Triathlon hopeful suddenly can't catch breath

[Trihope]

I'm a 35-year-old male, non-smoker, who has been training for a triathlon for about 12 weeks, and running and exercising for years.  Aerobic capacity seemed to be steadily improving. A few weeks ago, I increased the intensity of the exercise.  After riding the bike for about an hour, I started to run and could not catch my breath. Two days later, I experienced the same thing only minutes into my swim workout. Since then, I have had tightness in my chest and the feeling that my heart is beating harder than normal. This feeling seems to be slowly improving but I still feel short of breath at times. I went to doctor who conducted BPM, blood pressure, and EKG, all with normal results. He has recommended Holter monitor because of lone incident of atrial fibrillation one year ago. Cardiologist at that time attributed it to stress and caffeine. (Now caffeine-free). I have checked my pulse regularly and know this is not a-fib. Have an appointment tomorrow to check for EIA, which I was diagnosed with in high-school football but have had no symptoms since. Only thing that doesn't fit asthma is that I'm not coughing or wheezing. Am I on the right track? Any suggestions?  Triathlon is in 5 days and I'm still hopeful I can participate. Thanks.

[National Jewish]

You are absolutely on the right track.  Wheezing and coughing are certainly common symptoms of asthma.  However for some people shortness of breath is their only symptom of asthma.  Exercise is a common trigger for asthma.  For some people it is the only thing that causes asthma symptoms.  In well-conditioned athletes, symptoms of exercise-induced asthma (EIA) may only occur with the most vigorous activity or exercise.

An exercise challenge is a test used to determine whether or not exercise-induced asthma (EIA) is the problem.  You will walk or run on a treadmill or ride an exercise bicycle.  Before and after this exercise spirometry is checked.  Spirometry is a simple breathing test that provides detailed information about how your lungs are working.  If the spirometry drops by 20% after exercising the test is positive for EIA.  If your doctor determines that you have EIA, a prescribed bronchodilator inhaler can be used 10 to 15 minutes before exercise.  This pre-treating will quickly open the airways and prevent asthma symptoms during exercise.  Please read our Exercise-Induced Asthma MedFact at http://www.nationaljewish.org/medfacts/induced.html for more information.  It is important for you to be evaluated by a doctor to determine the diagnosis, appropriate treatment, and if it is safe for you to participate in the triathlon.

Ideally an EKG should have been done with a doctor present during your exercise challenge.  An EKG that is done while lying quietly may not identify an exercise related heart rhythm problem.  Feeling a regular pulse strongly suggests that this is not atrial fibrillation but does not rule it out with absolute assurance.

[starion]

Coughing & wheezing are NOT necessary for EIA/EIB (or any form of asthma for that matter).  It DOES sound like you MAY have EIA/EIB.  Hopefully the doctor who ordered the testing can prescribe some medications you can use to pre-treat before exercising.  Intal inhalers work wonders from many elite athletes.  Some folks find Foradil very helpful, or albuterol.
Good luck in finding the answers you need & getting good control over these symptoms so you can enjoy your triathalon.
Aloha,
Starion