Did you know?
Your respiratory tract produces more than a litre of mucous per day!
Q Hay fever destroys my summer running. Do you have any tips on managing it?
A The hay fever season can extend from March to October for some people, depending on which pollens trigger their symptoms. Itchy, watery eyes, a runny nose and sneezing are the usual symptoms, but hay fever can also cause coughing and wheezing, particularly in people who have asthma. In the UK, you can visit the Met Office daily pollen forecast online and avoid running on days when the count is at its highest or opt to run indoors on a treadmill instead (remember to keep the windows closed). The count is likely to be lowest on cooler days, during and after rain, and when there isn’t too much wind to blow the pollen around, so get your trainers on and head out when these days appear.
When you do run, try to reduce the amount of pollen reaching your face. A hat with a brim, wraparound sunglasses and a light scarf to cover your mouth will all help. Try dabbing some petroleum jelly just at the entrance to your nostrils to trap pollen. When you’ve finished running, shower straight away, and wash your hair and your running kit to remove the pollen. Dry your running kit indoors to avoid it getting coated with pollen. As with a runny nose (rhinitis), there are plenty of medications you can buy from the pharmacy to ease and prevent hay fever symptoms. You can direct treatment at the worst affected area, for example eye drops for itchy eyes and a nasal spray for sneezing, or you can take oral antihistamines to work throughout the body. Sometimes you need a combination of both, but your pharmacist can advise you. If hay fever is upsetting your asthma control, then make an appointment with your asthma nurse or GP for an assessment.
Q Will running will help my asthma?
A The belief that people with asthma shouldn’t exercise has long been discarded – we now have plenty of evidence that exercise helps asthma. A review in 2013 looked at 21 studies involving asthma and exercise (including running), and found no adverse effects on the participants’ asthma from exercising. In fact, there was an improvement in cardiopulmonary (heart and lung) fitness and an improved health-related quality of life too. Another review of the literature, published in the Journal of Asthma also in 2013, found that regular exercise improved the management of asthma symptoms, lung function and mental health, and that inactive people with asthma had more asthma-related difficulties. So regular exercise is an important part of a healthy lifestyle for people with asthma. However, if at any point you have difficult-to-control or severe asthma, then it’s essential that you speak to your health care team before you exercise.
Real-life runners
Running quickly for long periods of time hasn’t been easy for me with asthma. However, when I slow my pace and keep it relaxed and steady, I find I can run amazing distances that I never thought possible! The cold weather can cause me to cough, but I usually still run, and after I have warmed up it tends to calm down. I also find a neck scarf and thermal layers are really helpful in preventing symptoms on cold days.
Abi Chapman, runner and mum
Q What’s the best way to stop running triggering my asthma symptoms?
A Make sure you attend regularly for asthma checks with your nurse or doctor, even if you feel well. These are an opportunity to have your lung function checked, talk through any symptoms you are having and make sure you remain on the most appropriate treatment. Your nurse or doctor will also devise an asthma action plan so you feel confident about how to manage your asthma between checks and know exactly when you should seek help or further treatment.
Exercise is a common trigger for asthma, especially during hay fever season or in the winter months, when cold dry air can bring on symptoms. Adequate treatment should mean that you are able to exercise freely, although you may have to step up your treatment plan to keep good control during the times of year that you find hardest. Your ‘preventer’ inhalers (usually brown) are the mainstay of your treatment. They reduce inflammation in the lungs and stop symptoms occurring in the first place, so it’s vital to take these regularly. You should always carry your ‘reliever’ inhaler (usually blue) with you when you run, but it isn’t necessary to take it before you set off. Include a good warm-up and cool-down as part of your run to gradually get your lungs used to the change of exertion. See the tips on avoiding exposure to triggers in the question on hay fever above, but the trick of warming the air you breathe by covering your mouth and nose with a light scarf is really helpful for winter running with asthma. If you feel your asthma is not fully under control, for example if you have a viral infection, then don’t run and follow the steps in your personalised asthma action plan.
Did you know?
The right lung is bigger than the left lung, because the left lung has a ‘cardiac notch’ carved out of it to make space for the heart.
Q I’m OK normally, but I seem to get wheezy and cough when I get home afterwards. Do I have asthma?
A You may have heard the term ‘exercise-induced asthma’ (EIA), it refers to asthmatic symptoms, such as coughing, wheezing or chest tightness, which occur during or, more often, after exercise. It is sometimes referred to as ‘exercise-induced bronchospasm’ (EIB), describing the way the bronchi (small airways in the lungs) spasm and narrow in response to exercise. These two terms, EIA and EIB, are often used interchangeably, but there is debate as to whether they are the same thing, what causes each one and ultimately what is the best way to treat them.
A runner with EIA gets symptoms because they have underlying asthma and exercise is the trigger. A runner with EIB gets symptoms despite not necessarily having asthma. The American College of Allergy, Asthma and Immunology states that as many as 90 per cent of people with asthma also have EIB, but not everyone with EIB has asthma. EIB is more common in cold weather sports, such as skiing and ice skating, and in endurance running. The exact cause of EIB is unknown, but it is thought that heavy breathing during exercise causes the airways to dry out. This dehydration then triggers a range of chemical substances to be released in the lungs, which leads to inflammation and airway narrowing. Reliever (usually blue) inhalers such as salbutamol stop airway spasm by relaxing the smooth muscle in the lining of the airways, allowing them to open up. This is an ideal first treatment for EIB and salbutamol can be used 15 minutes before a run to help prevent it. However, if the underlying cause is more complicated and involves any inflammation, which may be the case in EIB and is certainly a component of EIA, then treatment with preventer meds such as inhaled corticosteroids need to be considered.
It’s tricky for the GP that sees you with your exercise-induced cough or wheeze! Advanced lung testing to determine the exact cause of your symptoms isn’t readily available for recreational athletes, and usually it’s a case of exploring your history and symptoms to determine whether you may have an underlying asthma, and monitoring your response to treatment. This is clearly not ideal, so don’t be afraid to make a further appointment with your GP if your symptoms aren’t improving, but read on as there may be another cause too.
Q Sometimes when I run I can feel my throat closing up and I can’t get enough air in. My breathing is very noisy and wheezy. It happens mostly when I race and I’ve had to pull out as I just can’t breathe.
A It’s often assumed that all wheezing and breathing symptoms when you exercise come from the lungs, but this isn’t always the case. There is a condition called Exercise Induced Laryngeal Obstruction (EILO) that is increasingly being diagnosed, but is still often overlooked. The larynx is your voice box and during intense exercise it can sometimes become narrowed. We don’t really understand why this happens, but the delicate folds of tissue in the larynx close in, partially blocking the airway and leading to a noisy, wheezy inward breath as air tries to squeeze past. It is more common in young, adolescent athletes. Currently, the only definite way to diagnose it is to look at the larynx with a fibre optic laryngoscope (a small camera on a tube that goes up the nose and down the throat) while the patient
is exercising at full speed on a treadmill or rowing machine. You may also hear the term Vocal Cord Dysfunction (VCD) to describe this phenomenon, but the narrowing really occurs above the vocal cords. EILO doesn’t respond to the (blue) reliever inhalers such as salbutamol used in EIB. Instead, treatment centres on behavioural management with a speech and language specialist. Techniques involve relaxing the neck and throat muscles, learning breathing techniques for when the symptoms start, and identifying and managing triggers such as stress, which might account for increased symptoms during races. If you think you may have EILO then discuss your suspicions with your GP who will be able to refer you to a specialist for investigation.
Real-life runners
During races and training I was finding it really hard to breathe, as if I couldn’t get any air in at all. I discovered that this happened when I was stressed. Since I learnt how to calm my breathing down it has been fine.
Steven, junior athlete and cross-country runner
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Diaphragmatic breathing
The diaphragm is a sheet of muscle beneath our lungs, dividing our chest cavity from our abdominal cavity. Its contraction and relaxation creates and releases a vacuum, which pulls air in and out of the lungs. Many of us, however, tend to use our upper chest muscles to drive our breathing. By focusing on and maximising our diaphragmatic breathing we can ensure that we’re getting the most out of each breath, which can potentially help our performance. If you observe a young baby, you’ll see their belly blowing in and out as they breathe. This is what we need to try to relearn.
• Lie on your back and place the flat palm of your hand on your abdomen, just below your rib cage.
• Take a breath in. As you do so, try to keep your shoulders and chest still, and use that breath to blow out your belly. You should see your hand moving upwards.
• As you exhale, watch your hand sinking back down again.
• Repeat this for 20 breaths or until you want to stop.
When you’ve mastered this technique lying down, you can try it sitting, standing and eventually running. When you do it, always make sure you have good posture and are standing tall with your shoulders back. Complete a session of diaphragmatic breathing every day and gradually it will become natural. Spending some time quietly focusing on breathing in this way is also a great relaxation technique.
Q Is it OK to run with a cold? I get one every winter and don’t want to miss training.
A It can be really hard to maintain training right throughout the main cold and cough season. When a respiratory infection strikes, it’s usually a virus and your airways respond by producing more mucous – which makes you feel very stuffed up, affects your breathing and can make you cough. The mucous may all come from your upper airways, drip down the back of your throat and produce a wet sounding cough, but sometimes the cough is dry and makes your throat feel sore. People often assume that the greener the mucous, the nastier the infection, but we now know this isn’t true and both bacterial and viral infections of differing severity (and even allergies too) can result in clear, yellow, green or brown mucous.
The key really is how does your breathing feel and how are you in yourself? If you just have a bit of a runny nose, sneezing and a dry, tickly cough, then you’re unlikely to do any harm by having a gentle run. In fact, exercise may help to relieve your nasal congestion and make you feel a little better in the short term. Don’t push it, though. Take it easy and see how you feel. If, however, you are more out of breath than normal (test this out by walking up a set of stairs), have any chest pains, or are wheezing or coughing repeatedly, then you really shouldn’t run. Similarly, if you have a high temperature, feel nauseated, achy or just fatigued, then stressing your body by running is not advised. It’s far better to allow a few extra days to get properly well and then return to training (see here for more advice on running and illness).
Did you know?
Vital capacity is the amount of air you can breathe out after you’ve taken a deep breath in. It’s basically a measure of your lung volume. It varies with gender, age, race and height, but it’s between three and five litres.
Q I keep hearing about VO2 max. What is it and is it helpful for runners?
A Exercise requires oxygen. When you’re running, your muscles demand it at a very high rate. The maximum amount of oxygen that your body can transport and use is called your VO2 max. It’s a marker of your cardiovascular fitness and capacity for performance. It’s measured in millilitres per kilogram of bodyweight per minute and VO2 max varies with gender, age and fitness. An inactive woman might have a VO2 max around 30ml/kg/min and an inactive man around 40ml/kg/min. Elite athletes tend to have VO2 max in the region of 60 to 85ml/kg/min with men, on average, reaching higher levels than women.
Many sports watches calculate your VO2 max for you, based on your gender, age and heart rate measurements from previous runs. These calculations aren’t terribly accurate, but they give you some idea. To truly find out your own VO2 max you need to be tested on a treadmill or static bike in a laboratory while wearing a mask to measure the gas concentrations in the air you breathe in and out. You will have to exercise until you reach the point of exhaustion so be prepared to work hard! Plenty of laboratories around the country offer this service to recreational runners.
You can increase your VO2 max through training, but your upper limit is largely determined by your genetics. As your VO2 max increases you will feel fitter, be able to run faster and longer, and you will find running easier. Running sessions that increase your VO2 max include running intervals of two to three minutes at a very fast pace and then allowing three to five minutes to recover before repeating. Hill repeats are good, but rather than a short, sharp hill, find one that takes you about two to three minutes to run up. Run down slowly to recover. Cycling and rowing are great for increasing VO2 max if you work hard or you can try some HIIT (High Intensity Interval Training) too.
Whether you are interested in your VO2 max is a very personal thing. Some runners love numbers and stats, and like to track their progress, while others are just happy knowing that they feel fitter as a result of putting in some hard work.
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Breathing and running
Whatever stage of running you’re at, your breathing is a useful, tech-free way to monitor your effort level. It can tell you how much you’re exerting yourself and you can use it to vary your intensity of effort as part of your training programme, without repeatedly looking at your watch. There are variations in definitions of the following running terms, but these are what I use as a guide. Your breathing will be faster with each one.
• The speed of chat You can breathe comfortably and hold a conversation. Great for sociable runs and for very long, slow runs when you’re building up the miles for an endurance event.
• Tempo pace A tempo run is faster than your chatty run and although your breathing may take a while to calm down, it settles into a nice regular rhythm at a pace that you can sustain for about an hour. You won’t want to chat away, but you could manage a few sentences. A good pace for a 40 to 60-minute training run.
• Threshold pace This is a ‘tipping point’ pace. Creep above it and your lactate levels (waste products of exercise) rise sharply and you won’t be able to run for long. Stay just on it and your body is stretched, but you’re able to tolerate the lactate levels and therefore the pace. You’re on the edge of discomfort, but you can still keep going. Your breathing is fast, but you’re able to speak a few words in a row. It’s faster than a normal run, but slower than your 5km pace. With practice, you can maintain threshold pace for up to 30 minutes, so it’s great to throw some threshold runs and intervals into your training if you’re looking to get fitter and faster.
• Sprint pace A super-fast pace for short distances. There’s no talking on this one and you’ll almost certainly be mouth-breathing at a very fast rate. You can’t sustain it for more than
a couple of minutes, so short sprints mixed with recovery periods during which you normalise your breathing work well.
Q I often get sinusitis. I usually just keep running through it and sometimes this seems to help.
A Sinuses are hollow air spaces in your facial bones, the main ones being the frontal sinuses (in your forehead) and the maxillary sinuses (in your cheeks). They are lined with respiratory epithelium (see here) that produces mucous which drains away through small passages into the nose and throat. When sinuses become inflamed it’s called sinusitis – ‘itis’ is the Greek word for inflammation. This can happen because of infection, which is usually viral, more rarely bacterial or even fungal. It can also be triggered by allergies. Sometimes cold air can aggravate sinuses too. Commonly, sinusitis is a one-off event, usually following a cold. This is called acute sinusitis, but if it lasts more than 12 weeks it’s called chronic sinusitis and other causes such as nasal polyps (non-cancerous growths) need to be considered. When the sinuses become inflamed and swollen, the holes draining the mucous away get blocked and mucous builds up in the sinuses, causing facial pressure, tenderness and congestion. Sinusitis can also cause a headache, toothache or earache and a sore throat. It may make you feel tired, dizzy and sometimes, with acute sinusitis, feverish.
When you run, adrenalin causes some of the small blood vessels in your body, such as those in your sinuses, to contract. With less blood flow to the area, the tissues become less plump and swollen and this may temporarily reduce your nasal congestion. Of course, the exercise itself can give you a feeling of wellbeing too. However, if you don’t feel well in yourself, can’t breathe properly or have a fever, then you shouldn’t run. Thankfully, viral sinusitis usually clears on its own within three weeks. You can use pain killers, decongestants and steaming to ease your symptoms. To steam, simply fill a sink with very hot water. Make a tent by placing a towel over your head. Inhale the hot, trapped, moist air. You can add some menthol crystals or a few drops of olbas oil to make it more effective. Have a chat with your pharmacist about whether nasal steroids or antihistamines might benefit you. Chronic or recurrent sinusitis and symptoms that are just on one side of the face should be assessed by a GP, because a referral for further investigation might be needed.
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