A bunch of things stick out to me. I have severe asthma, was born with it, so here goes-
-you were feeling tight the days before, but did nothing about it.
-sounds like you were pushing the pace until your lungs basically gave you no choice but to stop.

Go to your doctor, get your asthma under control.

I am very well experienced in having to back off during a race/training because my lungs are being pissy. Yep, it sucks. But at the end of the day, backing off and letting my lungs dictate the pace gets me to the finish healthy, not DNFing with a stay in the hospital having massive amounts of steroids dumped into me. I learned this the hard way, you absolutely do not want to do that.

My asthma is currently well-managed, but I have definitely found it a limiter on long days - especially if the water was cold on the swim (or if as in your case there was something like a smoke air pollutant), the body after a certain point just doesn't respond much to albuterol. If you're not taking controller medications (I am on Qvar and Singulair, both of which are very helpful), you should think about it - but like the previous responder, it has been my opinion that sometimes the smart thing to do is walk it in (or significantly slow down pace so that breathing is manageable!).

this makes so much sense! i never thought about it like that.

i would say my asthma is under control. i have triggers of smoke and common cold and maybe some others i'm not remembering and will either flare or have an attack then. i take a daily maintenance and albuterol for rescue. i Very Rarely need it training - just sometimes - and never more than a couple times a week (and that is rare). without my maintenance med i'm sucking on the puffer like an addict. :)

this was the first time in a race i've flared and it really sucks. not fair! (pouts and stomps foot). yeah, cry me a river. :) but you're right - avoiding an attack needing steroids is the better option. thanks for the insight!

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http://harvestmoon6.blogspot.com
https://www.caringbridge.org/visit/katasmit

thanks so much! i've never had a situation where (i guess i wouldn't let) my body respond to the albuterol. i mean, it did respond but then i'd try to push again and i guess it just said, 'nope" In the back of my mind I was thinking, "just lie down and then you won't have any trouble breathing and the albuterol will work" but i thought i could work through it. i'm also on maintenance - i got between pulmicort and fluticasone - and rarely flare except with certain triggers.

thanks again for the insight!

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http://harvestmoon6.blogspot.com
https://www.caringbridge.org/visit/katasmit

You are lucky. This is exactly how athletes die from asthma.

Your statement suggests one of two things. (1) It was something else causing you to feel short of breath such that albuterol was not the appropriate treatment. Given that you have asthma, this is probably less likely. (2) Your body stop responding to the meds. Asthma is where your airways spasm. Albuterol provides temporary relief and the airways will calm down after a bit. If not we add steroids to help with the underlying inflammation. Once your airways stop responding to albuterol (in a severe flare), giving more albuterol is not helpful. From now, take that as a sign to stop and seek help.

All of the comments seem spot on. I'd be curious to see what st member DrAloha says.

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I'm just this guy ya know?

i'm surprised to read this. i know i was flaring and a little more than usual as i couldn't walk, eat and breathe all at the same time so i just walked and breathed and took on no nutrition. when i'm really bad i can only breathe and lie down - no walking, no eating, no talking and breathing at the same time. if i had not been able to walk and breathe i definitely would have stopped at the med tent because that means a neb for me and maybe roids too.

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http://harvestmoon6.blogspot.com
https://www.caringbridge.org/visit/katasmit

Ask your doctor to prescribe you a peak flow meter and to teach you how to use it. It's a good tool to assess how you are doing and to take corrective steps before your asthma gets out of control.

Kar-Ming

My asthma is mild and only bothers me in certain circumstances but very rarely. My first IM was perfect conditions for a flare...cold and rained all day. About 1/4 into the run, I couldn't breath was honking like, stopped running and took my inhaler. I was afraid medics or officials would pull me from the course. I choose to continue on walking so I could finish and my breathing was okay. I went to a doc after my IM for help, and he said stop doing races or tris as that was an easy answer. I went to another doc who helped me.

For me cold and wet in the 40-60 range is a trigger plus if I get a cold.

I don't know the answer for you, but can empathize other than I was near the BOP of my AG. Hope you get it figured out going forward.

i have a peak flow meter and use it at home but you're suggesting i bring one to a race? i knew i was getting in trouble because I couldn't breathe and run. then i couldn't breathe and eat a pretzel and walk and i was gasping for air after taking a sip of water. i know from past experience where i'm going there (neb city) so i'm not clear why a peak flow meter would have been helpful in the race.

maybe i'm misunderstanding? or you're saying i should have used it when i was feeling tight the days before the race and pretreated? yeah, that's probably right. at any rate, rest and neb and yesterday i was recovered enough to swim.

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http://harvestmoon6.blogspot.com
https://www.caringbridge.org/visit/katasmit

thanks kath. i've never flared or had an attack in a race - in training, but easy to back down then and call it a day. i just figured out the smoke trigger a few months ago and now in retrospect it makes so much sense to other flares/attacks. :) hope all is well with you!

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http://harvestmoon6.blogspot.com
https://www.caringbridge.org/visit/katasmit

Here is a piece from a blog post I put up yesterday!

I titled it: Asthma Be Gone

It is about how I treated my own asthma.


How Did I Treat It?

I became a nose breather. There are less extreme options, but I will detail my exercises along with other life changes:

• Nasal breathing exercises (place finger under nose, breathe lightly as to not sense heat on finger) for 30 minutes 3 times per day. This could be carried out a few times for a few minutes. Always assess control pause before and after to see the difference. Mine would often double!

• I breathed through my nose during training, the little of it I could do. My asthma was so bad I had to train very lightly. Sprints in swimming were an auto-asthma attack. This is from the hyperventilation and expiration of large amounts of water through each breath. It is also from a severe drop in carbon dioxide in the lungs, a result of hyperventilation.

• I became well hydrated (a technique I completely refined recently, Drink pure spring water, mineral enrich it with concentrace drops, and consume pink Himalayan sea salt with food or before the water at a rate of 1/8 tsp per 8 ounces). The morning is a key time, after losing at least 1 liter through the breath and from sweating overnight. Asthmatics will lose more than this. Start the day with dissolving sea salt in the mouth, plus 20% of your body weight (kg) in ounces. An 80kg person would drink 16oz. Don't exceed this amount in a two hour period.

• I became a nose breather at night. For 6 months I shaved my face clean and duct taped my mouth shut at night. This may not be necessary, I later realized that once nasal breathing becomes a habit all day long - and the body gets well hydrated along with avoiding junk food - the body will take this habit and apply it at night as well. No duct tape required.

• I measured my control pause to gauge progress - after a half exhalation, record how long you can hold your breath before the first urge to breathe. Under 10 seconds is severe, approaching risk of death. 10-30 seconds is diagnosable asthma and needs improvement. 40-60 seconds is considered normal. 60+ is excellent. I started at 7 seconds. I got to 85 seconds over 6 months. For kids it is best to do "steps"- hold the breath and see how many steps they can take before needing to breath. Adults can just sit comfortably and hold the breath.

• Avoid smoking, all second hand smoke, and always breath filtered air (that means through your nose and not your mouth! - it's that simple). The last time I smoked pot was first year university. I was not a smoker, but I did it once that year. I coughed for 35 days!!! I am not kidding. Want a flare up of untreated asthma? Go smoke something! Needless to say, I haven't smoked anything since 2008.

• Avoid alcohol, once treated and healthy I limited beverages to 1-2 per day. I personally opt for none now, but that's just my choice.

• Eat a balanced, nutrient rich diet void of flour and sugars. These foods (bread, junk food) actually dehydrate the body (because the nutrients and water have been lost in processing), they also reap minerals instead of supplying minerals (once eaten, minerals and water are required for digestion -if not supplied by the food these would be taken from the body). In all cases, these foods will make asthma worse. There is no room for junk food when treating asthma. It will dramatically set back the progress, decrease sports performance, and worsen all symptoms. My asthma would often flare within minutes of a bread or pasta based meal. It boggled me until I studied and understood the nutrition aspect.

• .No Junk Food. This is so important I am saying it twice. Junk food is anything man made, pre packaged and contains refined sugar and flour. It is the staple in most people's diet (no coincidence that so many have asthma). If one seriously wants to get better, its going to have to be on a diet of fruits, vegetables, nuts, seeds, dairy, meats and fish, and pure clean spring water (www.findaspring.com).

Don't believe me? Christmas is three weeks away- watch your symptoms go through the roof with candies, chocolates and sweetened drinks. I advise against this, as asthma can result in death, but if you don't believe me yet, pay attention to your symptoms this junk-engorging holiday then come back to this post!

• The world's best anti-histamine. This is sea salt and water. In the case of allergies, dissolve 1/8 tsp sea salt on the tongue, then drink 4-6oz water. This is the word's greatest anti-histamine, don't take reactine or other drugs. They treat the symptom, but you are still dehydrated and needs minerals. Give your body what is needs and it will shut up. Don't just jump to shutting it up (drugs)!

• Kick the drugs. The most exciting part was not taking medications and knowing I didn't need them. When the control pause was over 45 in the morning, I no longer needed them. EVER. It saved me a lot of money, and my liver is now much happier for it! It has bee 4 years since I treated myself. Not a single though was given towards a medication since. Not a single symptom, actually.

Cheers!

Use it when you are starting to feel tight.


Before that you should calculate your peak flow zones based on your pulmonary function tests (or ask your doctor). Also get a rough baseline number in the evening and in the morning as some people have worsening of their asthma during the night. If there is significant variability between am and PM (>25%) then your nocturnal control is suboptimal or you may be beginning to flare.
Once you have a baseline then you can take your measurements periodically. If you are dropping into the yellow zone then beware, if it is in the red zone then you will likely need to be on prednisone.

I don't mean to be snide (nor do I profess to know it all). I really see this forum as a great place to educate people about their health but I am not sure where to begin. . .how does being a nose breather correct asthma? Also what is the concept of sudden drop in paCO2 levels with hyperventilation and how does spitting out water have anything to do with it?

I understand many people prefer alternative therapies to Western medicine and have their own personal health beliefs but there appears to be some errors in your understanding of human physiology and pathophysiology. I have to pick up the kids now but will address soon.

Kar-Ming

Go read the full article.

I didn't say anything about spitting water.

Maybe my knowledge of physiology is not perfect. What I wrote about cured my own asthma, has cured many others' since, and actually I have failed to see it fail in those who actually follow it.

It's too long to post here. I also know there rules against linking to personal blogs in a post.

In a nutshell, asthma is a protective mechanism to prevent further losses in fluid that would be lost via expiration. If that's what you referred to as "spitting out water", then yes asthmatics spit out a lot of water. At some point, the airways constrict to prevent further loss and prevent death.

The nasal canal contains a complex network of "filters". On both inhalation and exhalation this has many benefits over mouth breathing- which is a direct portal in and out of the lungs bypassing these important filters of the nasal canal.

One of these mechanisms is to limit the amount of moisture lost in a breath. Next time you are in the freezing cold, note the minimal water vapor (like a steam) from a single nose breath, then the much greater amount from a mouth breath. I think that should be clear enough. Now loose this extra amount of fluid all day long, every day (asthmatics breathe 3-4x the volume of a healthy individual per day, almost always through the mouth). See where this is going?

Chronic dehydration. What happens when you get dehydrated enough? You die. The body will do whatever is can not to die. Humans are armed with this mechanism to constrict airways and limit water loss.

There are many other reasons, but like I said go read it all.

I also do not know it all, but what I learned and applied works. Maybe it was by mistake? Confounding variables? Etc. I won't deny that. Considering that medications are a poor treatment, there's not much to lose.

Western medicine is nothing short of amazing and has it's place. But there are limitations.

My bad. I was confusing your mention of expiring water vapor with spitting the water from the pool. Nonetheless, I think that there is still a misunderstanding (perhaps I'm the one misunderstanding) re: your understanding of asthma. BTW, I did read your blog and am not certain what to say. I think you make jumps which are not there. In case people don't know, I'm a practicing pulmonary physician for the past 13 years. So here goes. . .

1. Unless you are talking about something else, asthma is NOT a protective mechanism. It is an chronic inflammatory process involving the airways. In particular, the airways is not referring to the nasal passage. Rather it is the lower airways also known as the bronchi. As a result of this chronic inflammation there is airway obstruction which, in layman's terminology, results in less air getting into the air sacs per unit time. As a result people get short of breath and wheezing. It has zero to do with preventing "further losses in fluid that would be lost via expiration." Water gets evaporated whether you breath through your nose or mouth. It is part of the insensible losses of fluid that occurs in our body. Other examples include sweating.

2. I am not aware of any data suggesting that asthmatics breathing 3-4x the volume of a healthy individual in any given day or have low CO2 levels "... many times closer to death than healthy on the continuum." Firstly, most asthmatics are not in exacerbation. As a result their minute ventilation (respiratory rate x volume per breath aka tidal volume) is only as much as is required to maintain a pH of approximately 7.40 (which is where the body is at equilibrium). If they did have a higher minute ventilation this would be reflected in the low Carbon dioxide levels that you mention. This does not happen. I know because I've ordered thousands of blood gases on patients, asthmatics or otherwise, and it doesn't happen.

3. In regards to the nasal filters, what are you even talking about? It makes no sense.

4. In regards to dehydration, we simply drink fluid. There are quite a few topics here re: the thirst mechanism. We don't get dehydrated from breathing. It does not happen to the degree you are implying. Sure we do things such as heat mechanical ventilator circuits for people on respirators so that we minimize insensible losses but this is clearly not what you are referring to.

Ultimately what you are saying is your interpretation/rationalization of what is happening. That's okay for you to think of it that way but it has no scientific basis. I think it is also dangerous for you to suggest that you cured other people's asthma. People will look to your blog and since it's on the internet, it must be true and so they may come off their meds because they want a reason not to use their medications or not to believe their physicians. Therein lies the problem. That's quack advice even if you put the disclaimer that you are not a doctor.

Kar-Ming

Kar-Ming,

You may not have noticed that my blog post and writing is an attempt to bring science into easy to understand terms. I offer nothing of possible harm (I suggest that once a person is asymptomatic, they may not find any need for medication. That is a self assessment, nothing I can predict), and therefore have no fear about jumping over science to provide the message that people need to hear. If I provided all of the science, everyone would fall asleep and learn nothing. They would never overcome asthma.

I attempt to get to the point and reach out to the average individual. I try to keep thing as easy to understand and practical as possible.

Unfortunately, you try to use big words to sound smarter and superior. Maybe you are, maybe you aren't. Yes you are a doctor, which is very credible to most. But don't try to sound too high and mighty. You may be just a bit too eager to drop the doctor plug on this public forum. Instead of increasing your credibility as you may wish, I see it as a weakness and rather a big "hey look at me". Big words and big titles are not going to help the average person comprehend what you are presenting. In fact, maybe even less then if you did not drop these features here. Remember that in the future.

In addition, I am blown away by your misunderstanding and lack of knowledge. By airways I refer to alveoli, bronchioles and bronchi of the lungs. This inflame, produce excess mucus, and therefore contrict to prevent loss of fluid. Yes, that is true.

I refer to CO2 in the lungs not the blood. I am aware that the blood pH will not alter significantly. I am simply referring to the % of oxygen and carbon dioxide in the lungs.

Hold your breath, the blood will pick up oxygen and drop off CO2. The longer you hold your breath, the higher the CO2 will rise. The opposite occurs when you hyperventilate. This becomes the issue with asthmatics. I am referring to the CO2/O2 ratio in the lungs, not the blood. The lungs help regulate the alveolar fraction of gases to maintain homeostasis so that the blood pH will not change in times of greater or lesser availability of oxygen, as you referred to the blood pH does not alter much. If it did we would die.

Maybe you have been practicing for 13 years, but maybe you also still have more to learn. Everyone does.

I will learn until I die. I then will only be approaching a fraction of the greatest science. But I won't stop. I will never know it all. If I help people with my knowlede, I am doing them a disservice not to learn the best and most that I can. The issue many make is that once they graduate from school and begin to practice, the learning stops. That's a huge mistake. Graduation is a beginning.

So what you are suggesting is that instead of correcting the health issue that lies in the person with Asthma, that they should continue to mask the symptoms with medication and ignore the underlying cause? There is an underlying cause. Asthma is not normal for anybody.

What I am suggesting is harmless. Do me a favor, try it with one person. Let me know how it goes. You may learn something new about humans! I mean that with the most respect.

Also thanks for chiming in. If what I presented was wrong, or has holes in it that people should learn - then I appreciate you helping with that.

As Roger Bannister once said "The human body is centuries ahead of exercise scientists". I think the same can be said for more than just exercise science!

Jon Slaney *Not a Doctor* - just and average guy sharing his experience with asthma and diligence to not suffer from it.

I have exercise induced asthma (one of far more annoying contributors to a shitty as tri experience).
At first my doc said to take ventolin whenever it happened. So I did. worked great. A short time later I went back and asked for another puffer. She said I was only supposed to use it when I exercised. (she didn't know I was an OCD triggek). I told her that's the only time I used it. I explained the tri thing and she switched me to flixotide twice a day. That works pretty well so I rarely used the ventolin. I managed to get that to swimming use only.

I never had a full on asthma attack during a race, but I always carry ventolin with me. I've never had an attack bad enough to stop me, but my pace slows and getting anything close to a real breath just gets harder and harder. In my case, my heart condition or my excessive weight are what stops me before asthma gets a turn :-)

Good luck finding a solution, but as others have said, an ounce of prevention is worth a pound of cure. Even then, you might get attacks. If you can identify triggers you might be able to deal with them (ie slow down but keep running, rather than keep running, then stopping for good) even jogging is faster than walking. Doing whatever you body allows is the best you can do. It's a royal pain to have some sort of physical limitation dictate your race, compared to what you think you should be doing, but your body is the boss at the end of the day. You can only play the cards your are dealt. We all have a cross to bear so to speak. Your cross seems to be asthma. Good luck

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TriDork

"Happiness is a myth. All you can hope for is to get laid once in a while, drunk once in a while and to eat chocolate every day"

Wow that's pessimistic!

I will have to say that you are wrong.

Please don't put poor thoughts like that into the minds of someone with an illness that needs treatment. Not just the OP - but many people who will be attracted to this thread because they too can't enjoy the ironmans they love due to asthma.

If a loved one had cancer, and has to undergo treatment and battle it do you tell them - oh well that was the hand your were dealt in life, time to die?

If you are not going to do people good - get out of here!

As opposed to posting a bunch of witch doctor, unscientific, n=1 bullshit.

Seriously???

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Favorite Gear: Dimond | Cadex | Desoto Sport | Hoka One One

Yes, seriously!

Nothing witch doctor here. Medicine is highly valuable. There is much more out there then medicine. I honor both of those.

If it wasn't for science and knowing how to read it, and hundreds if not thousands of good scientific articles at that - I wouldn't have found the answer that I searched for.

I am proud of that. I will not be put down by you.

But just so I'm clear - you think it's okay to tell someone to just give up?

Just so I'm clear - neither I nor tridork stated any such thing. Or implied such thing.

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Favorite Gear: Dimond | Cadex | Desoto Sport | Hoka One One

"It's a royal pain to have some sort of physical limitation dictate your race, compared to what you think you should be doing, but your body is the boss at the end of the day. You can only play the cards your are dealt. We all have a cross to bear so to speak. Your cross seems to be asthma. Good luck "

Quoting tridork.

You obviously think I am wrong - so if the above is not what you are suggesting, then what are you suggesting?

Please remember why we are on this particular forum. The OP suffers from asthma and struggled in her race. I provided some insight, tridork said that "you can only pay the cards you are dealt". I have a huge problem with that. Tridork is wrong on so many levels, in the case of asthma.

And since you are on this forum - which is about the OP's struggled with asthma in ironman, are you going to be of any help? Isn't that what you chimed in for?

I fail to see the part where he said to give up. Pretty sure he's saying that some of us have obstacles and we need to find a way to deal with it. He didn't say, "Oh, you have asthma so I'd just quit."

Let's get back to dissecting your quackery from above. :-)

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Favorite Gear: Dimond | Cadex | Desoto Sport | Hoka One One

Sure, please dissect my post. It is a small piece from a longer blog post, which is the non-scientific user friendly version of a 55 page meta-analysis.

Please read the post in it's entirety as well. Please keep in mind the goal of the thread. I am on here because I do not believe the OP needs to suffer asthma in ironmans. You appear to be on here to pick on me for trying to help someone. That is unfair, and low.

If I am presenting quackery (according to you), then maybe quackery isn't such a bad thing? After all, if you are not a quack - I am happy to be separated from the likes of you.

I am not suggesting use of some crazy oils, or herbal remedies, or even anything spiritual or anything in terms of alternative medicine at all actually.

Asthmatics breath too much. They loose too much water with each breath. I simply reversed that by reducing my breath and breathing through my nose, and becoming hydrated? I don't see the quackery?

Is it because I wanted to be a great athlete and refused to suffer from an illness that was obviously not necessary (which I realized because I did not suffer to it prior to a 3 month extreme heat exposure) and refuse to give up on my goals in life and sport?

Well if that makes me a quack - then I am very happy to be a quack. I am also even happier not to suffer from asthma. I am here to share my experience in hopes that to help another person. I gain nothing from that but the satisfaction of helping other people in need. Let me guess, that makes me a quack too?

Once again, what's your contribution to this thread?

I have mild asthma on a regular basis that gets bad when the exercise induced component gets mixed in. My last three Ironman races were affected by asthma to some degree. At IMAZ I had to stop at about mile 80 on the bike for several minutes to get my breathing back to normal. I didn't have my rescue inhaler with me and it was kind of scary. Ironman Canada 2013 I crossed the finish line and had to be taken to the med tent to get my breathing under control. Ironman Florida a couple of months later had me walking for a mile or two in the middle of the run in order to get my breathing under control.

So yes, I have experience in the matter.

So my "help" and advice is much like others... Kathy should seek the advice of a doctor. Dr. Lo was far too diplomatic in his response to you because he's a caring professional. I'm not so your advice from above was mostly a big steaming pile of bullshit. That's what he really wants to say to you but can't.

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Favorite Gear: Dimond | Cadex | Desoto Sport | Hoka One One

Okay, I hope I did not come across wrong. I can get defensive (as you may have noticed!). I do apologize.

I am really just trying to help. I feel for people who go through this. I can see how you or others may be offended and may immediately reject my ideas. Asthma is so harsh and tough to deal with - that once you accept it you will quickly frown upon suggestions like mine.

Here me out. I was told my asthma was also exercise induced. I learned that in the literature. It all came down to hyperventilation.

The higher your heart rate, the more you breathe. This is hyperventilation. This aggravates the asthma, because the person gets dehydrated quickly. Add on this the sweating in the event. You can see where I am going!

So exercise induced makes much sense in my proposed model.

I was a horrible asthmatic. I know how it feels. I initially went to University as a young punk who just wanted to swim and run varsity. I actually fell in love with learning too!

I sat out one varsity season because I could not train due to asthma. There were many swim sets where I would give it my all but no matter what I would have an asthma attack. That year I really studied. Not just my sports science courses - way beyond.

There was one in particular - I came to call it the asthma inducer lol. 30 x 50m dive start sprints on 60. The coughing by various swimmers by rep 15 was enormous. Though I made it many times, there were some ugly times. Once I ended up in the hospital on oxygen. Most times by stopping and slowing my breathing I would be okay, but not always. That's before I learned the root cause of asthma. Something had to give. The doctors did their best, I tried every medication. I got worse.

So I decided to see what science had to say. It had a lot to say, it just took a lot of reading!

I think you may have misunderstood my intent. Of course written communication loses a lot.

I have lots wrong with me. I've had tons of accidents (skiing and cycling) that have led to all sorts of lingering issues. I have heart problems, lung problems (I lived beside an asbestos mine for a while as a kid), asthma, heart problems, arthritis etc etc.

Yet, for almost 25 years I managed to get up every day, push myself to my feeble limits and give it a damned good go. I was a thoroughly addicted but mediocre triathlete

For ones limits, I include things like work. Trying to get training fitted around a job can be a right royal pain, and limit what we can achieve. Likewise, family can be a limiting factor. One of the reasons I was crap at tri was because I willingly gave up evening workouts when one of the kids would ask for a bed time story, or just to cuddle on the couch. Geography/climate is another limit imposed on us. Hard to go for a long bike ride after 30cm of snow fell last night. There are all sorts of limits on each of us. Slowtwitch helps us all to get over or around our limits and become better than we were yesterday. That is one of the great things about ST, we all (more or less) bring our experiences to the table so that others can learn from our own mistakes and successes, so we all win in some way.

In spite of the limits each of us have imposed on us, we can only do the best we can. Some limits are more obvious than others, but we are all limited one way or another, and we can all just do what we can with the limits we each have. Our limits should not stop us pursuing our dreams or enjoying our lives, but we need to acknowledge that they exist and to be happy and satisfied with doing our best each day.

It was not my intent to put anyone down or to discourage anyone, just to highlight that we all need to be happy with doing our best within the limits our own lives.

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TriDork

"Happiness is a myth. All you can hope for is to get laid once in a while, drunk once in a while and to eat chocolate every day"

You know how best your 55 page meta can help people? Don't present it that way. I read your "paper" and to it I say, "What are you saying?" Help people who you have the true ability to help, i.e. the people you see and test face to face. Pulmonologists don't dx people from afar and neither should you. The best advice you can give to your triathlete asthmatics is this: "Learn about you (Perceived Exertion) and when you feel like you are breathing too hard, back off." Tell it to THEM. And one last clarifier for me, if I breath through my nose when doing a long run will I need less electrolyte? Just wondering because I have not done the lit review...the kidneys are kind of far from there.

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Swimmer
http://www.usprotri.com/LAMASTRA.html
http://www.bodyphyxinternational.com