Help needed: restricted breathing on intensity training

Apr 14, 21 9:58

Post #1 of 29 (2528 views)

looking for some ideas/directions

Many years of training, FOP AG, 50 years old.

For the past few months, whenever I do workouts beyond endurance effort (i.e. tempo/seetspot) I feel raspatory restriction.
I've experienced exercise induced asthma in the past, but only on very long/hard efforts in high training stress periods. It always went away after a day of rest or recovery training. What I have now feels similar (though a milder), but it happens as soon as I increase intensity and my training stress now is lowest its been in years.

Negative for Covid and vaccinated, so that's not the issue.
My first through after eliminating covid was heart related; I went to a cardiologist and after months of extensive testing its almost 100% ruled out (I still need to do MRI to eliminate one last thing, but likelihood at this point is crazy low)
I thought maybe its overreaching, but I dropped volume by about 50-70% and reduced intensity completely (since I was concerned about the heart). Still, as soon as I raise the effort level it comes back.

I did a lot of long runs in the cold weather before this started. Could this be some lunge issue?

thoughts/ideas welcome. I'm going nuts with this minimal training and not knowing what the hell is wrong.
I already blew up training for one race, really hate to throw out the whole year.

thank you

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 14, 21 12:15

Post #2 of 29 (2492 views)

Where do you feel it? Is it a specific side? Do you eat or drink anything on the workouts or right before the workouts in which it happens?

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 14, 21 12:36

Post #3 of 29 (2480 views)

Not a pulmonary physiologist but It seems surprising that you would have a "respiratory restriction" at such relatively low stress levels as we have a large amount of ventilatory reserve. How long into your exercise do you feel this?

During your stress test, did you do a exercise stress test? How did that go? Any symptoms?
Would be interesting to see if you could obtain spirometry at rest and with exercise to see if there is some limitation in flow.

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 14, 21 12:50

Post #4 of 29 (2468 views)

If you've eliminated cardiac causes (all-but the MRI, anyway), then the next obvious course would be a pulmonologist. They are generally pretty clever folks, and have lots of exercise based tests at their disposal to see what's actually going on and determine a course of action from there. My wife's Pulmo is brilliant, and has done lots of very interesting tests on her to understand her asthma and related breathing issues.

Anything we might offer is just unqualified guessing.

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 14, 21 13:23

Post #5 of 29 (2445 views)

Are you sure it’s from your lungs? Could be a simple as reflux or some kind of constriction in your nasal cavity with increased intensity.

From 2010 through 2016 (late 20s and early 30s, but 10-15 years in endurance sport) I had progressive issues at “tempo” pace and I thought it was because I was out of shape and the intensity was too high. Initially it came on after 15 minutes at 6:30 miles, but over the course of that time it came on at lower and lower intensities to the point that I skipped over to ultras so I could still be competitive and not be screwed by not doing harder workouts. Eliminated heart issues, lung issues, etc over the course of that time. In late 2015 I went to a ENT due to some throat burning and turns out I had “silent” GERD the whole time. Things almost got completely better on medication, but I went back to the ENT in spring 2016 as I was still having some issues with what I thought was pollen and I guess my nostrils were pretty narrow - had them cauterized and I have been good to go since then.

What I mentioned may not be your issue, but if after all of the sinister stuff has been ruled out you’re still having issues, it might be worth checking on.

Re: Help needed: restricted breathing on intensity training [Vols] [ In reply to ]

Apr 14, 21 14:55

Post #6 of 29 (2392 views)

Trying not to be too mister simple here... but this has been a very wet, very green, very pollen saturated spring. Vol touched on it. I'm having one of my worst allergy seasons in a long time. It's really getting me in the pool, when I feel like I cannot get a full breath. And speedwork is killing me. But... I go through it to some extent every spring, so it's just something I'm used to. It may be just that?

Athlinks / Strava

Re: Help needed: restricted breathing on intensity training [iamAERO] [ In reply to ]

Apr 14, 21 15:27

Post #7 of 29 (2380 views)

iamAERO wrote:

Where do you feel it? Is it a specific side? Do you eat or drink anything on the workouts or right before the workouts in which it happens?

thanks for replying

Its not in specific side. Just a feeling like its hard to breath. If I take a very big breath and fill up my lungs with air I immediately need to cough.

Don't think it is food/drink related, I have not made any change to my nutrition/hydration. Generally I do all the easy stuff on water unless its 2 hours or more. Anything beyond that I'll take in carbs. I don't do any workout fasted (so even early morning swim I'll have oatmeal before)

Re: Help needed: restricted breathing on intensity training [Old lungs] [ In reply to ]

Apr 14, 21 15:34

Post #8 of 29 (2366 views)

Old lungs wrote:

Not a pulmonary physiologist but It seems surprising that you would have a "respiratory restriction" at such relatively low stress levels as we have a large amount of ventilatory reserve. How long into your exercise do you feel this?

During your stress test, did you do a exercise stress test? How did that go? Any symptoms?
Would be interesting to see if you could obtain spirometry at rest and with exercise to see if there is some limitation in flow.

It doesn't happen on easy/endurance sessions. But when I go up to tempo or sweetspot (I haven't done any threshold for a while) I get this.
It starts about 10 minutes into the tempo session.
I did a stress test for on of the heart CT scans, it was a joke. It wasn't long/hard enough to trigger this reaction.
I have not done a maximal stress test/ramp test. I'm still very nervous about high-intensity.

Re: Help needed: restricted breathing on intensity training [Tom_hampton] [ In reply to ]

Apr 14, 21 15:40

Post #9 of 29 (2356 views)

Tom_hampton wrote:

If you've eliminated cardiac causes (all-but the MRI, anyway), then the next obvious course would be a pulmonologist. They are generally pretty clever folks, and have lots of exercise based tests at their disposal to see what's actually going on and determine a course of action from there. My wife's Pulmo is brilliant, and has done lots of very interesting tests on her to understand her asthma and related breathing issues.

Anything we might offer is just unqualified guessing.

Thanks Tom, that is my next step.
I'll also look into ENT based on the other comments on this thread

Hope you are feeling well.

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 14, 21 15:53

Post #10 of 29 (2345 views)

Consider:

Vocal Chord Dysfunction (VCD). Happens on increased intensity as described.

Development of new allergy. Allergy-induced asthma is sensitive to spikes in intensity but more transient than pure EIB, in my experience, and will abate with reduced intensity.

My 2 cents. I am not a medical doctor.

Dr. Alex Harrison | Founder & CEO | Sport Physiology & Performance PhD
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Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 14, 21 16:24

Post #11 of 29 (2320 views)

Allergies?

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 14, 21 16:38

Post #12 of 29 (2309 views)

That fact that this is ongoing for a few months only with high exertion seems to be less suggestive of your asthma as I would think that would be more obvious. That said, you need to r/o suboptimally controlled asthma with PFTs.

If your PFTs are normal I'd consider checking exercise PFTs to see if obstruction happens at higher exertion levels to see if airflow obstruction develops.

That said, it is not readily obvious what's going on. Allergies seem less likely given that it's been months and isn't consistent.

Cardiac wise, it doesn't appear as though you are developing excessive tachycardia and your heart otherwise sounds functionally intact.

I suppose you could also have a PFO that pops open at higher exertion levels.

These are some random thoughts without knowing all the details. If you want, feel free to message me to go into more detail.

Re: Help needed: restricted breathing on intensity training [Dean T] [ In reply to ]

Apr 14, 21 20:23

Post #13 of 29 (2271 views)

Dean T wrote:

Trying not to be too mister simple here... but this has been a very wet, very green, very pollen saturated spring. Vol touched on it. I'm having one of my worst allergy seasons in a long time. It's really getting me in the pool, when I feel like I cannot get a full breath. And speedwork is killing me. But... I go through it to some extent every spring, so it's just something I'm used to. It may be just that?

+1 to this being cause of similar for me. Hayfever resulted in slight runny nose, which went into lungs when laying down and sleeping, which then led to cough and asthma like feeling when doing anything 6/10 or above effort wise. For me my asthma is crazily well controlled, but the feeling was the same as when I am hammering at 9/10 in the cold/damp of autumn and the one time of year I need my reliever. In the end an OTC nasal spray sorted it in 3 days.

I hope the answer for you is as simple. Took me months to get to those 3 days, but that's been a consistent fix each year for the last few. I'm not FOP, but late 40s and would say I'm front MOP with mild exercise induced astma controlled by singulair tablets for last 15 years after being diagnosed in my early 30s - I'd put my wheezing down to being unfit all my life until it was pointed out I wasn't unfit so why was I still wheezing.....

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 14, 21 20:26

Post #14 of 29 (2271 views)

I had a similar issue over the last several years that progressively got worse. I've dealt with allergies and occasional exercise induced asthma since my early 20s (I'm now 60), but this was different. When it first started, I would occasionally feel like I couldn't breath when running, mainly at higher efforts. But I didn't have any issues when swimming or cycling. It progressed to happening every time I ran, and then started to show up when riding. It didn't quite feel like my breathing was actually restricted, just that all the air I was taking in wasn't doing anything. If I slowed down to a jog or walk, the feeling would go away in seconds, and return as soon as my effort increased again.

I was seeing a pulmonologist, but he ruled out any lung issues. He referred me to a cardiologist, and (coincidentally?) I went into persistent afib the day before I was supposed to get a stress ECG. After getting an ablation, the breathing issue wasn't as bad but it was still there. It would get better for a while, then get worse again, with no apparent pattern. It eventually turned out that I was very iron depleted and anemic, and after getting on iron, b12 and folic acid supplements last year the issue has (at least for the time being) gone away...

"I'm thinking of a number between 1 and 10, and I don't know why!"

Re: Help needed: restricted breathing on intensity training [Warbird] [ In reply to ]

Apr 15, 21 8:35

Post #15 of 29 (2194 views)

Warbird wrote:

I had a similar issue over the last several years that progressively got worse. I've dealt with allergies and occasional exercise induced asthma since my early 20s (I'm now 60), but this was different. When it first started, I would occasionally feel like I couldn't breath when running, mainly at higher efforts. But I didn't have any issues when swimming or cycling. It progressed to happening every time I ran, and then started to show up when riding. It didn't quite feel like my breathing was actually restricted, just that all the air I was taking in wasn't doing anything. If I slowed down to a jog or walk, the feeling would go away in seconds, and return as soon as my effort increased again.

I was seeing a pulmonologist, but he ruled out any lung issues. He referred me to a cardiologist, and (coincidentally?) I went into persistent afib the day before I was supposed to get a stress ECG. After getting an ablation, the breathing issue wasn't as bad but it was still there. It would get better for a while, then get worse again, with no apparent pattern. It eventually turned out that I was very iron depleted and anemic, and after getting on iron, b12 and folic acid supplements last year the issue has (at least for the time being) gone away...

thank you. I believe my cardiologist did thorough bloodwork, but I'll go back and check

Re: Help needed: restricted breathing on intensity training [DrAlexHarrison] [ In reply to ]

Apr 15, 21 8:35

Post #16 of 29 (2193 views)

thank you Alex

Re: Help needed: restricted breathing on intensity training [Old lungs] [ In reply to ]

Apr 15, 21 8:54

Post #17 of 29 (2187 views)

Old lungs wrote:

That fact that this is ongoing for a few months only with high exertion seems to be less suggestive of your asthma as I would think that would be more obvious. That said, you need to r/o suboptimally controlled asthma with PFTs.

If your PFTs are normal I'd consider checking exercise PFTs to see if obstruction happens at higher exertion levels to see if airflow obstruction develops.

That said, it is not readily obvious what's going on. Allergies seem less likely given that it's been months and isn't consistent.

Cardiac wise, it doesn't appear as though you are developing excessive tachycardia and your heart otherwise sounds functionally intact.

I suppose you could also have a PFO that pops open at higher exertion levels.

These are some random thoughts without knowing all the details. If you want, feel free to message me to go into more detail.

Thank you very much, this is very helpful.

At this point, I highly doubt its heart related.
I had multiple EKGs (including stress test), ultrasound, cat scan, nuclear cat scan after stress test and there's still an MRI somewhere in my future.
Unless there's some negligence in interpreting the results I think they eliminated everything.

I'm now trying to get an appointment with pulmonary doctor (our health system really sucks), will ask for exercise PFT right away.

Thanks for the offer, will message you if the pulmonary doctor does not find anything

-Doron

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 15, 21 9:19

Post #18 of 29 (2182 views)

Have you been tested for vocal cord dysfunction? It is very common in triathletes and often misdiagnosed as asthma or something else. Are you having trouble inhaling or exhaling? Trouble with inhalation leans toward VCD while difficulty and coughing on exhalation is more likely asthma. An allergist or pulmonologist should be able to diagnose this. Disclaimer: I am not an MD, but I have worked with a lot of athletes to overcome VCD and teach them how breathe through the diaphragm rather than the upper chest (this is something you can try to see if it helps). You can determine if you are a chest breather by standing in front of the mirror and taking some deep breaths. If your shoulders lift and your back arches, you are a chest breather. If your stomach gets nice and round and your shoulders stay steady, you are using your diaphragm.

Last edited by: Joannazeiger: Apr 15, 21 10:48

Re: Help needed: restricted breathing on intensity training [Joannazeiger] [ In reply to ]

Apr 15, 21 10:44

Post #19 of 29 (2171 views)

this is why this forum is so awesome with people with so much experience. I neglected to think much about exercise induced VCD as my population is typically old, smokers who happen to be overweight to account for their shortness of breath. His whole story had been troubling me and was not all that great for asthma as the current cause even though he has asthma and it should be ruled out. Your thought is so much better and consistent.

Diagnosis can be challenging. Typically with VCD (at rest or during "asthma" attack) we will have the ENT visualize it when it's occurring. With it occurring during exercise, history will be important but from my reading, the gold standard remains visualization during continuous exercise when it happens. I imagine this is not easy (perhaps one of the ENTs can comment). Spirometry at exercise won't necessarily pick it up as he doesn't have the stress load to bring on the VCD. If airflow limitation is seen (as below) during regular PFTs, however, then it would pretty much confirm the dx.

The picture above left is normal breathing with the bottom left part of the curve being the inspiratory limb. With VCD (or laryngeal collapse) the inspiratory limb gets attenuated so that there is less open surface area for air to come in hence the flow rate (L/s) is reduced.

Last edited by: Old lungs: Apr 15, 21 10:48

Re: Help needed: restricted breathing on intensity training [Old lungs] [ In reply to ]

Apr 15, 21 10:51

Post #20 of 29 (2165 views)

Shoot, I don't know how to add pics. Plus I'm in the middle of my office so don't have time to figure it out. LOL!

Here's a link of the flow volume loop

https://www.pftforum.com/blog/vocal-cord-dysfunction/

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

Apr 15, 21 11:59

Post #21 of 29 (2148 views)

dgutstadt wrote:

Hope you are feeling well.

Yep, doing well, thanks. Had a bit of a dip in motivation at the start of the year, like a lot of people it seems. But, I started getting the itch a few weeks ago. After a bit of a practice week last week, this is my first full week back. Hence my reappearance 'round these parts. :-)

Hope you get this sorted quickly!

Re: Help needed: restricted breathing on intensity training [Tom_hampton] [ In reply to ]

Apr 15, 21 12:10

Post #22 of 29 (2137 views)

I think allergic asthma is the most probable cause. Try some anti histamines and see if you find some relieve.

It is good that you ruled out heart issues.

Re: Help needed: restricted breathing on intensity training [Old lungs] [ In reply to ]

Apr 15, 21 15:19

Post #23 of 29 (2105 views)

Thanks for all the suggestions everyone, really appreciate it.
I pushed on my cardiologist and after the MRI (which would rule out heart issue) he will get me a Cardio Pulmonary Exercise Test.
He said he will make sure that this time they will push me to near-exhaustion to make sure we are trying to trigger the response (the nuclear stress test was not even close to max effort).
Apparently this test will allow them to determine if the limitation is due to lung pathology or cardiac pathology (his words, I'm not a dr.)

So hopefully with these two tests we can eliminate that high intensity training is dangerous and I can get back to real training, though arguably may still not zero in on the issue

Re: Help needed: restricted breathing on intensity training [dgutstadt] [ In reply to ]

May 11, 21 7:43

Post #24 of 29 (1928 views)

Any update?? Have you had more tests done?
I've been in a similar boat as you for more than a year now.... Had extensive cardiac testing done (even an angiogram) as well as PFT, etc., etc. My shortness of breath is so bad that I even feel it when not exercising. Running for me is the worst (1.5 min./mile slower than usual), with swimming being a close second.
A couple of days ago, I had a bad cold coming on and the symptoms intensified. That's when I stumbled across VCD.

Re: Help needed: restricted breathing on intensity training [Joannazeiger] [ In reply to ]

May 11, 21 8:11

Post #25 of 29 (1917 views)

Joannazeiger wrote:

I have worked with a lot of athletes to overcome VCD and teach them how breathe through the diaphragm rather than the upper chest.

Can you please share how to overcome VCD and what kind of breathing exercises help? I'm definitely a chest breather. And breathing in is a chore - especially with my mouth open - even when just sitting down.
I've been suffering from shortness of breath for more than a year now. All cardiac tests (EKG, stress test, angiogram, etc.) have been negative. PFT is 40% above normal. I was put on an inhaler for a month, but it didn't give me relief. Extensive bloodwork didn't show anything abnormal either.
Throughout last year, I could tell that my endurance got worse almost weekly, as I got dropped by my cycling team mates earlier and earlier each week. 1 hour seemed to become the baseline. Running is even worse. Right now I'm running 1.5 min./mile slower than usual and sometimes have to call it quits after just 4 miles. All the races I wanted to do, I backed out of as I know I couldn't finish right now. I have my eye on another IM 70.3 in just 4 weeks and then Challenge Roth in September.
Any help would be greatly appreciated!

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