Hi Howie, I agree with much of what has been stated thus far regarding the asthma questions you posed. I feel your primary problem during your last bout with this was likely not an exacerbation of acute mountain sickness. Typically, a headache will be present with AMS, even with onset of HAPE. Not sure if a headache was one your symptoms or not. Nevertheless, proper acclimization is essential when coming to the Hardrock from sea level. Severe forms of AMS (HAPE) have occurred during this race. Your problem does sound like asthma. Big picture - it's important to realize that exercise-induced asthma (EIA) exhibits itself uniquely in different athletes. Given the symptoms you have described, I suggest you consult (again)an asthma and allergy expert for a definitive diagnosis and treatment. Your diagnosis may end up being straightforward; however, some cases do require the administration of more specialized tests to find an EIA problem. Coughing or other breathing problems are not signs of athletic accomplishment and should not be blown off. Don't be like many of us (myself included) and wait too long to seek definitive advice of an expert. Having rescue and preventive inhalers can make this race much more enjoyable and safer if you truly have EIA. Get it checked out. See you this summer. PS: Oh yeah, by the way, maybe consider a soft, warm, and dry bed post-race instead of spending the night in your car... you can always hang out with Dale and I in the gym - we do have nice warm cots :) Cheers, Leo Lloyd RN/Paramedic Hardrock 100 Medical/Rescue Coordinator Howie, I did mucho research before my 2012 HRH regarding acclimatization and spent days going up and down Mt Whitney with Dr Marty Hoffman where we discussed the topic in detail that can only be found - well doing hill repeats on Whitney! Net-net, we concluded, based upon the plethora of research on the topic, that 9-10 days prior to the event in an ideal period of acclimatization. And that regular exposure to altitudes over 11K feet was also recommended, especially during physical exertion. I practiced the above both for 2012 and 2013 and indeed had no issues with AMS. I did have a bad bout of shortness of breath during ascents from Telluride to the finish (counter-clockwise course) in 2013 which we later determined to believe was an allergic reaction to the wild flowers which were in extraordinary bloom in the meadows. So in summary, go early and find a Cat House above 11K ;-) Thank you to those of you who have responded. Some of you communicated with me about meds as well, so I thought I would add that in to the discussion, and a little more on my history. If you read on it seems to me that, based on the lack of any other symptoms, what I had is some sort of on an asthma type reaction (not AMS or PE). I am gathering from others that the "asthma-like" symptoms are hard to pin down or even to fully categorize. As for other meds, I take Singulair as described below, and know I saw one runner with Advair beforehand. My doc gave me that before Leadville, but as you will see, I don't think it helped. Here's some extra background and info: I had exercise induced asthma diagnosed in about 1999. I had trouble breathing one day doing hill repeats in the cold of winter and just backed off. Later that summer I had to go to the ER after an episode on a hard bike ride on a hot/humid day. I was given an inhaler and put on Singulair. I never once used the inhaler. The Singulair seemed to be the key... once or twice I started to go off it and had slight breathing issues surface. As long as I have been on it I had no problems until HR2011. The extreme altitude and time at exertion seems to be a clear factor. I had no trouble at Tahoe Rim Trail 100 (moderate altitude- maybe 8K on average, 25 hours) in 2010. My longest run outside the 100's was a 56 mile hut traverse (about 18 hours) in the White Mountains. No problems there. But no real altitude,even with climbs up to 4000' vertical In 2011 Hardrock I had moderate acclimatization... I arrived in Ouray Sunday morning and slept in Silverton 3 nights and Little Molas campground (?11,300?) 2 nights leading up to the race. I have had the high altitude headache in the past my first night at elevation, but did not have it on this trip. I had no other symptoms during the race (i.e. weakness or lightheadedness) but of course was limited on climbs such as Green Mountain, Handies, and Virginius just by the thin air. No distress there... just take it easy and pause from time to time. I have watched Bruce Grant's 2009 vimeo (thanks for that jewel of a video!) and liken it to his climb up Handies. I may have muttered something like "let's get the heck out of here" at the top of Handies, but overall I enjoyed the early climbs and took them on with energy and desire. I am not sure, but I would say my breathing was no worse than Bruce shows, probably better over the first half of the course (however I was probably 3 hours behind his pace, so not pushing as hard). But when I got to Oscars, then Grant Swamp it was nothing like this... I had to pause every uphill step and felt terrible from not being able to breathe. But I was able to run down immediately on the other side of both passes with little to no distress. I was scared to continue with the breathing problems and dropped from KT and immediately went to the race doc. He confirmed that there were no signs of pulmonary edema and I did get some relief from taking an albuterol treatment from a vaporizer. He described it as I had just "beat the crap out of my airways" I don't remember coughing stuff up. It sounds like if I get it again I will be able to push through safely. Leadville this year I had no acclimatization... I arrived in Leadville about 18 hours before the start of the race. My doc had put me on Advair a few weeks before the race. That did not seem to benefit me based on the symptoms I had soon after finishing. I don't know why I didn't use my inhaler AFTER finishing... that would have been a good experiment. I did have some thick stuff in the back of my throat later in the race... not too bad though. I get post nasal drip running in the cold of winter here in New England that can be much worse. I thought this represented perhaps an accumulation of that drip... I don't recall it being green. Regards, Howie I agree with many of Bruce's points. At least from your initial description it sounds more like Accute Mountain Sickness (AMS), or altitude specific related issues rather than exercise induced asthma which tends to be more transient and associated with chest tightness/shortness of breath even if not moving. Not to mention exercise induced asthma (EIA or EIB) is more related to stress in general; hard pace, cold temps, hot temps, altitude can be a trigger too, but its not specific to altitude. I've gone through some similar symptoms to Bruce and am trying to see if albuterol will help manage it, jury is still out as it does not help all cases. I've also had AMS and it is a different feeling and something that for me was only alleviated by returning to a lower altitude, where I could still exercise just fine. Here is an interesting article about exercise induced asthma that I picked up a few months ago when I was learning about the symptoms and treatments specifically for athletes (which I'd like to think we are). http://www.ericjlee.com/Articles/Mechanisms%20&%20Management%20of%20Exercise%20Asthma%20in%20Athletes.pdf In short its probably best to just work with your Dr, and if they think its exercise induced asthma it doesn't really hurt to try an inhaler when symptoms arise (as Bruce described). If it doesn't work, well just discontinue it and try other avenues to manage the symptoms. Eric Lee Howie - I am in a similar situation as you, living at sea level and having mild asthma that comes occasionally and unpredictably. After getting caught early in my running career with asthma symptoms, I always run/race with a salbutamol inhaler just in case my lungs act up. I have never been hospitalised, but have come close once, and I do not want to go through that experience again. My chest tightness can come and go on its own, but I take a puff when the tightness is sustained for 15+ minutes, or immediately if it gets worse. I will repeat as needed, but have never had to do more than 5 puffs. I am not concerned with dosage when I am having trouble breathing - the salbutamol will work by then or it will not, so there is no point blasting so much as to overdose but on the other hand I am not going to hold back if there is some benefit, either. Anyone with first-aid training will tell you that a patent airway is the primary concern in treatment! That said, from your description above it occurs to me that perhaps what you have experienced may not be asthma, but a reaction to altitude and some mild pulmonary edema. Again, I have had similar experiences racing at altitude at Hardrock, Leadville, Bighorn, and Jemez. Altitude will manifest itself in a number of nasty ways, including a total weakness in the legs, light-headedness and disorientation, and chest congestion. The weakness and light-headedness has, in my experience, been temporary and generally alleviated by dropping to a lower altitude (general lack of fitness and fatigue notwithstanding). The chest congestion, on the other hand, has happened to me during a race but more frequently after I have finished (almost like the actual exercise mitigated the problem). I have been hit with distressed breathing immediately after a race, where salbutamol administered with a mask for ~30 min made no difference. I have also had a delayed reaction up to a day later, when my chest tightens up with no alleviation with my inhaler. In both these situations, the symptoms only dissipate once I start coughing up chunks of firm green phlegm. This is an entirely different experience than the strict asthmatic reaction that I get. I would also note that this particular problem happens most notably when I am not acclimatised to altitude, i.e., going directly from sea-level home to a race site. If I spend time at altitude getting used to it, the chest problems are significantly reduced or non-existent. For Hardrock in particular, I have found that being there a minimum of a week prior to the race makes an enormously positive difference in how I feel, with much better outcomes in breathing, performance and cognitive ability during the race. I am not a doctor, but I run a lot and these are my experiences and the strategies I have learned to cope with how I am affected. Besides preventative acclimatisation, I don't know of a better way to clear the altitude-induced edema other than time. I carry my asthma inhaler all the time, and will use it when I get sustained chest tightness to the point where symptoms subside or it is evident that the drug is not making a difference. I hope that helps you figure out what is affecting you. I guess my overall point is that it may not be typical asthma but something altitude-induced instead, and you may need to look at alternative coping strategies to help. cheers, Bruce