Best types of training for those with asthma?

I can only answer generally about exercise induced asthma (EIA) -- and my information might not address your specific situation. In general -- with EIA when we find the right approach specific for the individual athlete, the asthma is no longer a problem. If you are having problems with your current plan you should consider consulting a pulmonologist with a strong interest in exercise induced asthma and exercise testing. Some basic info: Warm up is important. During warm up you drain a lot of the cells in the airway that contain the asthma triggering factors (this is called degranulation), then they are less likely cause you problems during actual exercise. Pre-treatment with short acting beta agonist (such as albuterol or xopenex) is usually the next most important step. This helps most people. If your inhaler is not working for you then it is either the wrong inhaler or you have inadequate medication delivery. It is actually very hard to get medicine into the lungs and inhalers used by themselves are terribly inefficient. When people put an inhaler in their mouth and puff, most of it winds up on their tongue and in their stomach. The right kind of valved holding chamber, used correctly, will increase medication deposition more than 3X. Some people need more prophylaxis than just one beta agonist right before work-out. There are a lot of options that can be added on top of that. This is where I think you would need consultation with an expert and lung function testing. Sometimes, after basic treatments have been initiated, we add exercise testing with pulmonary function to help isolate the problem. The most important thing I could say is: There is no need for any person to tolerate asthma symptoms limiting his/her activity -- we need to modify the asthma and not modify the activity. With the right personalized asthma plan, I believe that anyone can reach his or her athletic potential. It just make take a few steps to find that plan.

Thanks for your reply. I wish I could get the kind of health care you describe -- and I have pretty good health insurance. Instead, I seem to get the kind where they throw something at you (usually medication) and send you on your way. I'm skeptical that I'll get anyone to care about a mediocre middle-aged swimmer who'd like to swim a little faster. (If I was having trouble breathing in my everyday life, that would be a different story). I'm sure there are doctors who'd be willing to work with me, but my impression is that they are few and far between. I will, though, be more diligent about using my spacer with my inhaler as you suggest, and see if that helps. I wasn't suggesting that I limit my activity in any way. Rather, I thought I could work out smarter, rather than work out less, if I knew what to do. For example, you say that warm up is important for asthmatics, and my experience definitely bears that out. But what sort of warm-up? My impression is that long, slow warm-up is good at first, but that I can't go right from that into speed work. I need some sort of transition, but I'm not entirely sure what the best transition is -- what kind of set to do in between. (build-up build down sets? a medium speed set? etc.) I thought perhaps someone would have studied this. But maybe the reason I haven't been able to find any information on this is that no one has. :(

I've got full-blown asthma that seems to be under control for right now (amazing with all the pollen out). For warm-up, I find that doing an easy 400 I.M. and then 4 x 50 free on :50 is a good way to loosen up and get my HR up. If I follow this up with a descending set of something like 5 x 100 free on 1:45, getting 5 seconds faster on each 100, this works really well. Sometimes I get to practice late and have to use whatever set they are on as my warm-up. I find that going really slow at first and then descending my time through the set seems to work well. Overall, I think decending sets after a warm-up works really well for asthmatics because you gradually work your way into some really hard efforts. Also, if my flow meter shows that my breathing is not in the ideal zone, I'll make sure that I warm-up a little longer and allow more recovery between swims.

Thank you, Elise -- that's very helpful! I'm going to try that tomorrow. Roberta

I've had asthma since I was 6. When I swim, I take my albuterol inhalor 30 min before swimming. That helps with 90% of the problem. However, on those days that I forget my inhalor, I have to warm up, warm up, warm up. If I start out too hard and start wheezing, there seems to be little chance of recovery. I might still need to take it easy, but at least there's a chance that I can do some hard work or sprinting. A forgot-my-inhalor warmup might be: 300 free 300 IM kick 300 IM drill Re-evaulate and do another 100-300 free really smooth if my chest feels wheezy. Then on to a transition set. Typically, I do something like 6-10x50 on the minute with 25 drill/25 build... or 25 kick/25 swim... or build to progressively higher percentages... etc... This might seem like a ton of warmup pace swimming, but it's better (for me) to get started slow and easy and then have the chance to really cause some lactate pain and/or sprint my brains out than to do a bunch of yards in the medium to medium-hard range that accomplish nothing.

I know what you mean about "little chance of recovery" once the wheezing has started. So, I very much appreciate your suggestions!