Hillwalking With Exercise-Induced Asthma

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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