Hillwalking With Exercise-Induced Asthma

10 10 2022

I have seen many hillwalkers on forums I used to frequent suddenly being diagnosed with exercise-induced asthma and thinking that’s the end of their hillwalking ‘career’ – nothing could be further from the truth!

I’ve had exercise-induced asthma since I was around 20 years old – if you get asthma at this age, you’ve got it for life – you can only grow out of ‘childhood asthma’ (and many times people don’t).

For the first few years, while I had an elderly doctor, I was prescribed Ventolin – but in tablet form.  Tablets don’t work for asthma – you need to get into the chest directly with your medication and that means inhalers are the only way forward.  This meant that I was almost incapable of movement (almost like COPD) as my asthma was in effect completely untreated…

This all came to a head while I was back visiting the Outer Hebrides where I used to live and work.  In Hebridean houses, the main form of heating is generally peat fires as the peat is dug by the inhabitants on the moor and is therefore free.  However, they were open fires back then (late ’70s) and often very smoky.  The peat smoke really exacerbated my asthma that week until, when I went out to get some fresh air on the beach, I was literally coughing up blood!

The (lucky) decision was made to call the local doctor who promptly assigned me a Ventolin (reliever) inhaler.  This is the trade name – the actual drug is Salbutamol.  Within seconds of taking my first puff, I could breathe again and, by the end of the week, could stroll around quite happily on the beaches and on the flat.

When I got back and told my doctor about this, he agreed I could have my Ventolin in inhaler form in the future.  I was eventually also given ‘preventer’ inhalers to take every day (but this was possibly when he retired and I got a younger doctor).  These are absolutely essential (the preventers, not the younger doctors!) – they are basically an inhaled steroid and you’ll be on them for life but they don’t have any side effects that I know of.

By my 30s, I was interested in hillwalking again after a hiatus in my 20s when I was only really interested in socialising (as are most 20 year olds).  Armed with my Ventolin inhaler, I attempted to hillwalk again (my parents used to take us as children every holiday).  Unfortunately, I often found I’d get partway up a hill and would be doubled over coughing and spluttering and generally making little progress.

This was very offputting!  I always had my inhaler with me and would take 2 puffs of it (the maximum allowed) but often was still faring very badly indeed…

One huge drawback of not being able to breathe enough is that your muscles go totally weak which is very unhelpful for walking up hills!  This of course is due to your muscles needing oxygen to work long-term – you can do short bursts of exercise anaerobically but not long ‘endurance’-type exercise which is what hillwalking is.

During the next probably ten years or so, I was hospitalised every ‘flu and cold season as, if I got any kind of sniffle, it went straight onto my chest and I’d get a chest infection.  Chest infections in asthmatics are generally very serious and these certainly were.  There were many annual visits where the hospital staff were fairly convinced I was going to die including one visit where they took a blood sample every 5 minutes all night to see if any oxygen was getting into my blood (they didn’t have the clip-on testers then)…

Of course, the treatments in hospital start with being slapped on oxygen after being given a half hour on the ‘nebuliser’ machine (the hospital ones are far more effective than the portable ones you might have at home).  This would help for a while but I’d still need nebulising again as soon as it was permissible.  Luckily, they would also have started me on medication the moment I came in – the medication is always anti-biotics and oral steroids (e.g. Prednisolone).

Nowadays, if I’m given both anti-biotics and steroids for a chest infection, I generally hold off taking the anti-biotics as they’re not a great thing to take in these days of anti-biotic resistance.  I immediately start a high dose of the oral steroids and usually find I don’t need to take the anti-biotics after all.  Obviously you might have to though…

Oral steroids don’t tackle the chest infection as such but they are very strong anti-inflammatories and, basically, what is suffocating you in an asthma attack is gross inflammation of the airways and lungs.  I’ve generally found this to be the only medication I need and I usually start to get better within a couple of hours.

So, back to the hillwalking… I was struggling up the hills with the non-working muscles, wheezing and coughing.  BUT, I’m a determined bugger at the best of times and I was always determined I wanted to do a hill so I started to ignore the fact that 2 puffs of my reliever inhaler hadn’t helped and that my legs weren’t working and I started to continue on slowly up the hills.

No matter what state you’re in, you can pretty much get up the hill eventually and I found that, after an hour or so, I’d stop with the wheezing and coughing and start to get some oxygen into my muscles again.  By the summit I was often okay depending on how long the hillwalk was.

Now the reason that it’s important to continue up the hill and ‘break through’ the asthma attack (although obviously you need to slow to a crawl) is that, each time you do it, you get fitter.  And the absolutely crucial thing to rid you of your problem is getting fit.  Your asthma won’t completely go away as I’ve often found when I’ve stopped taking my preventer inhalers for a few days – but it will dramatically reduce in severity and you’ll probably be able to dispense with your relievers (although you should always carry them).

Pretty soon, I noticed that I didn’t get hospitalised annually any more or even at all (well, not for asthma anyway).  And, although I always carry a reliever inhaler in a pocket of every walking coat, I literally never use them!  My peak flow increased to a reasonable level (it will never be good as my chest capacity is very small) and, of course, the rest of my health improved dramatically too.

There are things you can do to help your breathing when hill-walking and I’ve often found that the biggest help to me is never to carry a rucksack.  No, I don’t mean give it to someone else, I use a bumbag instead – one with a flask/drinks carrier each side.  Some of these are quite large enough (mine is 10 litres) and I’ve done winter mountaineering in Scotland with just my bumbag.  I’ve had to strap my crampons onto the outside with the compression straps and carry my ice axe in my hand but, if you’re on winter mountain slopes, your ice axe should be in your hand most of the time anyway…

The reason I say to try not to carry a rucksack is that the downward pressure on your shoulders (and also the tight straps across your chest) prevent you from easily opening your lungs fully and, if you have weak lungs, you don’t want that.  Bumbags are also excellent for transferring your centre of gravity to a low position just above your legs anyway which is pretty helpful for stability on rough ground.  You also get battered about less then you would with a rucksack in very high winds.

Rather than keep my outer coat or fleece inside my rucksack, I just carry mine tied around my waist.  It keeps my middle nice and warm in winter and it’s easier to keep putting them on and off in mixed weather (which we get so much of in the British hills).

Another helpful thing is to walk uphill with your hands on your hips.  This also raises your shoulders and opens your chest.  Just about any photo you’ll see of me on my blog plodding uphill, I have my hands on my hips.

Other advice is that you really shouldn’t be setting off at the crack of dawn (and certainly not pre-dawn) in winter or cold weather.  This is because cold air is a very quick and certain trigger of asthma of any type and will upset your lungs badly.  Even on an apparently non-sunny day, it’s much warmer after the sun has come up.  If you’re walking in very cold air, it’s best to cover your mouth with a buff, balaclava, scarf or whatever to warm the air you’re breathing.

To sum up, by being persistent about my hillwalking and getting really fit, I’ve gone from a slow, wheezing plodder up hills who got hospitalised on a regular basis with life-threatening asthma to a pretty fit hillwalker who can actually run about on the flat and down the hills and walk very fast up them with no ill effect and with very much enjoyment!  Much better! 🙂

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29 responses

30 11 2022
Jayne

Fascinating and eye-opening, thank you.
I do not have asthma, but reduced lung capacity thanks to long-Covid. You’ve given me a few things to think about, thank you 👏

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1 12 2022
mountaincoward

I’m really sorry to hear that getting Covid damaged your lungs. I was lucky that I got a later version of Covid when I got it and it wasn’t a lung related one – I was terrified of getting one of those. Mind you, I did go blind for 4 days which wasn’t much fun either!

I hope you can manage to strengthen your lungs again eventually.

Liked by 1 person

18 11 2022
Alli Templeton

Hi Carol, sorry it’s taken a while for me to catch up, but as you can probably imagine, I’ve spent the last few weeks surrounded by boxes, dust and new home stuff. Still, this was a real eye-opener of a post. I’d never heard of exercise-induced asthma, and I’m sorry you had such a rough time of it. I know it’s not the same, but as a child a suffered from bronchial asthma and, likewise, any bug I got went straight down on my chest. I was hospitalised twice with double pneumonia and kept in an oxygen tent, so I know how scary those experiences would have been for you. Still, you soldiered through it with characteristic determination, and well done you for coming through it so well. Your tenacity and love of hillwalking clearly paid off and now you’re fit and well, enjoying the best of the great outdoors and writing all your adventures in your wonderful blog! 🙂

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18 11 2022
mountaincoward

Wow! I have to admit I never got pneumonia or double pneumonia. That must have been really scary as a child.

Have you got settled in yet or are you still surrounded by boxes? I found my last move bad enough and I’d already moved a lot of stuff by car over the year and a half I had both houses.

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18 11 2022
Alli Templeton

I don’t think moving is ever easy, however you do it, but at least we’re finally here! Yes, there’s quite a few boxes still around, but most of the rooms are taking shape now and we’re putting our stamp on the place so it feels like home. Of course, we’re slipping out to the odd castle and mountain range in between all the hard work, so that helps keep us sane!

Double pneumonia was indeed scary from what I remember. I was only 18 months old when I got it the first time, and I nearly didn’t make it, then I got it again when I was seven. I remember being stuck in a tent with lots of muffled talking around me and the zips on the side opening and random hands coming in to stab me with needles. But luckily I grew out of the weakness on my chest so don’t get problems with it any more. 🙂

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19 11 2022
mountaincoward

That sounds truly horrifying – especially for a child of 7! Glad your chest got stronger in the end. Mine has been weak since I’ve been a child but I only started with asthma when I was in the Army – presumably because everywhere you were working was a cloud of fug!

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20 11 2022
Alli Templeton

It was a pretty terrifying experience. I’ve still got the get well letters all my classmates sent in to the hospital for me. You’re doing amazingly well with your own trials though – I’d never have known from reading all your posts. All power to you. 🙂

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21 11 2022
mountaincoward

I kept one of the cards I got off all my workmates when I was in hospital with a serious asthma attack once – it brings back memories of all the people I worked with 🙂

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22 11 2022
Alli Templeton

That’s nice. It’s important to keep some things from our past that were part of big events or experiences we went through. They’re part of our personal history. 😊

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23 11 2022
mountaincoward

Yes, once in a while I take a stroll down memory lane and look at old letters and cards from people who meant a lot to me. I always enjoy that.

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12 10 2022
underswansea

Lisa has Exercise-Induced Asthma. She uses a puffer. She seems to have to ‘work through it’ when we start hiking. The first part seems the worst. Very informative blog post. Take care.

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13 10 2022
mountaincoward

Yeah – the working through it is horrible to start with but you just keep on plodding on and, eventually, it usually eases…

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12 10 2022
tessapark1969

An interesting blog. As you know I started hill walking after a completely different set of physical issues (a spinal injury) and thought hill walking would be impossible after that (not that I did it before though I had done loads of other walking). There seems to have been a lot of gritting teeth and powering through it in both cases though you are a heck of a lot fitter than I am.

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12 10 2022
mountaincoward

I’m definitely fitter now I’ve moved nearer to my favourite hills! 🙂

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11 10 2022
bob

I’ve read quite a few accounts of people with either breathing problems, life threatening illness, or some other thing that limits their potential who then go on to be super driven outdoors as it’s a personal challenge to overcome. I’m not like that… I just got fat and static as I drifted past sixty. Gathering dust, empty crisp packets, and a growing stack of watched box sets every winter, like a human bear in hibernation in my cave.

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12 10 2022
mountaincoward

I don’t believe a word of it! I can’t see you getting properly fat. We’ve all put it on around our middles though…

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11 10 2022
Janice Drake

Great read and very interesting. I’m not an asthmatic but I might follow the tip about bumbags and hands on hips for my very infrequent upward hikes. My knees are the issue at the moment!

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11 10 2022
mountaincoward

Bumbags are great for women as they just sit on your hips. I’ve got Richard to try one sometimes and I think they’re not so easy for men to carry as they have no hips so have problems with them sliding down!

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11 10 2022
Natalie Minnis

In my own case exercise seems to help my asthma. I was diagnosed with asthma in early childhood, but in addition I had a serious childhood illness (bronchial pneumonia) and had repeated flu and bronchitis in childhood. Luckily my asthma wasn’t too bad after that – I had a couple of attacks in my early 30s and then in 2006 when I started running with my sister, who is a doctor, she said she’d recently been diagnosed with exercise-induced asthma. We both started using our inhalers on cold days, but once I got used to running, the vague chesty feelings I’d been getting disappeared.

The only time I’ve had an asthma attack on the hills was about 18 months ago, when I was experimenting with nasal breathing as I climbed a hill – a very bad idea. It was a cold day, and I suddenly started sweating and my heart started racing. I thought I was having a heart attack – then I realised it was asthma. Luckily I was almost at the top of the hill, and a puff of my inhaler made me feel better. I’m lucky that my asthma has never been particularly bad, and I know how serious it can be, as a good friend died of an asthma attack several years ago. She also had a very serious congenital condition, neurofibromatosis, which made exercise dangerous.

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11 10 2022
mountaincoward

Really sorry to hear about your friend – I suppose if you have other serious complications, you really might have to avoid exercise.

Liked by 1 person

12 10 2022
Natalie Minnis

Yes, in her case a simple fall could have had serious consequences. Really interesting topic.

Liked by 1 person

11 10 2022
Matthew

I was diagnosed with asthma in 2018, after (in hindsight) around 20 years of being on the verge of it (winter coughs would take ages to disappear, and I could get into coughing fits that took me to the edge of blacking out). But what appeared to trigger it was hay fever, and it was an overdose of tree pollen that tipped me over the edge. I’m now on a combined preventer/reliever inhaler, but never have to use it as a reliever. Getting fitter has made a huge difference – at first the temptation is to succumb but ultimately, pushing through it, at whatever lowered level of intensity you need to adopt, does bring benefits. I’ve found I’ve become a lot more aware of my breathing, and consequently can tune into it and work with it a lot better. As a result I’m able to run faster and further than I ever really imagined, and I’ve noticed the stamina improvements on a long walk. I’d actually say asthma has made me fitter.

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11 10 2022
mountaincoward

Thanks for your comment – I can see we’ve had pretty much the same sort of experiences of asthma and exercise. I haven’t actually heard of a combined reliever/preventer before!

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11 10 2022
John Bainbridge

Well done and well said!

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11 10 2022
mountaincoward

Thanks John – I hope it helps asthmatics realise that they can probably have more fun than they think after the initial ‘pushing through’ and getting fit part.

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11 10 2022
Bitchy After 60

You are right. You are a determined bugger. Good for you to figure out what works best for you and your walking. It is so much better than sitting around using you asthma’s an excuse not to do it.

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11 10 2022
mountaincoward

I’m very devoted to my hills and could never have given them up (apart from the socialising in my 20s bit).

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10 10 2022
Paul Shorrock

Interesting post Carol, especially to hear the point of view of an asmatic. As a mountain rescue team member, we cover asthma in our casualty care syllabus, and asthma (for us MR people) is one of the scariest scenarios we are likely to meet. We treat with nebulised salbutamol on the hill, but it’s a potentially life threatening problem as far as MR are concerned (expect a helicopter!!) Respect to you for finding your way to a solution to keep on walking.

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11 10 2022
mountaincoward

I once started with a serious asthma attack just after I got on the Hebrides ferry and it had set out to sea. I knew I had 6 hours on the ferry and that, even if they’d called a helicopter, it was unlikely to get there in time. As it turned out, they’d just started carrying oxygen which helped to get me as far as Barra where they tipped me off into the hospital there!

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