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
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
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
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
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
The Breathing Dynamics Approach
Note it is recommended you read the comprehensive ‘Breathing Dynamics'
or ‘Respiratory Therapy' information 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 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
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 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
- 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
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.
To book in for a consultation to see Tim regarding the use of Breathing Dynamics to prevent or treat asthma, email Tim or call 0425 739 918.
Alternatively, the Breathing Dynamics for asthma and subsequent breathing retraining techniques and rhythm development can be purchased via the shop section of this website.