Running With Asthma, Part 1

[Editor’s Note: This article was written by the Trail Sisters’ Liza Howard.]

Except for an emergency appendectomy in second grade, I was a healthy kid.

And besides being ancient when I had my own kids, I have no medical history to speak of. I’d draw a long line down the ‘No’ column of patient-history forms. At annual physicals, I’d apologize for being so medically dull, and look for openings to mention my lost appendix.



“High blood pressure?”



“Not even a little.”


“Sorry, not one.”

“Coronary artery disease?”

“Again, sorry, no.”


“Well, no. BUT I did have my appendix out in second grade! I missed Halloween. I was going to be Snow White and wear real makeup. I was devastated.”

All this is to say, I was healthy, and I was used to my body cooperating with my plans for it. As a result, it took me almost two years to recognize I was struggling with asthma.

Hi, my name is Liza, and I’m an asthmatic ultrarunner.

Trail Sisters asthma 1

The asthmatic runner is easily identifiable by his or her red rescue inhaler. All photos courtesy of Liza Howard unless otherwise noted.

When I proposed writing about asthma to the other Trail Sisters, Pam Smith and Gina Lucrezi, and our editor, Meghan Hicks, I envisioned writing something with an inspiring Cinderella arc. I’d start with a description of myself, bronchoconstricted and ready to give up running, lying defeated under a pile of leaves at the JFK 50 Mile last November.

Trail Sisters asthma 2

Reenactment of bronchoconstricted woe and despair at the JFK 50 Mile.

And I’d end the article with a vivid account of standing on a podium having finally knocked out a qualifying time for the U.S. 100k team. My asthmatic sisters and brothers would take heart. Chronic lung diseased be damned! With the right combination of medications, patience, and training, anything was possible. And those of you without drama-queen lungs would embrace my broader message about vision and action, and self-awareness–because all that had clearly paid off. And there’d be lots of spit-your-coffee-out funny stories about my missteps during the asthmatic journey. (‘Cuz that’s how I roll.)

But I’m nowhere near the happily-ever-after part of the story. I’m maybe two-thirds into the fairy tale, tops–just after Cinderella returns home from the ball and is back to scouring floors. And there’s no sign that any princely pulmonologist is looking for me.

In my case, the floor scouring involves dragging a chair over to the kid-safe cupboard above the stove every morning, pulling down two inhalers and a bottle of Singulair, reminding myself to be thankful for medical insurance, washing the Singulair pill down with coffee, and ‘squeezing and breathing’ on the inhalers. That regimen allows me to run for about three hours without trouble. After three hours, my lungs turn into pumpkins and I feel like I’m breathing through a straw.

How to Simulate Asthma Symptoms

If you don’t have asthma and you want to experience the symptoms, grab a straw and stand somewhere you can jog in place. Jog for 30 seconds and then breathe through the straw while pinching your nostrils shut.

Trail Sisters asthma 3

How to simulate a bit o’ asthma.

Nice, eh? Hard to PR like that.

Us asthmatics get that tight-chested, air-hungry feeling when the muscles around our small airway passages (bronchioles) tighten. When someone says they’re having an asthma attack, this is what’s going on. (‘Bronchoconstriction’ for you Scrabble players.) And there are a great many things that can trigger an asthma attack. Dust, mold, scented cleaning products, cat dander, aspirin, cold air, stress, exercise… Basically anything. For me, it seems like sand, dust, cold air, altitude, and exercise are strong triggers. You know, trail running things.

I was in full breathing-through-a-straw mode by the time I made it to the mile-45 aid station at the Lake Sonoma 50 Mile last month. I hid behind a tree to use my rescue inhaler. (I would definitely be that choking person who gets up from the restaurant table, embarrassed, and then passes out alone in the restroom.)

Rescue inhalers contain fast-acting bronchodilators. They increase the diameter of the airway passages and make you feel like you’re not breathing through a straw anymore. Right now, my doctor has me using this inhaler 20 minutes before a run and every two hours during the run. I carry it in the top pocket of my hydration pack.

How to Use a Rescue Inhaler

For you uninitiated, you have to suck the aerosolized medication deep into your lungs for it to work. To accomplish this:

  • Exhale until you can’t exhale any more and you really want to inhale.
  • Put your lips around the inhaler’s mouthpiece.
  • Depress the inhaler while inhaling deeply (to move the medication to the littlest airway passages in your lungs).
  • Hold your breath for 10 seconds (to make sure you don’t just exhale the medication).

Most folks are instructed to take two puffs of medication, about a minute apart.

But here’s the deal, asthma isn’t just bronchoconstriction. There are three things going on in an asthmatic’s lungs that impede airflow and running PRs.

  1. Narrowed airway passages (bronchoconstriction)
  2. Inflamed airway passages
  3. Increased mucus production in the airway passages (Whee!!)
Trail Sisters asthma 4

Image: American Academy of Allergy, Asthma and Immunology

When I teach about asthma for NOLS Wilderness Medicine, I always feel like I’m doing a strange infomercial.


And a rescue inhaler doesn’t touch the inflammation and mucus. Gargh!

Long-term control medications are necessary for that. And figuring out exactly what those medications should be isn’t easy. It’s like blister prevention. What works for one person might not work for somebody else. And what works in one environment might not work in another.

That’s where I am right now. I’ve tried four different kinds of anti-inflammatories and anti-inflammatory combinations. The first medication helped a bit. The second and third helped a bit more. I went from jogging to being able to run at marathon pace from time to time. I still felt really fatigued on most runs, though, like I was wearing a weight vest. And I couldn’t always hold a good pace. The asthma doctor threw up his hands at that point and referred me to a pulmonologist. “I don’t know why you’re not responding. Maybe it’s your heart.” (Spoiler: It’s not.)

Unfortunately, the punt to the pulmonologist hasn’t maximized my field position much. It’s my fault. I answered her question about why I’d come to see her with: “I can only run for three hours before I need to use a rescue inhaler.” Her eyes actually glazed over. I tried to rephrase things so I didn’t sound like a privileged lunatic, but she just looked more and more like she was powering off.

“When I was in the Sahara Desert running this multi-day race, my heart rate was just so high…”

“At this 50-mile race, I was really short of breath…”

“You get belt buckles when you finish these races–and I used to do really well.”

“Training just feels harder than it should…”

Honestly, if I hadn’t had a back-from-the-dead experience at the JFK 50 Mile, I would have been entirely cowed by the pulmonologist’s disinterest. I would have stopped running ultras, made my peace with recreational jogging, and looked for other ways to occupy my time–like blogging about donut eating.

Trail Sisters asthma 5

But at JFK, after feeling like I was jogging through chest-deep water for hours and multiple hits on the rescue inhaler, a cold front moved in around mile 38. The wind kicked up, the temperature dropped 20 degrees Fahrenheit, and it began to rain.

And I was transformed.

I went from walking at a 30-minute-mile pace to racing. I felt like my old self! I ran the last eight miles almost as fast as the winning women. (Obviously that doesn’t mean I could run anything close to their 50-mile times. They were running hard the whole race while I took breaks, lying on the ground feeling sorry for myself.) But the night-and-day difference I felt when the weather changed filled me with hope. There had to be some medication or approach that would have the same miracle-like effect.

That faith got me through the appointment with the dismissive pulmonologist. And it’s kept me from despair and donuts. I just need to find the right lung doctor–someone excited to work with an old-lady runner who still has a big appetite for belt buckles and dreams of being on the U.S. 100k team, a niche miracle worker who accepts BlueCross BlueShield insurance.

I’ve signed up for JFK again this November. I need to run a sub-7:15 there to qualify for the 2018 100k team. If I do, it’ll be the perfect happily-ever-after ending to Part 2 of this article. In Part 2, which I plan to write in December, I’ll write about how things have progressed with me, how other runners cope with asthma, and issues surrounding asthma medications that are on the World Anti-Doping Agency’s Prohibited List. 

But just in case I’m not meant to be Cinderella, and I–or any other runner–walk into an aid station you’re volunteering at and tell you I can’t catch my breath or my chest is tight, I’d be grateful if you followed this checklist. 

How to Help a Runner Having an Asthma Attack

  • Crack open a can of calm. (Stress is a trigger. The more upset I am, the harder it will be to relieve the symptoms.)
  • Ask me if I have my inhaler, and help me get it if I do.
  • Ask me if I know what triggered the attack. Remove that trigger if you can.
  • Tell me to purse my lips like I’m playing the trumpet and breathe that way. (The back pressure created can make it easier to breathe. It also slows breathing, which has a calming effect.)
  • Make sure I’m hydrated to keep the mucus loose. (Loose mucus!)
  • Remind me not to take any ibuprofen or Tylenol or other non-steroidal anti-inflammatories. (They can make the attack worse.)
  • Don’t let me keep running until I feel better.
  • Take me to get medical attention if what usually makes things better isn’t working. (Make sure to take anyone who’s having a first-time asthma attack.)

Call for Comments (from Liza)

Asthmatic sisters and brothers, I’d love to hear your stories–Cinderella or otherwise. I’d like to include some of your experiences running with asthma in December’s Part 2 of this article. Please comment below. (Pam, of the Trail Sisters, is also in the asthmatic ultrarunner family.)

Trail Sisters

is a group of three women, each with unique opinions, ideas, and attitudes toward all things trail and ultrarunning. Pam Smith is a mom, physician, and lover of running who lives in Oregon. Liza Howard is a mom and 100-mile specialist from Texas. Gina Lucrezi is a Colorado-based short-distance speedster exploring the realms of ultrarunning.

There are 77 comments

      1. Robert

        The reference is to the growing controversy in the Cross Country Ski racing world with the supposedly extensive use of Salbutomol via nebulizers among the Norwegian Cross Country Skiing Team. The current top World Cup performer (Martin Sundby, a Norwegian) served a 2 month ban last summer for Salbutomol concentrations in excess of WADA maximium standards in the absence of a TUE. He also lost his overall World Cup title and the Tour de Ski title. Some think that Salbutomol is a PED:

        “However, the drug does not work only in lung tissue, and that appears to be part of the argument against high doses.

        Jørgen Jensen, a professor at the Norwegian School of Sport Sciences, suggested to VG that the drug may affect skeletal muscle, increase muscle growth and speed recovery. He cited research showing that the class of drugs, beta-2 agonists, appears to be more beneficial to sprinting and power events than to endurance performance.”


        It has been common for at least three decades for elite cross country skiers to use such inhalers/nebulizers to treat cold air exercise-induced asthma proactively (i.e. preventatively using an inhaler prior to racing). Ski races can be held at air temperatures as low as -4F (-20C) and breathing that cold of air at lactate threshold-VO2max (typical racing intensity) is taxing and can cause an asthmatic reaction. It is also more common in older elite racers (late career) who previously exhibited no symptoms.

        But the asserted extensive use of inhalers/nebulizers among the Norwegian Team supposedly among athletes that have not been diagnosed has brought quite a bit of criticism. Such use has not been proven however.

  1. Kathy Jambor

    Oh Liza! I am sorry for you and you pegged it for me. I had shared a picture with you of me breathing through a straw. your comment was how calm I looked for breathing through a straw. Somewhere along the line, I got acceptance. Acceptance that this is what I have to deal with and breathing like “Tell me to purse my lips like I’m playing the trumpet and breathe that way. (The back pressure created can make it easier to breathe. It also slows breathing, which has a calming effect.)” is exactly what I was doing in that picture. I really wanted to see Dr. Robert Kempainen, MD based on his Olympic trials video ( I believe he would understand you and me and anyone else suffering from lung disease that wants to run.

    1. Liza

      I remember talking to you about asthma with you at Leadville all those years ago. I’ve thought about how it’s never made you stop racing no matter how bad it’s been. You’re my role model for doing what you want to do. :)

  2. Christie Calin

    Great writing! I have struggled with asthma off and on all my life. I joined the track team in high school and had an episode early in in training. I went to the doctor and he said, “You’ll have to stop running.”
    So with a heavy heart, I turned in my gray OHS hoodie and sweat pants.
    I didn’t run after that until I enlisted in the Army Reserves…where I had to run!
    I did pretty well at keeping it together. I even maxed out on my PT tests.
    I ran so well in fact, that my first sergeant’s wife volunteered me for the run team. Ummm. What?!
    That’s when I was discovered. I was running much more, and faster than ever before. I was busted by that same first sergeant’s wife, while wheezing during a race. She said I need to get checked. Now…I was happy to address the situation, and try to not feel like I was dying. However, at that time, asthma was a disqualifier for being in the military. I told her I was worried I’d get kicked out. She assured me I would not. So I got a rescue inhaler, which was all I needed…for about 20 years.
    Fast forward to the past two years, where my asthma has worsened immensely. It’s clearly not just exercise-induced anymore. I have been on Prednisone four times in the past two years, just to get my lungs to calm down. And let me tell you..those things are magic!
    But I would go back to bad episodes shortly after finishing the meds. Here’s the other part that a lot of people don’t realize…when we aren’t taking in enough air, our blood, which nourishes our muscles, is not being oxygenated. Thus, not only are we not breathing well, but our muscles become fatigued much faster as well. It’s an exhausting experience!
    I have been on Claritin and Zyrtec for about four years. My doctor added a steroid inhaler to the mix. Also…after hearing from a friend that a B-complex he’d been taking had helped him immensely, I ordered some and have been taking it for about a month. I believe it is helping a lot! It is called Aller-B.
    Sorry this was rather lengthy, I didn’t mean for it to be.
    Raise your inhalers with me, and toast to days of better breathing for all of us! Cheers!

  3. Laurel Hunter

    Way to make an article about asthma entertaining! I have recently developed asthma due to the air pollution in Salt Lake City and nothing aggravates it like running. But I persevere… am now on singulair as well as the inhaler. Apparently, insisting on running in polluted air is also making the asthma worse, but I don’t like the option of exercising inside.

    I look forward to part 2!

    1. Liza

      Thanks, Laurel. I’m so sorry SLC is tough on your lungs. I live right off the interstate & can empathize a bit. My good friend in Poland was forced onto the treadmill because the air quality there was so awful this winter.

  4. Danielle

    When I was around 17 I started having frequent chest pains combined with trouble breathing so I went to the doctor for testing. The pains always happened after meals, not while exercising. But the doctor gave me a asthma test and concluded I had mild-asthma. The doctor couldn’t determine the trigger though. (Years later I’ve learned they are triggered by a food preservative) I had always had shortness of breath running but I figured it was normal. I played sports in high school but I didn’t start running until the end of college. Typically taking two puffs of my inhaler prior to running is enough. But during my first half-marathon I started to have an attack, I was gasping for breath by the end. (but stupid me didn’t bring my inhaler).
    I made the same mistake during my last 10 mile race and around mile 7 I started to feel an attack coming on. I started to panic that I didn’t have my inhaler, which of course didn’t improve matters. I was able to finish the race, but lesson learned. Always bring your inhaler!

    1. Christie Calin

      Nope…stress does not help at all. I have had to learn that it’s not just when I run that I need my inhaler. If I’m doing any high intensity training, I need to use it. Sometimes I still forget.

  5. Jim

    I feel your pain but was lucky to have a pulmonologist who understood my need to run. It took me several years to get somewhat under control but I never felt like it was quite right. She finally did another CT scan and found I had another issue on top of the asthma that was adding to the mucous retention and swelling. She added a saline nebulizer to my regime and it is amazing the difference it has made. Best part is it does not add to the shakes or palpitations I can occasionally get from the asthma meds so I can even do it mid race if I have access to a power source. Still slow but at least I can breath most days.

  6. Chris Hunter

    Entertaining article. I also hide whenever i need my inhalor in public. Hahaha. This comes at a funny time for me and I can’t help but comment and share my recent journey. I’ve suffered from fairly severe asthma my entire life. In the last three months I’ve made a concerted effort to get it under control naturally as I hate taking drugs every day of my life and am also an otherwise healthy person. My once a year trip to the doctor to refill my asthma prescriptions annoys the hell out of me. With some major diet/lifestyle changes I’ve gotten my condition 90% under control, no longer take a daily steroid and need my rescue inhalor only a few times a week. It may sound extreme but two major things I quit (which I never thought I’d be able to give up as they were my dietary mainstays) were beer and cheese. Cheese is a mucus producing food and is a nobrainer and I don’t know what it is with the beer/asthma connection is but Im fairly confident that I have some sort of allergic reaction to a compound in the beer which would in turn trigger my asthma reaction. Wine is bad too. Within weeks I was running with my inhaler in my pocket but not using it which was amazing to me. My bad attacks generally come at night and for the first time in years I could sleep through the night without having drowning dreams that would wake me up into a fit of wheezing and coughing. I also began taking a daily herbal supplement called Clear Lungs. It is supposed to help with mucus production and lung health as well as a turmeric supplement daily (for inflammation). I’ve been working hard to keep my stress levels under control with breathing exercises and meditation as I’ve noticed that stress is a huge trigger for me too. The positive changes I felt sans beer and cheese led me down a healthy eating crusade. I survived a two week candida cleanse diet (no sugar, no carbs = pure hell) and have begun a daily probiotic regimen which seems to have gotten rid of ALL of my allergy symptoms. ALL OF THEM! Allergies were another trigger for me. Did i mention that i got rid of ALL of my allergies? Its true. I just made it through the spring allergy season here in Moab without as much as a sniffle. The significance of this is hard to put into words. Springtime for me is traditionally and annually a horrible time of scratchy throat, itchy eyes, constant sinus trouble and incessant lung constriction. I’ve been adding things to my diet a little at a time since my cleanse and find that refined grains make me go backwards so no more bread or pasta (I know, horrible right?). I am not following a paleo diet or anything but my diet consists of all whole grains, beans and veggies with some meat. All the grains I eat are now soaked, sprouted, and fermented as well. I was once someone who said I’d rather die from an asthma attack than live without beer, cheese and bread but once I adjusted to my new diet I feel better than ever. To be able to go for a long run in the spring and not take my rescue inhalor is beyond amazing for me. I have no scientific evidence to refer to but I’m sure that keeping my gut flora in healthy balance is one of the main things going for me right now. I bought some kefir grains and have been drinking that daily as well as making my own yogurt. I’m lucky to have access to fresh raw goat milk for that but you can use store bought milk to make kefir as well or just buy it ready made in health food stores. I drink a pre-biotic tea (chicory root) everyday to keep the good bacteria well fed and begin and end every day with apple cider vinegar mixed with water. What exactly is happening that kicked the asthma into submission I can’t scientifically explain but I feel amazing and can’t help but share in hopes that it will help someone else. I believe that everything comes down to eating right, even asthma control.

      1. kate moga

        Jackie and Chris,

        My experiences have been similar to Chris in that my lungs fill up with mucus and inflammation. After a lot of trials (visit to heart lab to work up high heart rate, etc) I found that eliminating wheat and dairy from my diet made lungs quiet. I also use supplements similar to Clear lungs but recently did the 23 and Me DNA report and had someone run a “variant report for health and diet.” It is crazy how just the diet changes and supplements have improved something that has kept me back so many years.

        Jackie, I had a similar race (much slower) to yours last year at JFK50. After the weather turned cooler around mile 38 I passed 45 people! Felt like superwoman. FLYING. I just hope the Mountain Masochist 50 this year is cool – and lungs are still under control.

        THanks for bringing attention to this issue.


    1. Liza

      Cheese AND beer. This makes me sad, but you are very persuasive and there’s no reason not to try and clean up my diet and see if that helps. (Kind of really hoping it doesn’t because Beer.) ;)

      1. lancejohnson

        The best way to identify food-related issues is to try an elimination diet for 30-60 days. Keep a journal of what you eat and how you feel as you add things back in. It’s not a fun thing to do, but I found that I have a serious issue with soy (oh, and I was a vegetarian at the time buying soy like it was my favorite pair of shoes on closeout).

        Also, dairy is a great cause of mucus, and gluten is highly-inflammatory.

        In eastern medicine and holistic practice, food is considered to be medicine. It is a very logical approach – what we put into our system on a daily basis effects it. And while I will always see an western doctor for emergent issues, I prefer the systematic approach of eastern medicine and holistic practice for things that are related to my body being out of balance (like asthma, which I also have).

        Last suggestion – because as asthmatics we are much more likely to get respiratory infections (I used to get pneumonia 3-5 times a year) – try adding a solid dose of Oregano Oil as well as Tumeric to your daily supplement ritual. The Oregano Oil has had an incredible effect on my immune system, and the Tumeric reduces systemic inflammation quite well in my experience.

        1. Caramarrs

          Liza what a great article. I’m there with you, I have asthma as well, and while its usually fairly controlled, sometimes its not (huge asthma attack at the start of the 2016 Grand Traverse skimo race after skiing through firework smoke, coupled with some dietary missteps and days of insomnia causing more stress). From what I can, tell mine was initially triggered by running a 50K in very smoky conditions (wildfire) and that was enough to trigger my genetic predisposition about 7-8 years ago. I’m otherwise very, very healthy, I do live in Colorado at about 7500 ft, and often feel better at sea level. I just ran Miwok and used my inhaler minimally. As the other responders have mentioned I have found food to be one of my largest triggers, I am a Dietitian/Nutritionist so I have many resources in my brain to help treat myself which is a help. Years ago I did the LEAP MRT testing and protocol on myself, as I practice that in my office, and it helped immensely. Now I find that the high histamine foods are my main triggers, and thus the allergy induced asthma. In my case I have a extensive family history of asthma on both sides with all very fit, active people. Tea, dark chocolate, tomato, red wine, beer, aged cheeses and yeasty foods are my biggest triggers ( I know bummer). I do run with my albuterol and take it pre run, and just started on singulair after refusing meds for quite some time, its been a big game changer. I also take probiotics, curcumin and several other supplements that help immensely. I often find that people I work with are shocked to discover that their breathing issues can be related to food, and there is a big connection between asthma and “silent reflux” and regular reflux. While I am not an elite level runner, I do find that the glazed over looks you get when you say “I am struggling too much when I’m doing a race at 12,000 ft +” or “After running for 3+ hours I have issues”…..are perhaps less here in Colorado but still present. I am glad you have found a good plan for yourself and just know your not alone obviously with all of these comments. Keep us posted!

  7. Liza

    That’s so interesting about the saline nebulizer. So glad it’s helped so much too! “but at least I can breath most days.” ;)

  8. Bruce Cyra

    Thanks for the post. I have been through quite a few medications, still some left to try (flovent), but none worked for me other than albuterol. I don’t have triggers, its just constant inflammation, came on just over a year ago at age 58. Now I am trying an anti-inflammatory eating regime, no high-glycemic foods, trying to reduce internal inflammation. Hoping for better days!

    1. Liza

      Sending hope for better days for you too! I’ve dragged my feet about anti-inflammatory foods, but I need to check that box too.

  9. Molly M.

    Thank you so much for sharing this! I don’t think I’ve ever heard anyone really talk about running with asthma before. I had some seasonal asthma due to spring allergies when I was in elementary school, but didn’t have any trouble with it through high school and collegiate athletics. During spring of 2014 when I was training for an ultra, I was having some trouble breathing, I thought I was just slacking on my training a little bit/dealing with a bit of allergies. Before too long, I couldn’t ride my bike 1 mile to work without an attack that took me 10 mins to recover from, and my rescue inhaler wasn’t helping at all (scary). Saw several docs, one who told me I had an enlarged heart, one who told me I was just an anxious woman, before finding some good care. After lots of time without much exercise and lots of tests later, I take an inhaler (that I think is used for COPD) 4 times a day like clockwork that keeps things under control, along with trusty ole advair. I have more trouble on days where outdoor allergen levels are high for me, but my doc explains what I have going on as “an inconvenience I have to control.” Happy to be back to running, weird lungs/airway and all!

    Cheers! You and your inhaler keep kickin’ ass!

    1. Liza

      “Anxious woman!” Did the doc recommend a hysterectomy after that? Good grief. I wonder how common adult-onset asthma is. I feel like I’m surrounded by folks who only started having trouble in their 40s and later — but I recognize I live in an asthma bubble. ;) So very glad things are under control for you and you’re running again.

      1. Doug K

        yet another adult-onset here, started age 46 after a bad winter of flu followed by pneumonia followed by pleurisy..

        I’m a guy and the doctors still suggested it might be anxiety.. VCD (vocal cord dysfunction) was suggested.

        “I still felt really fatigued on most runs, though, like I was wearing a weight vest. The asthma doctor threw up his hands at that point and referred me to a pulmonologist. “I don’t know why you’re not responding. Maybe it’s your heart.”

        That is just what I experienced. Eventually wound up at National Jewish Hospital in Denver, where they really did everything they could, was very impressed by the care I received – but concluded after many tests ‘our next step is exploratory surgery’ which I declined.
        The cardiologist recognized me by my heart in the ultrasound – he’d trained at another cardio practice in Denver, where they apparently were using my ultrasound heart pics as an illustration of the ‘athletic heart’. Ha.

        None of the medications helped, except the albuterol type inhalers. I found a careful warmup of 10-15mins followed by the inhaler, would be enough to fend off attacks for shorter races, under 3 hours. On longer races I’m moving so slowly the problem doesn’t seem to appear..

        In any case I’m old now and no longer competitive, so have given up looking for solutions. The last thing I was looking into was EIAH, exercise-induced arterial hypoxemia,
        – suggesting that EIAH is in part due to the inherent characteristics of the athletic lung as well as to the extraordinary demands for gas exchange demanded by their very high maximum work loads. This implies that chronic physical training per se might precipitate maladaptation of lung structures at the alveolar : capillary interface, just as it does in the airways when heavy exercise training is carried out in cold environments (Karjalainen et al. 2000). EIAH involving a reduction in PaO2 also appears to be much more prevalent during running exercise, as opposed to cycling.

        I can get my blood oxygen saturation percentage into the low 80s just by running.. not sure how low I could go, as at that point the tunnel vision closes in and I’m afraid of blacking out.

        1. Liza

          Wow! That’s really interesting about EIAH. I’m going to read more. Also, that is pretty wonderful that your heart is famous. :)

  10. Alex

    This is a hilariously great and informative read. I hate using my rescue inhaler and cringe that it’s some kind of failure or resignation every time I do. I cling to this idea that when I’m in my best shape, my asthma should be magically controlled. My wife doesn’t see it that way and I’m thankful for her reality check. Good article. Thanks.

    1. Liza

      Thanks, Alex! I feel the exact same way about the rescue inhaler. I need to draw a friendly face on it or something to make it more appealing.

  11. Jenny

    I have a really great pulmonogist – he didn’t bat an eye when I said that the rescue inhaler stops doing much after about 8 hours of exercise! I was training for a very slow Ironman – definitely on the run I was somewhat wheezy and could mostly only jog or walk, but I can live with that, would have been mostly walking at that point anyway! My asthma is well-controlled with Singulair, a maintenance inhaler (prescription coverage has switched back and forth several times now from Flovent to Qvar based on the insurance company’s formulary changing, but both seem fine) and rescue inhaler pre-exercise and about every 1:45 during. I try not to run outside if it’s below freezing – 30-31 is fine, 28 is not, and inflammation and mucus almost certainly mean I WILL get sick a few days later. Being smart about consequences is hard, my asthma is mild enough that I can usually run through it but will pay a price later on. NB if you do triathlon – putting face in very cold water is very, very wheeze-inducing! Oh, and I’ve done better on illness (not perfect) since I’ve been having allergy shots – cats& dogs, spring and fall grasses, tree pollen, dust mites, etc. etc. NB I always get annoyed when I see people on Slowtwitch & similar suggesting that albuterol should be banned – I think they imagine it’s like you huff and puff it in and can suddenly do amazingly fast sprints without losing your breath – you will really only notice a difference with it if your airways are genuinely crackling/wheezing!

    1. Liza

      I was talking to Pam about that same thing — how albuterol inhalers don’t help you if you don’t need them. I always wonder if anyone will think otherwise when they see me using one during a race though.

    2. Doug K

      ” I always get annoyed when I see people on Slowtwitch & similar suggesting that albuterol should be banned ”

      see link from my name – looked into this at one point, there is really no evidence at all that it will help a healthy athlete. The dosage at which the effects start, requires intravenous administration – you can’t get enough from an inhaler to matter.

      In 2006 I had to get a TUE (therapeutic use exemption) for albuterol.
      In 2008, wrote that post.
      In 2010, albuterol inhalers were removed from the WADA list.
      Coincidence ? I think not.. ha. [Broken link to v5.1 updated to v6.0]

  12. Andrea

    Thanks so much for writing this, Liza! I really appreciate your description of *all* the symptoms – i.e. asthma isn’t just people wheezing. My non-Cinderella story is getting a rib torsion after an amazing asthma attach post-Waldo 100k last year. On the other side, I managed things well enough (the right combination of Qvar maintenance inhaler, Pseudafed, claritin, taking my rescue inhaler 30 minutes pre-race, then *as*soon*as*symptoms*started* during the race) that I recently placed 3rd in a marathon (normally the sustained hard pace would be super triggering this time of year when pollen levels are high). I’ve had difficulty actually getting doctors to acknowledge that I have asthma – I typically don’t wheeze, and the simplest flow-tests don’t often show an issue. …and admittedly, I’ve had to battle my own stubbornness with not wanting to take medications; the sarcastic comments from people (e.g. “is that a performance enhancer?”) when I use my inhaler pre- or during a race certainly don’t help.

    1. Liza

      Rib torsion! Good grief!! Congratulations on the awesome marathon! I wonder how common not wheezing is — and how many runners think there’s some other issue going on because they’re not wheezing.

  13. Donna Potts-Walling

    Had my first attack 2 years go about mile 28 on Cle elum 50k. doc visits, and just recently its offical post one of those numerous tests I did. that I have athletic induced asthma. Top that off with being T1D since 1976, on insulin pump. HR if I walk is 90, run? and I am an old grandma!
    more I train the slower I go. I am now at #32 DNF cause I cant make cut off times for Rainshadow races. Yep I am slow even with out Asthma…I think.
    I did nto realized on elevation gains, reason I had to stop put mmy head between legs and breath…was asthma! I did nto realize that that pulse at 182 on hills was Asthma!
    I just started a new type of inhaler. Plus of coarse Emergency inhaler. But I am still slow. yesterdays run through swamp area of skunk cabbage seems to be another trigger!
    But I keep trying. I am sure that # of DNF with Rainshadow will keep increasing as I think when it opens for a race sign up on Ultra sign up, Ill put my name down…thinking This year! This time! I’ll make those damn cut offs.
    I am glad I enjoy the journey. but i would love to cross that finish line some day!

    1. Liza

      Yeah, those “it’s about the journey” comments sound hollow when you’re actually on the journey in a skunk cabbage swamp. :) To the finish line!

  14. Jody Labriola

    Not like you can just whip up a cup of coffee on the trails….but I was told by a Respirologist years ago that if you are having an asthma attack and can’t get to your Ventolin inhaler, or have none available, the next best thing is coffee. Coffee, or more precisely, caffeine, is a drug that is very similar to theophylline. Theophylline is a bronchodilator drug that is taken to open up the airways in the lungs and therefore relieve the symptoms of asthma, such as wheezing, coughing and breathlessness. So although an asthmatic ultrarunner won’t be close to a coffee machine, the coke at aid stations or caffeine pills just might do the trick to assist you until you can get to your inhaler(s).

      1. Nathan Nelson

        Uh, yes. I plan to tell my asthma story in another comment, but yes. Sometimes during an attack if I drink a Dr Pepper, for some reason I find a little relief. I can’t explain this, but even if it’s psychological, all I care about is that I think it works. :)

  15. Sharon

    I’ve been asthmatic essentially all of my 48 years of life, the last 8 of which I have also been a runner. I’ve gotten used to being DFL or chasing cut offs. I try not to use my rescue inhaler while I am training, just my daily Advair. It is, literally, a daily struggle. In my head, I reason that if I can make my respiratory system “this” strong while training without help, when I use my rescue inhaler at a race, I will be “this much” better. And I get nervous that my body will become accustomed to the drugs I’m taking, and they will lose efficacy. My first big race last year, a 12 hour race, I used my Xopenex 30 minutes before the race and then every 2-3 hours afterwards. I felt like I was flying! I’d never run so well. And I got a 12 mile PR! 48 hours later, I felt like I was having a permanent asthma attack. No amount of Advair or Xopenex was really helping. It took a good 7-10 days to completely feel better. I attributed it to a cold I might have caught. But the same thing happened the subsequent 3 races. My doctor determined that I as experiencing some sort of late onset inflammation. Steriods, upping the dose on my daily inhaler and using the rescue one daily for 2 weeks fixed me up after my 50m race. And, so, now, I just resign myself to knowing that after each race, I will spend at least a week feeling like I’m wearing a 20lb brick on my chest. Asthma does suck. But I always try to remind myself that I CAN run, and that is enough for me.

  16. Benjamin Bruno

    I have been an asthmatic since I was very young. Some of my earliest memories are of using a nebulizer or a peak flow meter. I was told growing up that running sports would never be in the cards for me. Well, the doctors could not have been more wrong. I have now gone on to complete many Ultras and marathons. My first ultra was actually the Leadville 100. I have personally found that trail running has made my lungs stronger and has in a way helped diminish my asthma. I have not had an attack in many years, but still run with an inhaler just in case.

  17. KristinZ

    come to National Jewish Hospital here in Denver–some of the very top lung specialists! any chance you could have some vocal cord dysfunction going on also to throw into the mix?? this can enhance, mimic, and/or double your pleasure with asthma issues.
    good luck to you! it’s so irritating/frustrating/non-amusing to get sidelined by health issues.

    1. Liza

      Will tell NOLS, I need to teach in Denver ASAP and stay over a day. :) Don’t about vocal cord dysfunction. The kids would definitely say they’re just fine. ;)

  18. Lay

    So great to read this! I’m a newer runner (3 years in) who has been struggling with mysterious health problems for around a year. Mostly my running was impacted and it turned out to be asthma. It is so great to read about other people dealing with this stuff! The doctor’s eyes glazing over is very relatable and it’s really great to read about people trying different inhalers and finding what works. So many runs that ended in asthma attacks and me thinking sadly “maybe I’m just not a runner”. Thank you for motivating me to keep hassling the doctors until I find the inhaler combo that keeps me running :)

  19. Zoe F

    Thanks for explaining asthma so well for endurance athletes.

    At 49 years old I was diagnosed 6 months ago with exercise induced asthma. I had done two full Ironman’s plus many halfs 70.3 and cycling & running races. The had my first attack in a 104 mile triathlon race – unknown to me at the time it was asthma.

    Walking the dog was like breathing though a straw which I didn’t even consider as exercise so sought help & diagnosed as an asthmatic athlete.

    It’s early days and I’m learning to live with asthma – my triggers are sport, cold air and powders ( dust, smoke, pollen)

    Sometimes feels like 2 steps forward 3 steps back but my fitness is improving again and I’ve been told there are many more options in the medicine box

    A case of balancing the right inhalers for me, and hayfever treatment. Now on a prescription drug as over the counter didn’t cut it.

    Look forward to your next update

    I have another full ironman in August just before my 1st anniversary as an asthmatic Fingers crossed my lungs behave that day !

    Good luck with team selection

      1. Zoe Forman

        What a roller coaster my first year of asthma has been which I will write up soon.

        Short version I completed my third ironman, first as asthma athlete and got a 30 minutes Personal Record

  20. Fat CaliDog

    I’ve had asthma my entire life, I guess they thought I was going to die at one point between ages 1-2. That which doesn’t kill you makes you stronger!!

    Watch out for the side effects of Singulair. While it seemed to really cut down on the amount of mucus I produced during hard events (5k efforts are the worst), the drug also made drastic changes to my personality. I’m not an emotional person at all, yet I started to cry during the national anthem at a football game 6 months after starting Singulair. Read up on all side effects of all drugs–scary stuff from Big Pharma.

    Good luck to everyone!

    1. Liza

      Interesting! I’m an emotional wreck most days, and it’s hard to tell if it’s gotten worse since I’ve been taking Singulair. I did cry during Frozen’s “Let It Go” recently, but I’m pretty sure that was lack of sleep.

      1. Fat CaliDog

        I started taking Singulair last year, about a month before my old black lab died. The dog and I were very attached to one another, my wife used to joke that he and I had the world’s smallest mutual admiration society. After the dog died, I became very depressed, and at least once a day, I’d sit and just stare at my computer screen for about an hour, blaming myself for his death (he had a stroke, losing almost all motor control of his head, so I put him down). My wife was very concerned and she wanted me to see a psychiatrist, but I demured, believing I could work through my pain, preferring to medicate myself with vodka.

        Then, one day while I was in the kitchen making dinner and a college bowl game was on the TV in the living room, the national anthem started playing during the pregame; I broke down in tears, just sobbing for 5 minutes. This was completely out of character for me, most people think I am an Android, bereft if any emotional depth. That night, we talked about what had changed in my life to make me so emotional; I’m in my late 40’s, I run my own small company, nothing had changed for years, except being prescribed Singulair. She did a search for side effects, and the results were a real eye-opener​; thousands of people suffer pyschiatric problems with the drug. I quit that night, and within​ a few days, I went back to being the cold, unfeeling bastard I’ve truly am.

        Watch out for Singulair; you may breathe better, but at what price, your sanity?

  21. Luana Pesco Koplowitz

    Hello, I have had asthma for about 30 years. I am 61 years old. I have been running trail and mountain ultras for about 7 years. I have a different version of asthma called cough-variant asthma. I can breathe reasonably well (I tend to place in my age group in trail ultras, if not win the age group and sometimes I am in the top 5 females overall). My problem is that I just cough a lot, which is not only annoying to others but very tiring. I had a strange incapacitating injury in MAR 2017 at a 100-miler that caused all of the muscles in my back to seize up and contract and I could not stand straight or breathe for many hours. Some thoughts from healthy care providers was that due to the fact I was coughing a lot during this race, that my respiratory muscles just wore out. I am on Singular and Asmanex which is supposed to take care of the problem, and I am better on these medications but the cough just will not go away, and I suffer from headaches just from coughing so much. My primary care doctor does not know what I should do at this point but does think sending me to a pulmonologist would help any. I am a physician myself so I know the number of medications available are limited. Any thoughts anyone might have would be helpful. I even tried Respitrol (a natural product) but it did not help.

  22. N. Perry

    Great article, thank you! Allergies have been my nemesis for years and asthma has been part of the package (love to trail run and ride both MTB and road). I do take Singulair and have never noticed any side effects. Another very effective treatment for me has been acupuncture, but this is much longer term approach. Having been going regularly to acupuncture for over a year, I have gone about two months not using my inhaler (and this is one our worst allergy seasons in years). That said, I am still taking Singulair, but will hopefully be able to transition off that as well at some point in the future. It is imperative to find a good acupuncturist and I understand this isn’t an option for everyone, but wanted to share my experience in case it helps others. Happy trails!

  23. Wildknits

    Thank you for writing this article. I plan to share this with friends/ the local running community as it is a great description of what it is like to have an asthma attack and to run with asthma.

    I have had asthma my entire life (“Mild persistent”) as well as multiple allergies, with new ones developing randomly. I, like a few of the other commenters, have cough-variant asthma, with wheezing only noticeable if I am in a lot of trouble asthma-wise. This past year I DNF’d from a race for the first time due to an asthma attack that would not resolve with typical rescue inhaler use.

    Fortunately for me I have an allergist who, while he can’t quite wrap his head around ultra distances, is very dedicated to ensuring this middle of the pack grandmaster runner maintains her lung function. He also noted at a visit that while my current lung function might be acceptable for another person my age, it was not for me because “I am an athlete” (bless his soul). He started me on a new maintenance inhaler (I tend to have adverse reactions to many of them so there is a short list to choose from; and Singular caused depression/suicidal thoughts as well as joint pain so is a no go for me for allergy/asthma control) and instructed me on using the rescue inhaler more often (Q 2 hrs) if needed during races to control my symptoms.

    This past winter after a nasty case of influenza A my lungs just would not recover. Two months later I was still coughing all of the time during the day, and somewhat violently during/after running or biking, despite rescue inhaler use. It has taken three rounds of prednisone (two at low doses because to be honest the drug scared me) plus an antibiotic (turns out all that uncontrolled inflammation trapped some bacteria and led to an infection) to turn things around. I started the final round of prednisone and the antibiotic 24 hours prior to my first ultra of 2017. I also had a plan for more aggressive use of my rescue inhaler prior to and during the race. I still coughed my way through that race (one runner commented I sounded like an old guy who had been smoking his whole life) but mid-way through the race the medications kicked in, the cough loosened up, and I was able to finish strong (good enough for 1st place in the “old lady” age group).

    Lesson learned: when asthma flares, address it immediately. I let this “smolder” too long and it was much harder to get back under control.

    Looking forward to Part 2!

  24. Colin

    Great article. Just remember to take off the little white cap of the inhaler before sucking in super hard. I forgot once, and got it lodged in my throat! I had to self-Heimlich (throw yourself onto a sturdy object like the arm of a chair or a tree branch so that it hits your diaphragm and pops that little cap out). No fun…but it did give me that shot of adrenaline!

  25. gjls

    Easy doping excuse. At least you are smart not to compete while taking it. Races like Western States would result in a positive doping test unless you submit TUE.

  26. Nathan Nelson

    Lisa, all of this deserves a “yes”.

    I’m 42, born with asthma (I guess it’s not giving anything away if I tell you, yeah, I still have it.) All those years of, “You’ll grow out of it.” The sentiment was nice, though.

    In my youth I was given an out of running, because I had asthma. No doctors encouraged me to exercise. I decided that this was fine — didn’t really enjoy exercise, anyway!

    But now, here we are. I am a fellow ultrarunner (my first 100 coming in Oct!) and deal with all of this. For the last 4 nights I’ve been on breathing treatments. My inhaler is my training partner. It is where I am (currently 2 feet from me.) Somehow I’ve managed to make peace with this chronic illness. Every day I am grateful for the chance to run, knowing that I’m probably trying to make up for all of those years as a kid, watching my friends run around the perimeter of the soccer field.

    Thank you so much for your post. It was hilarious, apt and comforting to read about someone else in the same boat.


  27. SJ

    Just curious: how quickly are you able to breath after you stop running? Meaning, how quickly does the tightness go away? And is the tightness in your throat or in your chest?

  28. Lisa

    Thank you so much for your article. Helps to know that I’m not alone. I was diagnosed with asthma at age 41 while living in Wellington, NZ. At that time, I was competitive age group triathlete, having done sprint distance races up through Ironman (5x). I was out doing a fartlek session one spring morning and had to stop b/c I was wheezing so badly. Doctor diagnosed me with allergy-induced asthma and gave me a Ventolin albuterol inhaler. My significant flare ups were really only in the spring when everything was in bloom and the inhaler seemed to help. I moved back to San Francisco in 2008 and my breathing issues got worse. I no longer race triathlons but have been an ultrarunner since 2010. I still swim however, and if they’ve just put chlorine in the pool, my swims are pretty rough. I use my inhaler before every workout just to give myself a shot at being able to get deep breaths but it doesn’t always work. I don’t typically need to take it with me on my runs (which typically last from 2-4 hours) I saw a pulmonologist but she didn’t think my asthma was severe enough to warrant anything stronger than a Singular + albuterol combination.

    Yesterday I went up to Foresthill for day 2 of the Western States training weekend. There was a lot of dust on the trail right from the start and I could immediately feel it in my throat and the resulting impact on my breathing. Had some Coke at the first aid station (interesting…I didn’t know that Coke/caffeine could act like albuterol; that explains why it helped!) and felt better. We were in the trees for the next 5 miles or so, but once we got back out into exposed sections with heat, the dust was back and I felt horrible. I kept trying to blow air out to “make room” to breathe air in. By the time I got to the next aid station at mile 16 I was literally gasping for air. One of the volunteers had an inhaler. I took a puff and immediately felt light-headed and dizzy and had to sit down. Decided to accept a ride to the finish (only 2 miles away, but entirely uphill and in the dust) and took another puff. After about 20 min I felt much better, albeit exhausted.

    Saw my GP a couple of weeks ago and she prescribed Flovent, but my insurance won’t cover; cost would have been like $234 so I didn’t fill the prescription. After yesterday I’m wondering if I should have…Not sure what I’m going to do, but I’m not happy at the moment.

    I wish you all the best and look forward to your next installment and reading others comments.

  29. marion

    Loved the way you wrote this! I was a professional cyclist (Olympics, world championships etc) and really struggled with my breathing during hard efforts. I often wrote it off to just not being fit enough! I finally got tested and was told I had the record amongst the athletes tested for lung obstruction during efforts. I hate inhalers-tried ventolin which gave me jitters more than anything, innovair worked ok but my biggest breakthrough was stopping gluten and dairy! Made a huge difference and I use the inhaler only occasionally now
    have a great run at the JFK!!

  30. Raye

    Thank you, thank you, thank you! Have run on and off for years as cross training but long distance outrigger canoe paddling was more my thing. Moved back to my home country 4 years ago and with weather and lifestyle changes had to find something different from paddling to do. Turns out I love trail running. I’m not fast but I get the same thril running through trees and scenery while dodging rocks and roots as I used to catching waves and linking swells together in the ocean. 1.5yrs ago diagnosed w adult onset asthma having been an otherwise healthy individual up to then. This does seem to be getting worse similar to stories of others as it now seems to hit me on the ski slopes at times too. I refuse to give up the outdoors and drop back to lesser training or distances or weather extremes. I am definitely still on the journey of discovery about how best to manage it though. Had a 30+km trail run earlier this year where the first half was a dream. Running like I did before asthma. Felt like I was flying. Then it kicked in big time in the second half. I had even brought my spacer with me so I was stopping every 20-30mins or so at the side of the trail and puffing away to try and get to anything faster than a walk pace. I’ve never been one to panic so found myself waving and attempting a smile as fellow runners passsd by asking if I was okay. I never felt in danger, just really, really frustrated at not being able to go any faster. I took a longer rest at the last aid station and the last 7km managed a jog/run. Still felt it for a couple of weeks afterwards with mucus and inflammation in my lungs but it might just be the price I pay after an event. Triggers are cold, exercise, overly tired/lack of sleep. Possibly some perfumes and I think sawdust (home renovation + lots of diy led to this conclusion). Interesting posts about diet that I will have to work up some more willpower to try.
    Please keep writting and exploring the triggers. It is extremely inspiring to read! This is the first time on my jouney that I have not felt like a freak for wanting to know how to be an endurance athlete with asthma and not merely how to ‘exercise moderately as part of a balanced lifestyle’

  31. Wendy

    Thanks for the article, I’m very much looking forward to hearing what kind of drugs end up working for you! The docs say that I don’t officially fit in to the asthma category, but my allergies (to everything outside, animals, ie life) are what they think causes the bronchial challenges. And all of my allergies have gotten worse in the 15+yrs of adulthood, so it only makes sense that all my breathing difficulties seem to have gotten worse as well. I spent many years only racing up to the trail marathon dist, pretending that my issues were just fitness-related… but when I got to the point that each night sitting on the sofa was spent gasping for air and some nights going to bed I had to prop myself up on pillows to breathe a lil better, I figured something else had to go be going on. My nitricoxide readings were apparently off the chart, signifying ‘lung inflammation’, and I thought that after a year or 2 of steadily taking their recommended drugs, I’d be fine to continue increasing distances…

    But while I’ve been able to feel like I can breathe normally for 5-6 hr races, I’ve been less successful at the 7+hr time. I’m curious if others are told to regularly take the rescue inhaler before ‘trouble’ begins? I’ve been waiting til the 6+hr point, but I think it just barely staves off my issues. I spent the last 2 hrs (ie 8+hrs in) of my first 50mi (lungs coated in the dirt that was blowing around is the guess) and my first 100k (Cali BayArea smog the culprit perhaps?) barely being able to catch my breath, with it getting worse and worse no matter how slowly I move (which I insist on doing until I get to that damn finish line!). I would keep trying to use the rescue inhaler during those final horrible hours with less help each time (and when I’m finally done and get oxygen, I’m shivering). After my 50mi disaster, the docs tried to add Symibcort to my daily drug cocktail, wound up losing my voice for over a month from taking it for 2 wks :( !

    I really want to do more 50mi/100k and try a 100mi soon, but the 2+hrs of limited breathing is scary enough- I definitely wouldn’t feel safe breathing like that for 12hrs! I’d love to hear what other drugs similar runner peeps use that I can ask my doctor about to see if I can have success with it as well!

  32. Jessica

    Thanks so much for sharing your story! I haven’t seen much discussion online about runners with asthma, much less ultrarunners. It’s such a relief to find out that other people with asthma are finding ways to run despite their chronic condition. I’m looking forward to following your progress!
    I was diagnosed with asthma after my first asthma attack at age 2 (I’m 37 now). I was on prednisone on and off as a kid and used my inhaler for gym class and when I was sick. I remember so many nights sleeping sitting up in bed, waking up because I was coughing so much, and feeling that relief when my rescue inhaler kicked in (and then feeling jittery, because that’s how albuterol rolls). Obviously, I avoided running whenever possible. Until my senior year of high school, when my gym teacher taught the class how to train over the course of weeks to meet a running goal (rather than just busting out that annual mile for the President’s Physical Fitness Test), and I discovered I could actually run a little bit, and it didn’t suck. Over the years, I discovered that running on a regular basis actually helped tame my asthma. After living in the Midwest and East Coast my whole life, I moved out to the mountainous West 5.5 years ago, and the drier, less-polluted, lower-allergen air has further improved my running (except in April and September, when hayfever sends me inside, gasping on a treadmill because the inflammation is so bad). I now have moderate controlled asthma and take Singulair daily, in addition to using my inhaler before each run. I have run five road half marathons, three trail half marathons, and a challenging trail 14-miler (a too-short 25K), and now I’m trying to decide whether to take the 50K plunge. I love trail running, but the altitude and steep uphills are hard on my lungs and my heart, and I’m worried that more training and longer runs will have a long-term negative effect on my health. I get through difficult runs pretty well, although I get frustrated by how much I have to walk or take breaks to catch my breath as runners with healthy lungs zoom past me. Every body is different, but I recently discovered that my body functions much better on a grain-free diet, both in terms of consistent energy (no more energy roller coaster all day!), and in terms of my acid reflux, which affected my running. I have also found that running hills and doing speed intervals on a track have improved my VO2 max; I can definitely notice a difference when I get back into track work after months away. I also do yoga and strength training, and I feel like stronger muscles help make up for my lower aerobic capacity. I never considered using my inhaler more often during a run, but your story inspired me to give it a try during longer trail runs. Has it helped with your recovery time? That’s my biggest challenge right now – recovering from long runs. Well, that and accepting that I just have to walk more uphill than other folks, and that’s okay.
    In any case, I’m inspired by all of the commenters here who continue to run despite their asthma! I’ve been ruminating lately over whether to attempt longer distances, beating myself up because I’ve been afraid to give it a try. But this post and all of the commenters have me feeling encouraged to give it a shot (not this year – I need a break after a couple of big races). Maybe your experience will give me some additional ideas for ways to train and recover better. Good luck and have fun!

    1. Gigi

      I have no idea if anyone is riding this anymore, but i am so happy to have found this article, and also your post. I started running in my late 30’s and i’m 60 now. I find i was pretty good and could win masters at fairly big races. But some years ago running continuously got so hard. I dropped out of racing for several years. I started again a bit about 10 years ago, but the past 4 years I picked it up a lot. But I couldn’t figure out why I could never get “in shape” again. It got really bad a bad flu, and then I got diagnosed with EIA. Although I use a rescue inhaler before runs and races and 2xs a day Pulmicort, I still can’t make it through a race without walking breaks. It’s like an overwhelming breathing issue, but until this article, I still wasn’t convinced it’s not in my head. Does this mean my asthma isn’t well controlled?
      Also, for anyone on Singulair, when do you take it? I have tried it before races, but I seem to struggle with higher HR’s. Any else experience this?

  33. Mariette Stoltz

    Hi Lisa This morning I decided to look for asthma info and found your encouraging “story”.
    I ran a 21km over the weekend, Skukuza 21km Kruger Park South Africa. An amazing setting and a fantastic experience But… All went well for the first 10km and then my asthma symptoms started my struggle to finish. I had these visions of running well and finishing strong but it was not to be. The cut off time is 3 hours but it was extended to 3.5 hours because of the heat I finished in 2 hours 43 minutes and should be happy but I am so disappointed. I did well in my previous run. Just a few walking and wheezing episodes. I am a control freak and the asthma is not to be controlled. A very unpredictable factor indeed.
    The race organisers positioned game rangers every 300m or so – lion, elephant and other big animals do roam – and have a cut-off at 5,10 and 15km. For safety. When running in the wild we all picture a lion bursting out the bush. A bit nervy. So when it happened to be a bush buck jumping we all just saw a lion. Fortunately just a great story to tell. I seriously considered falling down at 15km and weep. Fortunately my much better runner husband walked with me and got me to the finish. So thankful. I played netball and did some running, long and high jump at school but then life happened with only walking and hiking trials now and then.
    I stopped working at 53, and for the first time had time to do a proper medical check-up. My cholesterol measured quite high and I started boot camp and running to try reduce it. This triggered the asthma (EIA) and I stopped after 3 years since it was just one uphill battle. This year, at 59, I started training again. I now try to deal with the symptoms of which the lead in my legs, no air, excess mucus and severe visions of near death at the kerb are my major obstacles.
    I have been taking all the medication that should help but have not found the magic potion as yet. The pulmonoligist just said “O that is abnormal” when I told him about my daily struggle with excessive mucous. Really!
    I now think that I must accept that one cannot solve this asthma problem like you solve a tech problem at work. I have to accept that I have to deal with it, continue looking for a magic wand doctor or potion, accept that I will not easily die at the side of the road and be very proud when I finish my effort before a race cut-off.
    I am tough and tenacious although somewhat anxious and unfortunately much slower than I thought I should be.
    Thank you for your positive attitude post. Hope you run far and wide with much fun.

  34. Filipe Jorge

    Hi, let me explain my conditions, I have asthma since I born, in normal situations, daily basis everything it’s, however running with asthma is very difficult. First of all I don’t bread trough the nose it’s trough the mouse where all pollution goes directly to the lungs, so after a few km’s I’m completely tired. Also it looks like that this year my conditions is becoming worse. About running I do prefer long runs, mainly because it looks like that my lungs a respiration on a good day, becomes regular only after 6 or 7 km’s, so and as you can imagine on a 10k competition it’s not good. I basically i’m thinking in change my sport, not running at all and find something else better, but I also was thinking instead of running on the road running trail’s. Can you give my your opinion? Regards

  35. Richard Friedel

    My method for asthma is to use a sympathetic nervous system reflex.
    1) Finger pressure on the face between the nose and the upper lip overcomes asthma by the reflex.
    2) Train nose inhales with compression of the upper lip to get this effect. R.Friedel

  36. Dave

    Thanks for your blog post, I’m sitting here at the end of my tether wondering what to do and playing those mind games. Like you, Ive run some long distances, and like you I am waiting for my Cinderella moment.
    I started running about 10 years ago, nothing serious. In 2009 I ran my first 5km without walking, in 2010 I ran a half marathon under 2 hours. In 2012 I ran a marathon under 4 hours. Loving it! I never remember asthma being a problem.
    I forgot to mention I’ve had asthma my whole life, and remember my school camps being punctuated by having to sit still for 15 minutes while I had my ventilator pump.
    About 3 years ago I finished a half marathon and had really bad asthma. I had my ventolin puffer with me, and remember taking it multiple times, and was really sick for the next few days with inflammation and mucus. I realised that it had been sneaking up on me for some time, like a frog slowly boiling. Always having asthma, it’s not something I really took notice of until I looked back and realised it was out of control.
    On and off over the last 3 years I have been up and down, quitting running completely for months at a time when things got me too down. I swapped to riding, took up karate, lost fitness and just trained for 2 or three events each year. After each of these I stopped again cos it was too hard.
    It’s hard to explain to people the feeling, the mental games and doubts that creep in and become entrenched, the barriers your body puts up to stop you running faster, to protect itself.
    10 months ago, I started training seriously for a 28km run. I’ve done it before, and it is a tough one, with over 700m of vertical elevation. But my mates wanted to do it again, so that meant I would as well.
    I trained hard, 5 runs per week, starting with 25km and building up. I felt good, I was lucky enough to join in with a local run club doing intervals at the track weekly. My speed increased, my endurance increased, my unconscious protections started to fall away, and I was loving running! I ran the event and was happy with my time at a touch over 3 hours. Sure there was some inflammation and a few days of excess mucus, but that’s normal right?
    I kept up my training, increasing the mileage to a consistent 200+km per month and 2000m of vertical, but started to notice worsening asthma again. I’d upped my preventer to 2 puffs twice a day with the blessing of my doctor, although a year ago he had tried to tell me I was on the strongest one and should be taking one puff a day only or reducing the strength. I’d signed up for a trail marathon, and my plan was to clear it up by taking 3 days of prednisolone I had left over from my last serious bout. So off I went, taking my preventer, reliever, antihistamine and nasal spray along for the run, using them all multiple times. ‘This is not ok!’ I said to myself. So I made an appointment to see a GP. And that’s where I’m at. My asthma is not under control at the moment, I’m running slow and long, which is ok, and adding in a hard run where I can, but being embarrassed when I can’t make it to the track or do the prescribed workout. I’m having to make asthma my excuse for what feels like the first time in my life, and I’m trying a bunch of different medications. I’m not going back to prednisolone, Im going to rest where my lungs need it, and I’m going to ride it out. I’ve signed up for a 56km in January, so still need to get kms and time in the legs, but realise I need to accept where I am at and try and enjoy it. Keep the intensity down and stop the runs where my lungs aren’t coping.
    I’m also planning to do more running inside on the treadmill in the colder months, Ive read it helps.
    It’s great to hear the comments from all these people with the same issues, keep up the blogging!

  37. Jill

    Mercy. I have been running ultras for more than 5 years and about two years ago I noticed my asthma was getting a lot worse or my heart was working extra hard and I couldn’t catch my breath during a 50 miler which should’ve been cake. I had my heart checked and lungs tested. The doctor said my asthma had just gotten worse and that my heart was good. So I’m taking a steroid Inhaler and rescue one before I workout, but I still feel like my heart goes too fast so I’ve slowed down my pace. I have a finished a couple flat and hot hundred milers since, but now I’m kind of panicking since I have signed up for run rabbit run one hundred miler this fall. Now I’m a little scared that altitude may get me? Do you have any advice for altitude training for someone living In Michigan? Right now I’m pushing myself and Jacobs ladder for 100 steps and my heart rate reaches into the 170s. Then I let it drop back down to about 100 to 110. And then do it again. I feel like I could puke.

  38. Kelsey

    Great article and while I know it’s been some time since you posted…wanted to affirm earlier comments about VCD (vocal chord dysfunction) and dietary changes. I was incorrectly diagnosed with asthma and they just couldn’t find a solution for years. None of the inhalers or other meds worked. It was frustrating to know I was capable but just not able to breathe. I was determined to keep running and dreamed of longer distances. Now, finally…I am hopeful. Last year my new allergist suggested my breathing problems may actually be VCD related and scope observation confirmed this. And for reasons unrelated, my neurologist pointed out that I may have a gluten sensitivity that is not tested for typically, yet very common. After beginning some therapy for VCD and major food protocol changes…it’s life changing! Crazy enough today I was online doing a little runner VCD research for non-menthol/mint throat lozenges as that aggravates the VCD (our air is still quite cold/dry here). And your post was at the top of my search results, I bet it was in the comments prior. Best of luck as you continue your journey and dial in to your best you!

    1. Paul Snyder

      This is interesting Kelsey. Thanks for posting. I have been running for 30 years and about 2 years ago I started having these asthma like attacks occasionally. Now it is constant. I have a pulmonary test scheduled for Oct. Chest x-rays were neg. Just minor sign of some form of lung disease (asthma , COPD ?). I tried finding Liza on I.G to see how she is managing but no luck.

  39. Carol

    Reading these posts have been so helpful. I have had asthma since I was a small child, but managed it well enough to be a D1 swimmer in college (moist pool air = good; freezing Northeast unheated pool temps = very bad). After taking 20 years off of serious exercise to raise my kiddos, I joined a trail running group two years ago. I was surprised that my asthma didn’t bother me, even in freezing temperatures. (I am on Singulair, which wasn’t around 30 years ago). But what did surprise me is the two scary asthma flares I had at the Hyner View race (PA) yesterday on the steepest two hills. It is a 25k race with 4K elevation. I took my rescue inhaler and stopped running until I was sure I was okay (lots of mental talk “You are okay… you are okay”). I managed to finish the race but was frightened by the experience. My takeaways is that I should have taken my inhaler before the race, should better train the hills, and should drink the Coke, not the Gatorade, at the stations. Anything else you would suggest?

  40. Lisa


    Glad you were able to get through that situation okay. One thought, if you don’t use your rescue inhaler regularly, is that it may need to be primed prior to use. My levobuteral inhaler says to prime it if it’s been more then 3 days since last used. “Luckily” for me that rarely happens due to the exercise -induced component of my asthma.

    Yes, using the inhaler pre-race should help and then keep using as needed during the race (my inhaler never leaves my pack during races that I expect will last 2 hrs or longer).

    1. Nathan Nelson

      This is my experience as well. I prime at least a few minutes before a run (then put on my shoes, watch, etc.) and then head out. I’ve learned to start at a very slow pace and then work into the speed I’m targeting.

      I haven’t looked into Levobuterol, but since I’ve been on my albuterol for years, it might be worth another look. :)

Post Your Thoughts