Altitude and Asthma

[Pippy]

I’m hoping to do the Frances in 2025, I’m 52 not in the best of shape so lots of plans to improve that before I go. My question though is has anyone had any issues with Asthma. I’m a little concerned about going over the Pyrenees, does higher altitude affect asthma? Pollens are also a concern but less so than the mountains and altitude. Thanks.

 

[DoughnutANZ]

Take your inhaler, obviously. I have scaring in my lungs from the Legionella that I caught in 2019 and I use a preventative inhaler and I carry a reactive inhaler as well.

Obviously we are all different but in my case I have never had to use the reactive inhaler. I have walked from St. Jean in 2019 and from Madrid this year.

If you think that it might be a problem for you then consult your doctor.

 

[Anamya]

My husband has asthma. Like @DoughnutANZ above, he carries the preventive inhaler and the reactive inhaler. He never needed the second one in Spain. Our most recent visit was to Andalusia, in the south (start of the Via de La Plata) and he used neither. Also no problems when we crossed the peaks of Europe during the Camino Lebaniego, but his asthma was much milder at the time.

Check with your doctor what is the best approach for your personal case. Because yes, there will be altitude and different plants and pollens. All that may affect you (or not).

 

[Anamiri]

I have asthma in normal life, but rarely in Spain. I do remember having to use Ventolin near the top of the Pyrenees, but from exertion not altitude.
I suspect an unknown allergen I come into contact with at home is not in Spain.
But across 3 different Caminos in two different seasons, I rarely used an inhaler. I am way more healthy in Spain than at home.

 

[Pippy]

Thanks for the encouraging replies. It doesn’t sound like altitude in particular is anything for me to be concerned about then. I also use a preventative at home but rarely the inhaler. I will certainly have a full check before I leave but was curious to know in advance if there were any issues to be aware of and get on top of ahead of time.
Thanks again!

 

[dougfitz]

Pollens are also a concern but less so than the mountains and altitude.

Last year (2022) on the CP, I found myself suffering from rhinitis, and worked out that it was typically leaving and entering towns where there were particular weeds along the verge. While I was able to use an anti-histamine, I eventually worked out that I was carrying a some N95 masks in case I needed to go to a pharmacy or medical facility, and wearing one when I spotted weeds along the side of the road proved very effective at stopping my hay-fever being triggered.

 

[Rick of Rick and Peg]

I’m a little concerned about going over the Pyrenees, does higher altitude affect asthma? Pollens are also a concern but less so than the mountains and altitude.

You may be thinking about the high Pyrenees at about 3,000 meters but the Napoleon Route is in the Pyrenees foothills and you cross short of 1,500 meters. At that elevation the amount of oxygen per volume of air is about 5% less than the same volume at sea level. A lot of detail can be found here:

Oxygen Levels @ Altitude 101 | Center For Wilderness Safety

At high altitude, Oxygen Levels may be significantly lower than at sea-level. Learn more about how air & barometric pressure are affected at altitude

wildsafe.org

 

[Pippy]

You may be thinking about the high Pyrenees at about 3,000 meters but the Napoleon Route is in the Pyrenees foothills and you cross short of 1,500 meters. At that height the amount of oxygen per volume of air is about 5% less than the same volume at sea level. A lot of detail can be found here:

Oxygen Levels @ Altitude 101 | Center For Wilderness Safety

At high altitude, Oxygen Levels may be significantly lower than at sea-level. Learn more about how air & barometric pressure are affected at altitude

wildsafe.org

Thankyou!

 

[Camino Chrissy]

You will work up a sweat as you head up to and cross over the Napoleon route, but your issue will not be related to altitude sickness. If you have exercise induced asthma, I'd go slow and bring your inhaler.
As @Rick of Rick and Peg says, these are not in the area of the hgh Pyrenees.

 

[Perambulating Griffin]

Thanks for the encouraging replies. It doesn’t sound like altitude in particular is anything for me to be concerned about then. I also use a preventative at home but rarely the inhaler. I will certainly have a full check before I leave but was curious to know in advance if there were any issues to be aware of and get on top of ahead of time.
Thanks again!

I’m not sure about your triggers… but for most of us it will be cold rather than altitude that triggers anything, and the threshold for the cold trigger is -11C, so one ought to avoid anything after -7 if one intends to stay out… (this won’t apply on Camino). That said… yes, carry your inhaler, and also, if you have a preventer, use it… do what you can to strengthen your capacity before you leave and know that the hills will still require you to take breaks for the first 3 days or so.
I am a data geek and wear a smart watch… on my first 3 days on the Salvador, I would have real heart-rate spikes and would have to rest (because heat can also be a thing that makes drawing breath a little harder for asthmatics, even if it does not usually trigger an attack). That was last September. This past May I was on the Primitivo… same thing: first 3 days… take a break on the steep inclines as often as every 75M if it’s hot… but after day 4? I was *great*…. It is amazing how rapidly one can gain fitness and how quickly it drops off (I currently have a stupid cold!! and ugh!) … but at 56 y/o with “complex asthma and BPD caused by infant lung injury” — altitude is not a worry.
In fact: my respirologist and immunologist both encourage any activity at moderately higher altitude — anything from 1500 to 2500 m.
After that, there are *some* people who can get into altitude sickness even though they are still below the altitude threshold.

 

[Anniesantiago]

As Rick said, the altitude isn't that high at all.
If you're worried, just start in Roncesvalles or even Pamplona.

 

[El Cascayal]

Exercise induced asthma occurs when the airways get cooled (so in cold weather) and also depends what cold weather triggers are for each individual person. Covering your nose and mouth helps ameliorate as does using a prophylactic B2 agonist ie albuterol, salbutamol in Spain. The MDI (meter dose inhaler) is way cheaper in Spain 3-5 Euros as compared to big bucks in the US even with insurance. I personally have had no problem getting an inhaler in Spain without a prescription.
Do give your Pulmonologist a heads up regarding your plans and it never hurts to review the correct use of the MDI. Even folks using it for a long time can learn may find they have been using it sub-optimally.
Buen Camino.

 

[Perambulating Griffin]

Exercise induced asthma occurs when the airways get cooled (so in cold weather) and also depends what cold weather triggers are for each individual person. Covering your nose and mouth helps ameliorate as does using a prophylactic B2 agonist ie albuterol, salbutamol in Spain. The MDI (meter dose inhaler) is way cheaper in Spain 3-5 Euros as compared to big bucks in the US even with insurance. I personally have had no problem getting an inhaler in Spain without a prescription.
Do give your Pulmonologist a heads up regarding your plans and it never hurts to review the correct use of the MDI. Even folks using it for a long time can learn may find they have been using it sub-optimally.
Buen Camino.

So good to know about the inhaler! I take enerzair now, and omalizumab. When I move to Spain, I will have to pay for my meds out of pocket and have learned that even these are much less expensive in Spain than in Canada (where they would bankrupt me without insurance). I had no idea that one could get an MDI in Spain without a script. I no longer use a turbo-inhaler, but still have my ventolin in case of attacks. Any info on that? I’ve worried about what might happen were I to lose my stuff somewhere…

 

[El Cascayal]

So good to know about the inhaler! I take enerzair now, and omalizumab. When I move to Spain, I will have to pay for my meds out of pocket and have learned that even these are much less expensive in Spain than in Canada (where they would bankrupt me without insurance). I had no idea that one could get an MDI in Spain without a script. I no longer use a turbo-inhaler, but still have my ventolin in case of attacks. Any info on that? I’ve worried about what might happen were I to lose my stuff somewhere…

I have no information on the price or need for a prescription for the combination inhalers like Enerzair (long acting beta agonist + long acting muscarinic antagonist + inhaled corticosteroid. Omalizumab, as you know, an injectable monoclonal antibody is very expensive. Both medications are available in Spain and manufactured by Novartis.
I know the rescue inhalers (short acting beta agonists) like Ventolin can be purchased easily in Spain.
Try to find out what will be your best options re: pricey respiratory meds in Spain vs with insurance in Canada. Buena suerte. Aymarah

 

[Pathfinder075]

Hopefully Omalizumab isn't as expensive as Dupilumab. That was serious money for an injector. I'd see your doctor and see if you can swap on to something more mainstream for while you walk, it will probably be infinitely cheaper than trying to source a monoclonal antibody injector while abroad. I use Fostair and Salbutamol for mine, with Flixotide if I need it. From what I've seen, all are easily available in most European countries. Although I will be taking enough for my trip.

 

[Rita Flower]

A short note about accessing medical help on Camino.
In my experience medical centres / hospital outpatients are easily accessible for pilgrims (and I presume other tourists) even though there is a bit of paperwork to complete. My experience is also that it is not that expensive and they might occasionally wave payment as it’s often the easier option for a non-complex problem.
Buen (healthy) Camino

 

[Pathfinder075]

If you are from a country that has a reciprocal health agreement, having proof of that is useful.

In the UK we have the GHIC card (formerly known as the E111/EHIC card). When I ended up in one of the hospitals in Santiago (the University Hospital), that is what they asked for. They weren't bothered about my health insurance.

 

[dougfitz]

If you are from a country that has a reciprocal health agreement, having proof of that is useful.

In the UK we have the GHIC card (formerly known as the E111/EHIC card). When I ended up in one of the hospitals in Santiago (the University Hospital), that is what they asked for. They weren't bothered about my health insurance.

Even with reciprocal health agreements, some doctors appear to assume that travellers will have health insurance, will refuse to treat patients under those reciprocal arrangements and insist on using private patient arrangements. The reasonableness of the charges involved varies considerably. Where we have faced additional medical expenses, Spain was more reasonable than other countries where we have had to do that.

Over the years, my wife and I have found that ensuring that we have an adequate supply of our prescribed medications is a better approach to managing our health conditions, and then using emergency departments for accidents or injuries when they occur.

 

[Pathfinder075]

Yeah that's how I do it. I literally carry all medication I need for whatever length of time I will be out. I would rather not end up in any hospitals if i can help it either, but I also have a full travel insurance policy should it happen. The one in 2017 was an anomaly and once they ascertained the problem I was already carrying the meds I needed to fix it, so problem solved.

I have nothing but good things to say about the hospital i went to and although the only person that spoke any English was the doctor treating me, it was fine. Everyone was friendly. I haven't been to any doctors or clinics besides that one.

 

[Keith H]

Long time asthma guy here. For me, it can be induced by exercise so if I am going to be doing solid intensity exercise I’ll use ventolin before I hit the hard bit (if I’m doing a workout I’ll do it before). I always have an inhaler in my pack within easy reach. Cold weather can be a factor but heavy breathing exercise hits me much harder.

Ventolin is easily accessible here. I’ve not tried it without a prescription so can’t comment on that. It is very inexpensive though. I pay cash and I’ve never winced when getting a new one.