February 18, 2024 - Airtrim And Exercise Induced Asthma

Yesterday, I had the opportunity to hike and run in the Black Hills of South Dakota in relatively cold and dry air for a few hours. That also gave me the opportunity to test out the Airtrim Sports Mask I recently purchased. The Airtrim Sports Mask is a heat exchanger mask intended to warm and moisten air before the mask wearer breathes it. An interesting idea that would hopefully resolve one issue I have experienced when running high altitude ultramarathons in dry climates. And this trip to South Dakota would be perfect for this test, as I had just wrapped up with a head cold that had also getting into my lungs a bit, and having a way to possibly protect my lungs just made sense.

The first year I ran Ouray 100, I dropped out of the race at mile 62. I was actually several hours ahead of the cut off and quite lucid and moving reasonably well. Well enough that the aid stations workers at the spot I dropped were doing their absolute best to get me up and out of the chair. But I wasn't dropping because I felt miserable or unable to continue form a leg strength or mental strength perspective. I dropped because in the long, steep, technical climb up Hayden Pass to the aid station, I had developed a significant wheeze in my lungs and felt like I was barely able to breath at all. I had stopped two thirds of the way up the 4,000 foot climb for about 30 minutes wondering and worried about how I'd finish the climb and make it to the other side. I wondered if I'd be hitting the SOS button on the GPS tracker and needing help down. I simply was breathing so poorly that it felt like I had no energy and no power to move. In that moment, I took a diamox pill I had carried just for such a moment, and 30 minutes later found enough in me to get up the climb and down the other side of the mountain. But I had also told myself ahead of time that if I took that diamox pill, it meant my race is over. Not just because it's a banned substance, but also because it was a sign to make a smart decision and be safe. And that's what I did. (Sidenote: knowing now what I do about the final 60 kilometers of the Ouray 100 course, even if I hadn't dropped when I did, I would not have finished the race. I simply was not ready for it in that first year.)

After the race, continued to have breathing struggles and wheezing and a cough for many days. Frustratingly for me (and probably for everyone around), on the way home, that cough sounded quite nasty in the airport and on the flight home. This was in July 2021 when many people where still extremely concerned that every cough they heard around them meant a severe case of COVID would shortly follow. I didn't have COVID, but I sure sounded like I did. Once I got home, I visited with my doctor to make sure something I hadn't been hit with something more significant in my lungs, something altitude related perhaps. My doctor could hear a rattle in my lungs, was a bit concerned about this, and sent me for some imaging. In the end, there really wasn't anything to find or be worried about. By the time the imaging had been completed, about 14 days later, my breathing was back to normal and everything was fine. After some reading and conversation with my doctor, we decided I had likely experienced some lung alveoli inflammation and exercise induced asthma that had been brought on by heavy breathing and hard effort in the cool dry nights in the San Juan Mountains. And the wheezing had begun during the first night of the race when it was cold enough for snow to fall.

This made a lot of sense. My second year at Ouray 100, I did not experience the same issues. I had gone out to acclimatize. But more importantly, it was a much warmer year. So warm, I never required gloves and my jacket rarely stayed on long. The air was dry, but it was not nearly as cold. And my lungs didn't suffer the same way. My finally confirmation that this was probably the right diagnosis (it was just a guess after all, with no way to absolutely confirm it), was a trip to South Dakota in 2022 in the winter. I ran a hard track session while during a cold, clear, dry evening. By the time I got back to the warmth of my room, I was experiencing the same wheezing and a little bit of heaviness in my breathing, similar to what had happened at Ouray 100 year 1; though on a much less impactful level.

So, exercise induced asthma and lung inflammation brought on by hard aerobic efforts in cool dry air was the likely culprit, and the search for solutions was on. The Airtrim mask was one of the first solutions I came across, an a pretty inexpensive and simply solution at that. It has taken me over a year to finally purchase one and test it out, but I have been doing so this week. And so far, the results are very encouraging.

I've run in the cold dry air in Rapid City each day since Wednesday, and worn the mask all but once. Yesterday, I headed out to Spearfish, South Dakota for some long challenging hiking and running through quite deep snow up Crow Peak and wore the mask for most of the time. The entire time, my breathing felt better than it normally would, I noticed no lung distress, and I was very encouraged. It makes sense, of course. The mask slows the flow of air just long enough for it to warm from own body heat and moisten from the dampness of my breath. And breathing absolutely felt warmer and moister. And there was another side benefit, I didn't expect. Despite running in some relatively cold conditions from someone just arrived from South Florida (shady, windy, and in the mid twenties on my second hike yesterday); I felt considerably warmer than I normally would in those temperatures. Warm lungs, warm body, I guess?

There are some confounding factors I experienced yesterday that need to be worked out. For one, my go to trail sunglasses and the mask did not play nicely together at all. If I wore both, the sunglasses would constantly fog up from warm, moist air escaping the mask onto the sunglass lenses. I could not find a position to wear them together that avoided this. So I may have to find different sunglasses to wear with this mask. Or it may not be all that important. Mountain ultras are generally in the summer months, and I would likely only wear the mask at night as the temperature cooled down, a time I would not be wearing sunglasses anyway. So, not a massive challenge.

Second, the headband holding the mask on is less than ideal. It is thin and doesn't stay tight. The mask headband constantly slid down my head and the mask would fall off. I think I will try using a snorkel goggle neoprene band cover to see if that minimizes this issue, though that may ultimately prove too warm. I'll search out other ideas, as well.

But the final issue is by far the biggest and most challenging. While the mask could prove extremely beneficial to me and my lungs in mountain ultras (I mean, if I can breath better and remain stronger for longer, that's gotta help!), wearing the mask creates a physical barrier to eating and drinking regularly. I already struggle with prioritizing keeping up with hydration and calories during long ultramarathons. Any friction in that feeding process is bad news. And right now, with the problematic headband, it's not just a small thing. Each time I wanted to get some water or a bite of food yesterday, it was a three or four minute stop. Stop to pull down the mask, then eat and drink, then an arduous process of repositioning the mask and its headband and the headband I was wearing to keep my ears warm. It was a real pain for the belly! Hopefully an improved headband solution will minimize this friction somewhat and make the demasking and remasking process much quicker. But at the end of the day, the mask will always be a physical barrier between my mouth and the food and drink I'm carrying. It will always create one more step in a process I always struggle with. Balancing the mask benefits with the potential challenges in properly hydrating and eating will be something I have to work through.

All this said, the Airtrim is an overwhelmingly successful experiment so far. Today, I'll be heading out for a very long hike and run of about 6 hours. I will be wearing the mask at least to begin, though may remove it as the day is expected to warm from 30 degrees to near 50 during my expected exercise time. I'm not sure I want nor need the mask once it has gotten that warm, though the air will remain extremely dry even if much warmer. If I continue to experience such significant benefits today and through the rest of my stay hear, I'll be carrying that mask with me any time I head west and plan to do any running.