Breathing Dynamics for Prevention & Treatment of Asthma
Asthma is defined by the Global Initiative for Asthma as “a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyper-responsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness and coughing particularly at night or in the early morning. These episodes are usually associated with widespread, but variable airflow obstruction within the lung that is often reversible either spontaneously or with treatment”.
Asthma is clinically classified according to the frequency of symptoms, forced expiratory volume in 1 second (FEV1), and peak expiratory flow rate. Asthma may also be classified as atopic (extrinsic) or non-atopic (intrinsic), based on whether symptoms are precipitated by allergens (atopic) or not (non-atopic).
Asthma is caused by environmental and genetic factors. These factors influence how severe asthma is and how well it responds to medication. The interaction is complex and not fully understood.
Studying the prevalence of asthma and related diseases such as eczema and hay fever have yielded important clues about some key risk factors. The strongest risk factor for developing asthma is a history of atopic disease (hypersensitivity or allergic diseases – eczema or atopic dermatitis, hay fever or allergic rhinitis; atopic conjunctivitis). This increases one’s risk of hay fever by up to 5× and the risk of asthma by 3-4×. In children between the ages of 3-14, a positive skin test for allergies and an increase in immunoglobulin E increases the chance of having asthma. In adults, the more allergens one reacts positively to in a skin test, the higher the odds of having asthma.
Research is also beginning to show a strong correlation between the development of asthma and obesity.
Asthma is probably one of the world’s most over-diagnosed and over-medicated ailments.
According to Associate Professor Colin Robertson, Respiratory Physician at the Royal Children’s Hospital, 80 percent of children diagnosed with asthma may have symptoms induced by exercise; therefore the community at large perceives asthma in a certain way. This can be positive in the sense that the problem can be easily recognised, however sometimes other respiratory conditions can mimic asthma.
Professor Robertson suggests, “Doctors, relatives and enthusiastic physical education teachers can mistake a child who exercises and gets out of breath as having asthma when they are actually just unfit”.
“This gets interpreted as Exercise Induced Asthma (EIA) but it doesn’t respond to anti-asthma therapy. What they need is breathing exercises to learn how to control it. It is a simple effective intervention and it is important for people to know that it exists”
Medications for Asthma
Medications used to treat asthma are divided into two general classes: relievers or quick-relief medications used to treat acute symptoms; and preventers or long-term control medications used to prevent further exacerbation.
Relievers which include Ventolin, Bricanyl and Spiriva are recommend to be used only for relief or tightness or breathlessness. They are adrenaline based so they increase heart rate and over use can be dangerous, or even fatal. Those who use relievers more than 3 times per week are considered being at risk and are recommended to cut back dosage.
As a result of these dangers, long acting steroid preventers were produced to suppress the immune reaction or inflammation and hypersensitivity in the body, and therefore reduce reliever usage. These medications are usually inhaled gluco-corticoid steroids and include Flixotide, Pulmicort and Alvesco.
A third group of asthma medications have now been developed that combine the reliever and preventer medications. These include Seretide (the most widely prescribed asthma drug in the world) and Symbicort. These combination drugs were produced as a result of dangers caused by the development of high-potency, long acting reliever medication which, as people were getting longer lasting relief, they often discontinued use of their preventer. After several hundred deaths (due to over-exposure to adrenalin), a solution was devised to combine preventer medication with reliever to prevent patients.
The problem with the combination drugs is that each puff of Seretide or Symbicort contains around 4-6 puffs of Ventolin. Given steroid preventers were developed in the first place to prevent patients using more than 3 puffs of reliever weekly (remember that more than 3 puffs per week were considered risky), these combination drugs actually increase the dosage of Ventolin to up to 24 puffs per day!!!
The irony of the medical approach to asthma and breathing difficulties is that, whilst these medications relieve symptoms in the short term, they can exacerbate or cause asthma and breathing difficulties in the long term.
For example, adrenaline based reliever medication opens the airways and relaxes smooth muscle which eases symptoms in the short term. But, adrenaline causes the breathing rate to rise which, over time leads to over-breathing.
And, steroid based preventer medication reduces inflammation in the lungs, reduces breathing rate on a short term basis and suppresses the immune system response, which results in less asthma symptoms in the short term. But, the suppressed immune system response leads to more colds and flus, and chest and lung infections – which, ultimately, result in over-breathing.
As we will see now, over-breathing plays a major role in creation of asthma and breathing difficulty symptoms, and correction of over-breathing is fundamental to reduction in symptoms and reliance of pharmaceutical drugs.
The Breathing Dynamics Approach
Note it is recommended you read many of the blogs on ‘Breathing Dynamics’ or ‘Respiratory Therapy’ on this website prior to reading this section, as the following is a simplified summary based on a knowledge of this theory.
The Breathing Dynamics approach to dealing with asthma is to look for the ‘root cause’ of asthma. It is not a disease as such – more a condition that can be managed.
Based on “The Bohr Effect” we know that low arterial blood levels of carbon dioxide (CO2) will lead to haemoglobin having a higher affinity for oxygen, and therefore O2 is not released into tissues for energy production. As a result of lower CO2 levels, the body will cause restriction in smooth muscle to prevent CO2 loss (and as a result reduced release of O2 into cells).
In asthma, this constriction of smooth muscle occurs in the airways and alveoli in the lungs resulting in inflammation and spasm in the respiratory system, and ultimately, breathing difficulties such as wheezing and shortness of breath.
We know also that over-breathing results in reduced arterial blood levels of CO2. So, it can be logically deduced, that over-breathing plays a significant role in the pathology seen in asthma.
Also, generally those who over-breathe tend to be sympathetic nervous system dominant (see general breathing notes), which produces the ‘fight or flight’ reaction in the body. This reaction causes a surge of adrenaline in the system and leads to a cascade of other reactions in the body including elevated heart rate, breathing rate and, amongst other things, elevated histamine levels.
Elevated histamine levels will promote or increase immune system hypersensitivity associated with asthma.
Therefore, in dealing with asthma via breathing retraining, we aim to correct over-breathing in order to:
- Elevate arterial CO2 levels – reducing smooth muscle constriction and spasm in the airways and alveoli.
- Balance the autonomic nervous system – (between sympathetic and parasympathetic enervation) to reduce adrenaline and histamine levels.
This is achieved by a number of techniques aimed at:
- Breathing through the nose at all times – including at night and during low level exercise (and even higher levels over time with training).
- Increasing brain tolerance to elevated plasma CO2 levels (via breath hold and breathing rhythm techniques) to allow the body to be comfortable with lowered breathing rates and volumes.
- Developing breathing rhythms using CapnoTrainer biofeedback technology aimed at maintaining elevated plasma CO2 levels and keeping the airways nice and open – therefore preventing the likelihood of constriction and inflammation in the airways and reducing elevated histamine and adrenaline.
Once developed, all of these techniques can be replicated long term, turned into one’s habitual breathing pattern, and offer not only prevention of breathing difficulties and asthma, but also allow optimal respiratory function. And once trained, the practice is free!!
There is now an overwhelming amount of evidence supporting the use of breathing retraining in the management of respiratory disorders such as asthma.
One study published in 2006 in ‘Thorax’ a highly respected International Journal of Respiratory Medicine, found that in a 30 month, double blind randomized trial of two different breathing techniques in the management of asthma, confirmed that both groups achieved an 86% reduction in bronchodilator reliever medication and a 50% reduction in the dosage of inhaled cortisone medication.
My clinical experiences in treating asthma using Breathing Dynamics or breathing retraining have certainly echoed these results.