home, first thing in the morning, etc) she'll probably have a good sense of where her numbers are at *without* needing the meter in a pinch. That way she'll be really accurate and saying ok, time to pause during the race, time to use the inhaler, and she'll know why. And she can meter before and after exercise and know whether/when the patterns show the inhaler is warranted. 

Edited January 13, 2018 by PeterPan

[mermo]

If you do end up getting a spacer- it is usually covered 100% under medical equipment, but maybe quite expensive from the pharmacy since they don’t bill through medical equipment coverage. Try to find out from your insurance.