Exercising Outdoors with Asthma with Neha Solanki, MD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials podcast. I'm John Horton, your host.

Exercise is one of the most important things you can do for your health, but if you have asthma, getting that physical activity, especially outdoors can become complicated. So how can you protect your breathing while working out and building fitness? I'm going to find that balance today with the help of pulmonologist Neha Solanki. Dr. Solanki Is one of the many experts at Cleveland Clinic who visit our weekly podcast to give you information you need to live your best life. Now let's see what sort of workout plan we could put together to keep you a step ahead of your asthma. Dr. Solanki, so nice to see you again. Thanks for taking the time to come back in and talk shop.

Dr. Neha Solanki:

Yes, thank you so much for having me. I'm very excited to be here.

John Horton:

We're excited to have you. And you're here today to talk about asthma and exercise and I think the best place to start is to emphasize that the breathing condition does not have to be a barrier to working out or participating in sports. It just seems like it's kind of a different obstacle that people need to overcome.

Dr. Neha Solanki:

Yes. I think asthma, it's definitely something that should not hold you back from working out. You should be able to work out, participate in any sport or activity you want regardless of the diagnosis of asthma.

John Horton:

And to that point, Dr. Solanki, there have been some incredible world-class athletes that have reached the top of their professions while managing asthma. The list includes legends like soccer player, David Beckham, Olympic Track star, Jackie Joyner-Kersee, marathon runner, Paula Radcliffe, and many, many more. And I know in reading about their experiences, it seemed like the common thread was that they all talked about learning how to control their asthma in order to compete at those high levels.

Dr. Neha Solanki:

Right. So I'm just so proud of the patients that I have with asthma who are able to exercise and to even do activities such as scuba diving, but what's important is that they have a very good asthma action plan, they work closely with me and we make sure that their asthma is controlled. And so all of those things are very important in being successful in the sphere of sports or physical activity.

John Horton:

Yeah. I mean, it seems like a lot of it is just, it's changing how we perceive it. And I know in my own life, my son has asthma and he was diagnosed young and then he got interested in running cross country and we were like, "Oh man, I don't know. That just doesn't seem like a good combo, you have asthma and you're going to run." And he thrived at it and it seemed like it helped his breathing. So I mean does that kind of something that you see often in the patients that come to you?

Dr. Neha Solanki:

Absolutely. The more you exercise, the more you improve the capacity of your lungs. So you're able to take larger breaths in, which means your body is able to get more oxygen so your lungs see more oxygen, your heart sees more oxygen and the rest of your body sees more oxygen. So it's very good for you, the more you exercise, the better it is for your heart and your lungs regardless of your asthma diagnosis.

John Horton:

And that seems to be the opposite of how most people would think. You look at it, you go, "Oh, you had a breathing problem, you shouldn't stress your lungs." But it sounds like from what you're saying, putting that extra work on them, that extra load may make them stronger in the long run.

Dr. Neha Solanki:

Yes. However, you want to ensure that your asthma is controlled and you have a good plan in place before and during your exercise. With that in mind-

John Horton:

That's why you're here.

Dr. Neha Solanki:

With that in mind, I think exercise is highly beneficial, but if you're just going into it and you're not aware of your own health and not aware of warning signs, I think it can be bad. So as long as you're approaching it with that kind of awareness, it can be very beneficial.

John Horton:

All right, well yeah, it sounds like you want to be smart about it and the way you go about doing it. And that is why we have you in here today, so you can help people get a smart plan together and figure out how they can have asthma and do all of these athletic things, whatever it is they want to do. So let's get right into it then with how someone can guard against that tightening of the airways that comes with asthma so they can get a workout in and particularly if you're doing this outside, which I know can be really problematic.

Dr. Neha Solanki:

Yes. So everybody is going to have different triggers. That's what makes asthma challenging to treat at times. So some people, their triggers are going to be cold weather, cold, dry weather. Some people their trigger is going to be humid, hot weather.

John Horton:

That's a big range. We're hitting everything.

Dr. Neha Solanki:

So, you have to. You have to, um... So you have to know your body, your lungs to know what seems to be your trigger. So for most people in the late spring summer months, you want to avoid pollen. So the best time to be, or the worst time, I guess, let's say to be outdoors is probably the morning until 10 A.M.

John Horton:

Why is that? Is that just the air's heavier or the pollen counts higher then-

Dr. Neha Solanki:

The pollen count is higher, so you want to go outside when the pollen count is lower, so the evening tends to be a little bit better in terms of exercise. The air is not as heavy, it's easier to breathe. The other thing I would say for people, especially now is to check for air pollution.

John Horton:

Dr. Solanki, we did an entire podcast on that, if somebody's interested in looking back on it, where you went over all the different things with the particulates that are in the air. We've had a lot of stuff with fires of late and the smoke that comes with that. There's a whole lot of stuff that can affect your breathing and that's why those air quality alerts are kind of important to monitor, especially if you do have asthma.

Dr. Neha Solanki:

Very important to monitor. And now we are also dealing with these Canadian wildfires and of course there's traffic related air pollution, so check air pollution alerts, check humidity, how humid is it? You probably don't want to be outdoors if it's very, very humid. So you do have to kind of keep track of these things, but once you do, I think it's great to be outside, be outdoors, running, walking, biking.

John Horton:

And from what you just said, it sounds like even, picking your location is something that can come in handy. If you are bothered by the traffic, everything coming out of the cars, try to stay away from those walking along highways or things like that. It sounds like selection is a big part of it too with where you work out.

Dr. Neha Solanki:

Location is very important, yes. And then also on those days where it is bad outside, you could always go to a gym, work out indoors if you are not able to find a location that works for you outside.

John Horton:

Now what about gear? You had mentioned cold weather. If you wear a mask, does that help a lot or can it help minimize asthma conditions from setting in?

Dr. Neha Solanki:

I think a mask helps keep the humidity inside when you're running outside in the cold, dry weather or you're exercising outside in the cold, dry weather. I would add that it's very important to also be using your maintenance inhalers if you're prescribed with that and your rescue inhaler if you're prescribed with that as well. But yes, a mask or a scarf, something like that over your nose and mouth would help. Definitely.

John Horton:

So this is going to... Silly question, but I always thought running in the cold it was more the temperature itself, but it sounds like from what you're saying a lot of the issue is more the lack of humidity. It's that dry air that's setting things off.

Dr. Neha Solanki:

That's correct. I think it's both. The cold air can trigger and then when you're very, very dry, that can also irritate your airways. So you do have to have... You don't want too much humidity, but you don't want a situation where there's very little humidity as well.

John Horton:

Yeah, that's got to be really tough then if you're in one of those kind of arid climates, you're down south in some of those locations. I'd imagine that's something that can just trigger it all the time when there's almost no humidity out there.

Dr. Neha Solanki:

Yes. So we see people who will do better in... So say they move here and their asthma gets better, then we have people who move here and their asthma gets worse. So it just depends on what kind of asthma you have and what tends to trigger your asthma.

John Horton:

And that is what makes it so tricky because like you said, different things set different people off with their asthma, so it's like you don't know until you get there and you start doing stuff.

Dr. Neha Solanki:

Exactly.

John Horton:

You had mentioned making sure that you have an inhaler with you. I mean, is that something if you're somebody with a serious case of asthma that you always recommend, you're out exercising, keep that handy.

Dr. Neha Solanki:

Yes. Whenever I hear people who are asthmatics or who have asthma and they exercise and they don't have their inhaler and they're wheezing, I get very worried. I get very concerned because asthma is okay until it isn't okay. So it's very important to be proactive about your health. It's very important to carry your inhaler with you, to use your inhaler 10 to 15 minutes before you exercise and then if you get short of breath while you're exercising because your lungs need that extra assistance. So it is very important to carry that inhaler with you at all times.

John Horton:

So you recommend if you have asthma then it sounds like people should take a hit of that inhaler, you said about 15 minutes ahead of exercising, what does that do?

Dr. Neha Solanki:

If they have exercise induced asthma, so not everybody has exercise induced asthma, so some people they can run several miles and they're fine, but some people they run a mile or two and they have a hard time breathing or they start wheezing. These people need to be taking inhalers. What happens when you're running, your airways get constricted so they get smaller and the air gets trapped in your lungs and you're not able to get all of that air out. There's also inflammation going on in your airways, so there's several processes there, air that need to be taken care of before you really push yourself in the exercise sphere.

John Horton:

Yeah, and it sounds like the inhaler then kind of opens those airways up. It keeps them from constricting, it keeps that inflammation down so that way you can get that trapped air out and I guess and get new air in.

Dr. Neha Solanki:

Yes, if you're managing your asthma correctly and you are using your inhalers as you should use your inhalers, functionally, you're just like anybody else. So you can do the same things anyone else can do, but you have to be compliant with your asthma action plan that you've come up with your doctor.

John Horton:

Now you had mentioned that you worry about your patients who go out and they kind of exercise and they don't bring their inhaler.

Dr. Neha Solanki:

Yes.

John Horton:

I'd imagine that can be extremely dangerous, especially if it hits quickly. How fast can somebody just have asthma just grip them and just really tighten nose airways up where you're really having trouble breathing?

Dr. Neha Solanki:

It can happen very quickly, like an acute asthma attack where if somebody is working out strenuously and they ignore the warning signs, so they're wheezing, maybe they have chest tightness, they're coughing, the air is getting stuck in their lungs and they're unable to get the air out and this can cause people to flip on a dime, so to say, and need urgent attention, need to go to the emergency department or urgent care and need aggressive care. So it can happen very quickly and I think some people get comfortable, "Oh, it'll be fine, it'll be fine," but you really can't predict when it won't be fine. So it's very important to be compliant with the medications and the asthma action plan as laid out with your doctor if you have asthma.

John Horton:

Yeah. And I think athletes have a tendency also to try to push through, so you start having some of those issues or you're having trouble breathing, you just think, "I need to tough this out." You can't tough out oxygen, not going in and out.

Dr. Neha Solanki:

There are people who for some reason they think that you get addicted to the inhalers, but that is not the case. You can't train your lungs out of this. And I think some people think that you can train your lungs, but that's not the case. Your lungs are actually, they're inflamed, they're narrowing, and what they need is some kind of anti-inflammatory inhaler and what we call a bronchodilator, and that's basically like an albuterol inhaler to open the airways up and to decrease the inflammation so that your airways can open up more and you can tolerate more of the exercise.

John Horton:

Yeah, there's no buzz coming out of it, you said with being addicted, it sounds like the only buzz you're getting is actually getting oxygen in and out.

Dr. Neha Solanki:

Right. There's no addiction to inhalers. Your body doesn't get addicted to it, your body needs it if you have asthma, there's no addiction.

John Horton:

Now you had mentioned, like you said, always have your inhaler with you, do you also recommend people take a cell phone out with them if they're going to be out or even to make sure you run with a buddy so that way you've got somebody there in case things go south in a hurry?

Dr. Neha Solanki:

I think that's generally a good idea whether or not you have asthma. We live in a society where we have cell phones, we have that access to the world. I think in terms of safety, it's always important to be with a buddy, but it becomes more important when you have a health condition, especially a lung condition such as asthma. I think it's important that you're not alone without any access to the outside world in case you were to have an asthma attack. So I do think it's important to have a phone, have a friend, let people know where you're going, when you're going, when you're expecting to be back.

John Horton:

Yalk to us for a moment about the importance of warming up. Because I read where that was a pretty big component of working out with asthma. Is it just a case of getting the lungs primed and getting things moving a little bit before you launch into the big stuff?

Dr. Neha Solanki:

Again, I think warming up is important in any exercise for any person because what it does is it helps your heart rate get used to the workout, it helps your breathing rate also get used to your body increasing its activity. In asthma, it's even more important because your airways are more sensitive, they're more reactive. So for someone with asthma, it's even more important to spend 5 to 10 minutes warming up so that your lungs get used to having that increased airflow, and so you're more likely to have an enjoyable exercise session.

John Horton:

It's always good to get the engine warmed up.

Dr. Neha Solanki:

It's always good, for anybody. A lot of this advice is good for anybody, but it's very useful for people with asthma.

John Horton:

Well, and I think all these things you mentioned, like you said, checking the temperature, pollen counts, air quality, those are things that, as you said, applied it to everyone. It's just if you have asthma, there's even a little extra on it and you need to be aware of the surroundings.

Dr. Neha Solanki:

Absolutely, absolutely. Always be aware of... I think asthma is interesting because it is an airway condition that is very... The person with asthma has to be very perceptive of their own triggers. So I can't tell you I what triggers you only. And when you have that knowledge, it's really important to use that knowledge to ensure that you are taking the best care of yourself. And that's done of course with the help of good partnership with your doctor, but it can be challenging in that way because you have to have that insight into what is actually triggering you.

John Horton:

Yeah, and it sounds like being flexible with your plans is a must in all of this, but as we know with a lot of athletes, that's not easy. Sometimes you have a training plan and it'll say, "Hey, you need to get in X number of miles today." Or, "This is the workout we have planned today." Or, "The game's tomorrow, so you need to practice outside today." So that gets tough. So what advice do you give folks having trouble adjusting for the weather or whatever else is going on because it doesn't quite fit with what their plan is?

Dr. Neha Solanki:

So as we've discussed, the warm-up is going to be very important. That is something you can control. The other thing you can control is using your inhalers as prescribed. So say you have to work out in the morning because that's when your team is working out, that's when you have to do this particular exercise. Please use your inhalers as prescribed and make sure to stop and take breaks if you need to stop and take breaks. It's really important not to try to push through those times where you develop chest pain, chest discomfort, wheezing, shortness of breath, and I don't think anybody wants you to push through those times. No one wants anyone's health to be at risk. So I think it's really important to be very aware of your limitations.

John Horton:

Yeah, it sounds like it's very critical to talk with your doctor, your pulmonologist, whoever you are working with on your asthma about what you're doing. So, "Hey, I've got these workouts at this time of day," and it sounds like they'll put together a plan for you. And it sounds like that can include then you said using the inhaler ahead of the activity, but then would you also maybe use it during breaks, like you go for an half hour or an hour and you use it as a maintenance thing, or is it just you use it when you start feeling symptoms coming on, or both?

Dr. Neha Solanki:

So now we're moving to instead of just using a short-acting albuterol, we want people to use a long-acting inhaled steroid. So oftentimes if you use that, you may not need an extra inhaler dose during the exercise. So to answer your question, I don't think someone has to use it every 30 minutes or anything like that. I think what we would recommend is you use your inhaler as prescribed prior to exercise, and then if needed during. In theory, it should cover depending on what your doctor has prescribed, because we're no longer doing just the albuterol inhaler. The paradigm has shifted in asthma management.

John Horton:

What are the inhalers that are available? I guess I always assume there was just an inhaler and you think it's one thing, but it sounds like there's long-term ones that can carry you a little more through the day and maybe some short-term emergency ones.

Dr. Neha Solanki:

So there are long-term... There's so many inhalers. There's so many inhalers.

John Horton:

We can do a whole podcast just on that.

Dr. Neha Solanki:

A whole podcast on inhalers. But I think the key is that now what we're recommending is that you want to, in addition to what we call a bronchodilator, so an inhaler that opens up your airways, you want to also take an inhaler that decreases inflammation in your airways. So that's a newer recommendation that doctors are starting to make. So if you're just taking your albuterol inhaler, chances are that you probably could be doing more for your asthma. You probably should be taking either a second inhaler or changing your inhaler to one that includes an inhaled steroid in it.

John Horton:

And this is where it gets... I'm trying to wrap my head around it. So the broncho... I'm going to mess up the second word. The one inhaler it sounds like it will keep work to open your airways, but you said the other, the steroid inhalers kind of hit the inflammation. I guess I always assumed those were the same things going on, but it sounds like there's two different mechanisms that are being addressed with inhalers depending on what you take.

Dr. Neha Solanki:

Right. And there's even more, there's so many different mechanisms of asthma, and that's what makes asthma so interesting to me, though maybe not to everybody, but there are many, many different mechanisms to asthma. And right now inhalers target, like we talked about, they target airways that need to be dilated, decrease inflammation. They also, there are inhalers that relax the muscles in your airways because some people have muscle tightening. Then there are medications out there, not necessarily inhalers too, but there are medications that'll help break mucus down because inflammation in airways also cause mucus to build up. So those are just inhalers. We also have pills. We have biologic medications that are shots that people take that target other mechanisms. So there's a lot more out there for asthma than we had 15 years ago. We've made a lot of progress.

John Horton:

Well, and this is where it sounds like it really is key to work with your healthcare provider to come up with a plan that hits your needs and what's happening in your body in response to what you are individually doing.

Dr. Neha Solanki:

Yes. And that's what makes asthma so cool is that we can make it very personalized and individualized to you and help you find that insight. There are ways we can do that. We have peak flow meters that we give our patients, which can help them figure out when... They check their peak flow every day, they blow into it and you can see, "Oh, today I'm not breathing as effectively as I normally do." And You can make notes and really learn what is it, is it when you're at work, is it when you're outside, is it when it's morning, is it when it's evening? And so we can really work with each individual person to map out exactly what is causing their asthma and how to treat it best.

John Horton:

Yeah, I just feel like asthma has come so far. I remember back when I was a kid in elementary school when you're doing activities and kids with asthma sitting out, and it seems like now everything has become very empowering and with these medications and in taking the time to figure out what's causing your issues and how you can address it, you really are able to do whatever you want as long as you kind of understand it and take steps to address it.

Dr. Neha Solanki:

Most people, yes. I mean, there are people with asthma that, they have a more severe form of asthma that makes it difficult. But for the purposes of this, we're talking about I think more mild to moderate asthma, people who are trying to exercise and we're talking more about physical activity in that group. So yes, absolutely, you can have a completely normal life if you just see a provider and make sure you have a good plan in place.

John Horton:

Well, that's great advice. And I guess we've kind of gone over a lot of stuff to help people get a good plan together and how they can take some precautionary steps to make sure they don't trigger asthma and even the ways they can manage it when they're out. So before we say goodbye, do you have any other just words of encouragement to offer for people with asthma who are just, they want to get out there and exercise and be outdoors?

Dr. Neha Solanki:

I would say don't give up. I think a lot of people, they just don't know... They think that this is the best that it's going to get in terms of their breathing, and I think that's not necessarily true. So if you want to exercise and you find that your breathing is limiting your ability to exercise, please don't give up hope, there are so many medications out there now to help you reach your potential. So I think just hang in there and try to see a doctor who is comfortable with managing asthma.

John Horton:

Well, Dr. Solanki, as always, you have advice to help everyone breathe a little easier.

Dr. Neha Solanki:

Yes.

John Horton:

I appreciate you coming in-

Dr. Neha Solanki:

All right

John Horton:

I appreciate you coming in again and sharing your wisdom, and thank you so much.

Dr. Neha Solanki:

Yeah, no problem.

John Horton:

The key to exercising outdoors with asthma is learning how to control symptoms and recognizing potential triggers like extreme temperatures or poor air quality, take the right precautions and there's no reason why the world can't be your training ground. If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

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