Well, this week was full of ups and downs. I swapped my asthma long-acting medication this week with mixed results - a great workout on Tuesday, but a lousy race on Saturday.
I should give some background here first.
Asthma 101 is that there are short-acting drugs (albuterol inhalers - aka rescues) and then longer acting drugs. You first try to treat exercise-induced asthma with a rescue inhaler, puffing it as needed, or right before a workout. If one starts using the rescue a lot, then one's asthma "is not well-controlled."
The next step is to try a longer acting drug. The longer acting inhaled drugs come in two categories - a "LABA", which relaxes bronchial muscles that are spasming, or a LABA plus a corticosteroid that should reduce lung inflammation. [there's also other drugs that are taken orally].
In the past I've used either Dulera or Foradil for my longer acting inhaler. Foradil, which is just a LABA, seems to work very well on non-pollen days, but doesn't cut it when my allergies are flaring. Dulera, which contains roughly half the amount of the LABA in Foradil but adds a corticosteroid, seems to handle allergy-influenced asthma better -probably by reducing the inflammation of my lungs resulting from allergies.
However, there are a few downsides to the Dulera. Some of these are common to all inhaled corticosteroids - risk of an oral thrush infection if you don't rinse your mouth after inhaling, slight suppression of the immune system, and potentially reduced bone density. The bone density issue is particularly worrisome to me because of my past history of osteoporosis.
For these reasons, I've generally tried to limit my use of Dulera - only in allergy season, and only for races (and a workout every once in a while to make sure I still tolerate it). For any other hard runs, I use Foradil. However, Foradil has now been discontinued. So I'm going to have to use something with a corticosteroid regularly (or go without, but that's not really an option at this point).
Dulera has an additional side effect specific to it - it makes me very tense and tight and anxious. I get irritable and snap at people (and then feel horrid afterwards). I often get a mild panic attack about 90 seconds after inhaling (nothing too crazy - just a very strong urge to crawl back into bed under the covers - it takes a bit of willpower to walk out the front door instead).
Because of that last side effect, plus the fact that I felt like the Dulera wasn't working as well as it could for my spring allergy-provoked asthma, I tried Symbicort instead. Symbicort is also a combo drug - the same LABA that Foradil and Dulera have, but a different corticosteroid. The hope was that Symbicort would 1) work better for the spring allergy-related asthma than Dulera did, and 2) would avoid the tenseness side effect, which I feel works against me in races and workouts.
I tried the Symbicort on last Sunday's long run, and then on Tuesday, for an interval workout. Both runs went well. Heck, I ran my first 80 second 400 in a long time. The only negative that I noted was that I felt mentally sluggish and more mellow on it - swapping out my type A personality for a type B. And honestly, that wasn't all negative - being less type A is a good thing for me.
So I tried the Symbicort in Saturday's race, as a test before using it for Broad Street (race effort challenges my breathing much more than short intervals or progression runs). And that didn't go well at all. It might be that Symbicort is not the right drug for me after all. Or alternately that I just didn't get a good puff on Saturday. Or that I would have had a bad day no matter what I puffed.
I'm probably going to try the Symbicort once more in a race I don't care too much about before giving up on it altogether. But for Broad Street I need to go with the drug I know.
I'm also going to start using the Dulera for all of my hard workouts, rather than saving it for races and using the Foradil for workouts. I honestly don't have a choice here, once I'm done with my last pack of Foradil. But additionally, I also think I've been shooting myself in the foot by trying to run most of my allergy season workouts with reduced lung function - it just makes it harder for me to recover from workouts, encouraging a plateau.
On that same note, I'm also going to be slowing my workout paces down, and dropping back a workout group. I think I'm in much better shape than my recent race times suggest. Which also means that I haven't run a race recently that comes close to equating with my workout paces. Which is a red flag, regardless of the excuses one may have for each race, indicating that one needs to slow down (plus it's always better to work out too slow than too fast).
My coach also noted that I really need to be careful not to push my workouts too hard (and also to feel free to skip one now and then). I'm in my 40s and I don't recover as fast as my younger teammates, so I need to shift things a bit to be sure to hit the right balance. I noted that I was worried about losing my leg speed if I did the intervals too slow - I'm slowtwitch and a shuffler by nature. He noted that I could always just crank down the pace for the last 1-2 reps, while keeping the others much more controlled. So that's the plan for the next few weeks of workouts.
(and yes, you've read some version of the above paragraph in the past on this blog - about once every 6 months or so... I remember, and then I forget and need to be reminded....it's the cycle of running life)