Improve Your Breathing - Improve Your Asthma
Asthma is a condition that lowers one’s ability to breathe due to narrow airways. The condition has become increasingly common during the past 50 years, and today approximately 10% of all Swedes are diagnosed with asthma. In the US, more than 18 million adults and 7 million children suffer from asthma according to the CDC (Center for Disease Control).
There is a close correlation between asthma and poor breathing habits. Studies, as well as lots of anecdotal reports, show that improved breathing habits are an effective alternative or complement to asthma medicines.
This knowledge has, however, not yet quite struck home with the healthcare system. For example, the National Heart, Lung, and Blood Institute’s (NHLBI) 440-page report from 2007 on guidelines for treating asthma determined that “there is not enough evidence indicating that any particular breathing techniques create any benefits for a patient with asthma.”
The conclusion of the report in undeniably interesting, as most of us, upon second thought, realize that there should be a very close correlation between asthma and how we breathe since the condition indeed affects our airways.
Breathing retraining can help in dealing with asthma
Even if many asthmatics are aware of having breathing habits with room for improvement, few appear to have realized what a powerful tool breathing retraining is towards helping them improve their asthma.
Testimonials from people whose asthma symptoms have diminished and, in certain cases, disappeared entirely thanks to improved breathing habits are plentiful. Mattias Andersson is one of many happy asthmatics whose life changed for the better through a class on Conscious Breathing.
Mattias Andersson, aged 37, is a former Nordic Countries Taekwondo Champion, and he has over the years had major problems with his asthma. He says:
– I haven’t used any asthma medicine for close to two months; it’s fantastic! Thank you for a brilliant course, and particularly for a revolutionary discovery. Before the class, I took Bricanyl two to five times a day, and Pulmicort twice a day. Since the class I’ve begun implementing my new knowledge and immediately experienced an unbelievable improvement. I will always be thankful! In a way, you have saved my life.
What is asthma?
Asthma involves difficulty in breathing due to narrow airways which limits the airflow to and from the lungs. When we inhale, oxygen is transported to the alveoli. This is where oxygen enters the blood and carbon dioxide is moved to the exhalation.
The airways diverge 23 times before the air reaches the alveoli. For every division the airways get narrower. If the airways are decreased by 50%, 16 times as much effort is required to transport air in and out of the lungs.
To summarize, the air travels quite a long distance to reach the alveoli. This distance can be compared to a snorkel. In this “snorkel,” nothing happens; it’s simply a transportation route. In medicine, this transportation route is called “the dead space.”
We have hundreds of millions of alveoli, and the majority are found in the lower part of the lungs. This is also where most of the blood flow, ten times as much as in the upper regions.
When the airways are narrow, breathing becomes shallower, and less air reaches the alveoli and the blood. This is a very inefficient way to breathe, and we are forced to compensate by breathing faster.
Narrow airways are sort of like driving with the emergency brake slightly engaged. You get to where you need to be, but to reach the desired speed, you have to push the gas pedal harder. The most effective method, is obviously to disengage the brake, in other words, to find the cause of the narrow airways and solve it.
Common asthma symptoms
When an asthma attack occurs, the exhalation is particularly difficult, and a serious attack can be potentially lethal. The most common asthma symptoms are:
- Shortness of breath
- Wheezing sounds in the chest
- Pressure on the chest
- Excessive mucus production
- Inflammation in the airways
- Tight & blocked nasal passageways
- Sleep problems
Stress hormones in asthma medication
Asthma patients are generally offered two different medicines to widen their narrow airways. The first contains substances similar to adrenalin, which help the muscles in the airways to relax and widen. The other one contains substances similar to cortisone to suppress inflammation in the airways.
The problem with these medications is that they don’t solve the cause of the problems; they only minimize the symptoms, that is to say, opening the narrow airways. As soon as one stops using the medicine, the symptoms return like a letter in the mail.
Nearly all medicines also have side effects. Since both adrenaline and cortisol are stress hormones, it’s common for asthma medicine to make it harder for asthmatics to wind down and relax.
Are you your own asthma diagnosis?
Anna Sundkvist Kräutner has been diagnosed with asthma. She works as a conversational therapist and has educated herself as a Breathing Instructor. Anna says:
– To not be able to breathe is terrible, anyone who’s experienced it knows that. The panic, stress, and anxiety are sky high. I myself have asthma and pollen allergies, but the problems are largely non-existent nowadays, after four years of breathing retraining. This is something I am incredibly happy about. Many asthmatics/people with allergies feel like they are their condition and turn their entire body and their thoughts to ‘NOW the pollen season begins, and I will get sick.’ The body becomes tense, breathing speeds up.
Earlier, when I visited someone with a cat or a dog, my body and thoughts were already on the way there for having an asthma attack.
Now, I know that I can use my breathing to help if my airways, against all odds became narrow, and I am, in other words, entirely relaxed. Just the knowledge that I always have a powerful tool with me, no matter where I go, in breathing, automatically relaxes me.
I have taken the Conscious Breathing Instructor course and now I spread this important knowledge to my clients. When they understand how it all connects and realize that they can affect their situation on their own, many stop being victims of their diagnosis. Everyone with asthma and allergies should learn to breathe better.
Five reasons for breathing difficulties in asthma
1. The carbon dioxide pressure is too low
A healthy person’s breathing volume at rest constitutes of approximately 8-12 breaths, and approximately 4-6 liters of air per minute (1 to 1 ½ gallons). For an asthmatic who tends to over-breathe (hyperventilate) the breathing volume instead lies closer to 18-25 breaths and 12-15 liters a minute (3-4 gallons).
When we breathe in a way that exceeds the body’s needs, there is an imbalance between oxygen and carbon dioxide. We inhale too much oxygen and exhale too much carbon dioxide, which decreases the carbon dioxide pressure. Since carbon dioxide has a relaxing and widening effect on the smooth muscles in the airways, a lowered carbon dioxide pressure leads to constricted airways that make it harder for the air to pass.
Since carbon dioxide leaves the body nearly exclusively through exhalation, a large breathing volume (many and large breaths) leads to a lowered carbon dioxide pressure. Narrow airways due to a shortage of carbon dioxide, can be viewed as a defense mechanism, which has the purpose of preventing the outflow of carbon dioxide so that optimal levels are retained in the body.
When we breathe in a relaxed way, the breathing volume decreases, and the body can then normalize the CO2-pressure. The narrow airways then widen as the defense mechanism is no longer required.
Here are some scientific studies which confirm the correlation between over-breathing and asthma.
Liters per minute
14 (±6) l/min
13 (±4) l/min
13 (±2) l/min
2. Breathing through the mouth provides less nitric oxide (NO)
Nitric oxide (NO) is an important substance which is produced in large quantities in the sinuses. Just like carbon dioxide, NO has a widening effect on the smooth muscles that surround our airways. It is also antibacterial, antiviral, and antifungal. In other words, bacteria, viruses, and fungi don’t like it.
When we breathe through the nose, NO follows the inhalation down and widens the windpipes so the air can pass easier.
Once down in the lungs, the NO’s blood vessel widening effect contributes to the oxygen entering the circulatory system more easily. If we breathe through the mouth, the inhaled air isn’t spiked with this important substance, so it doesn’t reach the lungs either.
3. Inflamed airways
Our body always responds to physical, surface injuries with the same inflammatory response: redness, heat, swelling, and pain. These reactions are the first step towards healing. If you sprain your ankle, it becomes red, warm, swollen, and begins to hurt. In part, the blood vessels widen in order to supply the foot with more blood so the oxygenation is increased and more energy can be produced. By this process, more heat and carbon dioxide are also produced. Furthermore, more liquid gathers in the foot so it swells up.
Finally, pain increases as chemicals are released and nerves are stimulated. The swelling and pain occur to protect the foot by making it harder to use. If the pain and swelling remains, it is an indicator that the damage has not yet been healed.
The inflammatory response works the same way in our airways. When we breathe in cold and dry air, air rich in pollen, bacteria or viruses, polluted city air, or poor indoor air, it can trigger inflammation which makes the airways swell. The swelling makes it harder for the air to pass and the breathing becomes shallower.
When we breathe faster to compensate for the ineffective shallow breathing, the mechanical wear and tear on the airways increases, which gives rise to even more inflammation, and we wind up in a vicious cycle. If we don’t fix the problem, there is a risk the inflammation becoming chronic and permanent damage in the structure can occur, which is the case with pulmonary emphysema and COPD (Chronic Obstructive Pulmonary Disease).
4. Increased mucus production
According to researchers at Karolinska Institute in Sweden, we inhale up to 100 billion particles daily, and more if you live in a polluted city environment.
The mucus production in the airways is an important part in the body’s defense system, since the mucus catches and prevents foreign particles and intruders from traveling to the lungs.
A smoker, who inhales masses of particles to the lungs, often develops a wet cough. Smoker’s cough is one example of how the body produces more mucus when the need to get rid of foreign particles increases. More mucus is also produced during inflammation, for example a blocked nose.
At the same time as the mucus neutralizes damaging bacteria and other particles, it also makes it harder to breathe by making the airways tighter and tighter. An increased need for mucus for an extended period of time eventually leads to permanently enlarged mucous glands and thereby chronically narrow airways.
When we breathe through the mouth, we miss the opportunity to use the body’s first and most important defense against intruders. The nose doesn’t just heat up and moisten the air, it also catches many of the bacteria and particles we inhale.
By exhalation through the nose the air is heated and moistened again, and the majority of the particles which got stuck with the inhalation travel out. In other words, the nose is an effective heat exchanger as well as a self-cleaning bacteria filter.
Water is needed in the lungs in order to keep the wind pipes from drying out. With every breath we lose water as our exhalation is 100% humid air, while the humidity in the air we inhale is rarely more than 70-80%. During dehydration, it is therefore natural for the body to contract the airways in order to avoid losing too much water as we breathe.
This is another example of a defense mechanism from our wise body. When we finally understand how our body works, it’s easy to realize that it ALWAYS wants what’s best for us. Our body is our best friend that is always with us, never against us.
The winter breath that occurs when we breathe and it is cold outside, is comprised of water and heat. As we can see in the short video below, nasal respiration can help us avoid unnecessary loss of water and heat. The cloud of vapor is massive through the mouth, while it’s nearly non-existent through the nose. A Swedish study showed that we lose 42% more water when we exhale through the mouth compared to through the nose.
When we have a shortage of water in the body, we can’t produce as much mucus. When the mucus production in the airways decreases, the lungs become more easily irritated. We become more susceptible to bacteria and viruses and react more severely to dust, mold, and other damaging particles in the air.
For an asthmatic, it is extra important to drink water and to breathe through the nose. Note that it is, however, as bad to drink too much water as it is to drink too little. It’s all about balance.
Improved breathing habits can relieve asthma problems
Among asthmatics, poor breathing habits are very common. In a study involving 38 asthmatics, it was determined that 95 percent had developed poor breathing habits. All of them were taught to breathe effectively, which resulted in the asthma problems being reduced in 90 percent of the participants.
Three studies performed in New Zealand, listed below, showed 66-95 percent decrease in the use of bronchodilating medicine (adrenaline-like) and a 41-50 percent decrease in the use of inflammation-suppressing steroids (cortisone-like) when breathing was improved. The researchers in one study also note that: “In addition to a decreased use of medicine, the participants also experienced improvements of symptoms and an increased quality of life.”
There are also a multitude of studies that point in the same direction, and many asthmatics who have improved their breathing habits have, due to this, been able to decrease or stop using their medicine entirely. There is no doubt that it is possible to significantly improve one’s asthma symptoms through improving one’s breathing habits.
Effect on medicine use
Decrease of bronchodilators
Decrease of inflammation suppressors
Close connections between asthma, depression, and anxiety
Crudely put, you get to ride a wheelchair if you can’t use your legs, and you get to use asthma medicine if you can’t breathe. To include breathing retraining during treatment of asthma should be obvious, as basically all asthmatics hyperventilate.
There is also a close connection between asthma, anxiety, and depression. In a meta-analysis of surveys which included a total of 83,000 personal interviews in 17 countries, anxiety, depression, and alcoholism were 50% more common among asthmatics compared to non-asthmatics.
Dr. Alicia Meuret has investigated this deeply, having followed more than 100 people over the course of several years and documented their breathing. In her report, she noted that asthmatics, as well as people who suffer from anxiety, tend to over-breathe, which causes a lower carbon dioxide pressure.
The study revealed that approximately an hour or more before an asthma or anxiety attack, the participants would begin to breathe just a little bit worse. What triggered the less effective breathing could be many different things, but the little change in the breathing was enough to decrease the already low carbon dioxide levels and pave the way for an attack.
Preventing an asthma attack
To prevent the panic reaction when an attack is happening, the body needs to relax, which is easier said than done, but fully possible. The person about to have an asthma attack tends to begin hyperventilating and as a result experiences shortness of breath.
Exhalation is particularly hard during an asthma attack, and a high-pitched wheezing or rattling noise during exhalation is normal. The reason for this is that during stress, we tend to exhale quickly and forcefully.
An effective way to get your body to relax is to utilize a slow, low, and rhythmic breathing. To achieve this, the lungs must be emptied of enough air when you exhale. When an attack is occurring, it is best to focus on a prolonged exhalation, so the inhalation has a chance to reach lower, and the body can relax. Sort of like the expression, “Okay, the danger’s gone, we can breathe out now,” and we relax, exhale with a sigh and lower our shoulders.
An easy way to extend the exhalation is by pursing your throat a little to create a resistance to exhaling and then softly pushing out the air. Another option is to use the Relaxator, which gives you an adjustable resistance on the outbreath. The inhale should be low, slow, small and rhythmical through the nose. When you breathe like this, it will open up the airways thereby reducing the need for the body to release stress hormones - cortisol to reduce inflammations and adrenaline to widen the airways.
When the carbon dioxide pressure is restored to normal levels, thanks to breathing consciously, the cramping muscles in the throat relax and the airways open up. Inhaling through the nose makes the air warm, moist and freer from bacteria which reduces inflammations and decreases the need of excess mucus production to protect from harmful airborne particles.
Lack of knowledge about breathing in the health care sector
Eivor Bergman is a nurse and asthmatics. After reducing her asthma problems thanks to Conscious Breathing she contacted me:
– On my asthma check-up I wanted to ’test’ my asthma doctor and asked: – Being a doctor for all these years, specializing in the lungs and airways, have you noticed if nasal breathing has any impact on your clients' asthma? Or do you think that the way of breathing has an impact at all?
She laughed, threw her hands up, and said – Actually, I don‘t know anything about breathing, so don’t ask me! I do yoga sometimes, but that’s all!
A major reason why so many people with asthma seek our advice is probably because there is a lack of knowledge about breathing in the health care sector. Among the people contacting us, Eivors story is unfortunately more of the rule than the exception.
Maybe you yourself are reading this article because you haven’t got satisfactory answers to your questions about breathing issues within the health care sector!?
Major need for breathing specialists in the medical profession
After medical school, most doctors choose to be further educated in a variety of specialties, for example allergology, rheumatology, oncology, or surgery. Breathing is, however, not an area of specialization. I feel that this lack of a specialized education within breathing is as surprising as what it reveals. At the end of the day, our breathing is the body’s most important function, and how we breathe affects all of the body’s organs and systems.
One way to view the people who turn to the healthcare system is as being customers. If these customers don’t experience the help they need, they naturally will look somewhere else. In this way, the healthcare system works exactly like any other competitive market.
It is not my intent to attack the healthcare system, on the contrary it is intended as a helping hand. By pointing at the present knowledge gap and noting the importance of improving medical education, the medical practitioners will be able to more frequently give advice that fits their customer’s (patient's) needs.
Instead of dismissing homeopathy, supplements, Ayurveda, etc. my advice to the healthcare system is to reduce their attitude a bit, and humbly and curiously ask the question: “How come so many people with chronic problems choose other alternatives instead of the healthcare system?” and also ask whether the customers (patients) really want symptom suppression, or if they actually want help with fixing the causes to their problems. In the corporate world this is called needs analysis and competitor analysis.
If I were allowed to continue wishing, it would be fantastic if part of healthcare’s job also could involve giving people tools and knowledge to help them take responsibility for their health. The corporate world calls this working proactively, constructively, and long-term.
What can you do on your own?
- Get to know your asthma. To be able to prevent your asthma problems, you need to get to know them, and become aware of which environments, situations, and foods trigger or increase your asthma symptoms. Avoid foods that help form mucus and give rise to inflammation, for example, sugar, wheat, and dairy. Make sure to drink enough water.
- Improve your breathing. Figure out where your breathing is by answering the questions in The Breathing and Health Index. If the results show that your breathing habits have room for improvement, you will likely benefit from doing The 28-day Conscious Breathing Retraining Program.
- Unblock a blocked nose. If your nose feels tight and you struggle to breathe through it, it is often a sign of impaired breathing. In your nose, under the turbinates, there are erectile tissues. As you improve your breathing, they will decrease in size and your nasal passages will become less tight. Learn more about how to unblock a stuffy nose.
- Close your mouth. We often catch colds during the night, and one reason is that we sleep with our mouths open, which cools down our nose. To tape your mouth shut at night with Sleep Tape is an extremely easy, yet very powerful tool. Since it isn’t easy to watch your breathing while you sleep, the use of Sleep Tape guarantees that your mouth remains closed at night so your breathing only occurs through the nose.
- Breathing retraining. Retrain your breathing with the Relaxator, or by pursing your throat a little to create a resistance on the exhale, and then softly push out the air. This prolongs the exhalation, which creates a slower but more relaxed breathing and allows for a lower inhalation. Additionally, you strengthen your immune system by doing low-intensity exercise with a closed mouth.
This article is based on the book Conscious Breathing. Thank you for taking the time to read this, I hope you enjoyed it.
Regulation of ventilatory capacity during exercise in asthmatics
|Regulation of ventilatory capacity during exercise in asthmatics
|J Appl Physiol (1985). 1995 Sep;79(3):892-901
|Johnson BD, Scanlon PD, Beck KC
|In asthmatic and control subjects, we examined the changes in ventilatory capacity (VECap), end-expiratory lung volume (EELV), and degree of flow limitation during three types of exercise: 1) incremental, 2) constant load (50% of maximal exercise capacity; 36 min), and 3) interval (alternating between 60 and 40% of maximal exercise capacity; 6-min workloads for 36 min). The VECap and degree of flow limitation at rest and during the various stages of exercise were estimated by aligning the tidal breathing flow-volume (F-V) loops within the maximal expiratory F-V (MEFV) envelope using the measured EELV. In contrast to more usual estimates of VECap (i.e., maximal voluntary ventilation and forced expiratory volume in 1 s x 40), the calculated VECap depended on the existing bronchomotor tone, the lung volume at which the subjects breathed (i.e., EELV), and the tidal volume. During interval and constant-load exercise, asthmatic subjects experienced reduced ventilatory reserve, higher degrees of flow limitation, and had higher EELVs compared with nonasthmatic subjects. During interval exercise, the VECap of the asthmatic subjects increased and decreased with variations in minute ventilation, due in part to alterations in their MEFV curve as exercise intensity varied between 60 and 49% of maximal capacity. In conclusion, asthmatic subjects have a more variable VECap and reduced ventilatory reserve during exercise compared with nonasthmatic subjects. The variations in VECap are due in part to a more labile MEFV curve secondary to changes in bronchomotor tone. Asthmatics defend VECap and minimize flow limitation by increasing EELV.
Buteyko breathing techniques in asthma: a blinded randomised controlled trial
|Buteyko breathing techniques in asthma: a blinded randomised controlled trial
|Med J Aust. 1998 Dec 7-21;169(11-12):575-8
|Bowler SD1, Green A, Mitchell CA
OBJECTIVE: To evaluate the effect of Buteyko breathing techniques (BBT) in the management of asthma.
DESIGN: Prospective, blinded, randomised study comparing the effect of BBT with control classes in 39 subjects with asthma. The study was conducted from January 1995 to April 1995.
PARTICIPANTS AND SETTING: Subjects recruited from the community, aged 12 to 70 years, with asthma and substantial medication use.
MAIN OUTCOME MEASURES: Medication use; morning peak expiratory flow (PEF); forced expiratory volume in one second (FEV1); end-tidal (ET) CO2; resting minute volume (MV); and quality of life (QOL) score, measured at three months.
RESULTS: No change in daily PEF or FEV1 was noted in either group. At three months, the BBT group had a median reduction in daily beta 2-agonist dose of 904 micrograms (range, 29 micrograms to 3129 micrograms), whereas the control group had a median reduction of 57 micrograms (range, -2343 micrograms to 1143 micrograms) (P = 0.002). Daily inhaled steroid dose fell 49% (range, -100% to 150%) for the BBT group and 0 (range, -82% to +100%) for the control group (P = 0.06). A trend towards greater improvement in QOL score was noted for BBT subjects (P = 0.09). Initial MV was high and similar in both groups; by three months, MV was lower in the BBT group than in the control group (P = 0.004). ET CO2 was low in both groups and did not change with treatment.
CONCLUSION: Those practising BBT reduced hyperventilation and their use of beta 2-agonists. A trend toward reduced inhaled steroid use and better quality of life was observed in these patients without objective changes in measures of airway calibre.
Respiratory center output and ventilatory timing in patients with acute airway and alveolar (pneumonia) disease
|Respiratory center output and ventilatory timing in patients with acute airway and alveolar (pneumonia) disease
|Chest. 1982 May;81(5):536-43
|Kassabian J, Miller KD, Lavietes MH
|To investigate the mechanism for hyperventilation in two common but dissimilar conditions, asthma (A) and lobar pneumonia (P), we examined the ventilatory pattern in 17 A and six P subjects. When acutely ill, hyperventilation (PaCO2) was similar in the two groups. Minute ventilation (VE) however, was slightly greater in group A than in P. In A patients, measurements of occlusion pressure (dP/dT) and inspiratory flow rate (VT/ti) during quiet breathing showed enhancement of respiratory center output. By contrast, in P patients, dP/dT and VT/ti were not elevated. Tidal volume (VT) was 0.59 +/- 0.19 L in A; 0.45 +/- 0.09 in P. Respiratory rate was increased in both groups. With supplementary oxygen therapy, neither VE nor PaCO2 changed in either group. The mechanism for the increased ventilatory drive in group A is unclear. Most likely, reflexes initiated by either bronchospasm or by the sudden increase of end-expiratory lung volume (EELV), not operative in P, account for the increased respiratory center output seen in A. To examine the latter possibility, we studied the ventilatory pattern at both normal and increased EELV in six nonasthmatic subjects. Both dP/dT and VT/ti were increased in all subjects after elevation of EELV. Thus, changes in EELV may be important for the regulation of ventilation during bronchospasm.
Ultrafine particle deposition in subjects with asthma
|Ultrafine particle deposition in subjects with asthma. Link to full text
|Environ Health Perspect. 2004 Jun;112(8):879-82
|Chalupa DC1, Morrow PE, Oberdörster G, Utell MJ, Frampton MW
Ambient air particles in the ultrafine size range (diameter < 100 nm) may contribute to the health effects of particulate matter. However, there are few data on ultrafine particle deposition during spontaneous breathing, and none in people with asthma. Sixteen subjects with mild to moderate asthma were exposed for 2 hr, by mouthpiece, to ultrafine carbon particles with a count median diameter (CMD) of 23 nm and a geometric standard deviation of 1.6. Deposition was measured during spontaneous breathing at rest (minute ventilation, 13.3 +/- 2.0 L/min) and exercise (minute ventilation, 41.9 +/- 9.0 L/min). The mean +/- SD fractional deposition was 0.76 +/- 0.05 by particle number and 0.69 +/- 0.07 by particle mass concentration. The number deposition fraction increased as particle size decreased, reaching 0.84 +/- 0.03 for the smallest particles (midpoint CMD = 8.7 nm). No differences between sexes were observed. The deposition fraction increased during exercise to 0.86 +/- 0.04 and 0.79 +/- 0.05 by particle number and mass concentration, respectively, and reached 0.93 +/- 0.02 for the smallest particles. Experimental deposition data exceeded model predictions during exercise. The deposition at rest was greater in these subjects with asthma than in previously studied healthy subjects (0.76 +/- 0.05 vs. 0.65 +/- 0.10, p < 0.001). The efficient respiratory deposition of ultrafine particles increases further in subjects with asthma. Key words: air pollution, asthma, deposition, dosimetry, inhalation, ultrafine particles.
Arterial-blood gas tension in asthma
|Arterial-blood gas tension in asthma
|N Engl J Med. 1968 May 9;278(19):1027-32
|McFadden ER Jr, Lyons HA
|Arterial oxygen and carbon dioxide tensions, pH and forced expiratory volumes were measured in 101 asthmatic patients during acute attacks of bronchospasm. Hypoxemia was observed in 91 subjects. The cause of the depressed oxygen tensions was found to be an alteration in ventilation-perfusion ratios. Overall alveolar hypoventilation and increased venous admixture were found to contribute to the hypoxemia in some patients with very severe levels of airway obstruction. Seventy-three subjects had hypocarbia and respiratory alkalosis. Carbon dioxide retention (observed in 11 patients) occurred only at extreme degrees of obstruction. Age, history of asthma and duration of the acute attack were unrelated to the alterations in blood gas tensions, pH or severity of airway obstruction.
Hyperventilation - Asthma
|Hyperventilation – Asthma
|The Lancet. 1946 Jan 19;83-86
|Bronchial asthma is a syndrome rather than a disease and can be brought on by allergic factors outside the patient (extrinsic), or within the patient (intrinsic), or both. The intrinsic may be metabolic (endocrine), psychological (“nervous asthma “), infection (acute bronchitis), or primary emphysema. In all cases bronchial spasm followed by asthma is, elicited very easily, and in many patients, once the syndrome has been established, the spasm can be elicited by various ” trigger ” factors, not only allergic but also of different origin.
It seems to be certain that this disposition to bronchial spasm can be present from birth-many children develop asthma very early-but there is an important group of intrinsic asthma where the syndrome develops only at the age of about 40, thus suggesting that it is acquired. Even in these cases the tendency may have been present from birth-the gun may have been loaded, to use the metaphor of Rackemann (1938), but the trigger has not been pressed till late, when a suitable trigger factor developed. One of these trigger mechanisms to which little attention seems to have been paid is hyperventilation and in some cases hyperventilation seems to be the only cause of the asthma.
It is difficult to estimate in what proportion of cases of asthma hyperventilation through excitement or muscular exercise acts as a releasing mechanism. In many cases voluntary hyperventilation has no such effect, and in others muscular exercise is well tolerated. In some of them voluntary hyperventilation even seems to be beneficial.
Controlling Asthma by Training of Capnometry-Assisted Hypoventilation (CATCH) vs Slow Breathing
|Controlling Asthma by Training of Capnometry-Assisted Hypoventilation (CATCH) vs Slow Breathing Link to full text
|Chest. 2014 Nov; 146(5): 1237–1247.
|Alicia E. Meuret et al.
BACKGROUND: Hyperventilation has been associated with adverse effects on lung function, symptoms, and well-being in asthma. We examined whether raising end-tidal CO2 levels (ie, Pco2) compared with slow breathing is associated with improvements in asthma control, including peak flow variability.
METHODS: One hundred twenty patients with asthma were randomly assigned to capnometry-assisted respiratory training (CART) for raising Pco2 or slow breathing and awareness training (SLOW) for slowing respiratory rate. Patients received five weekly sessions and completed bid homework exercises over 4 weeks. Blinded assessments at baseline, posttreatment, 1- and 6-month follow-up of asthma control, Pco2, and diurnal peak flow variability were primary outcome measures. Additionally, we measured pulmonary function (spirometry, forced oscillation, exhaled nitric oxide, and methacholine challenge), symptoms, quality of life, and bronchodilator use. Because the control group received active treatment, we expected improvements in asthma control in both groups but more pronounced benefits from CART.
RESULTS: Improvements were seen in 17 of 21 clinical indexes (81.0%) in both interventions, including the primary outcome variables asthma control (d = 0.81), peak flow variability (d = 0.54), quality of life, bronchodilator use, lung function, and airway hyperreactivity. Most improvements were sustained across the 6-month follow-up. Compared with slow breathing, CART showed greater increases in Pco2 (d = 1.45 vs 0.64 for CART vs SLOW, respectively) and greater reductions in respiratory impedance during treatment, less distress during methacholine challenge, and greater reduction in asthma symptoms at follow-up (P < .05).
CONCLUSIONS: Brief interventions aimed at raising Pco2 or slowing respiratory rate provide significant, sustained, and clinically meaningful improvements in asthma control. Raising Pco2 was associated with greater benefits in aspects of lung function and long-term symptoms.