Breathing Exercises as Allergy Treatment
Breathing Exercises
Breathing is a delicate art, and it is possible to get it wrong, in a variety of ways and for a variety of reasons. A poor breathing pattern can gradually become habitual,
without the person concerned being aware that his or her breathing is at all abnormal.
Allergy and sensitivity reactions sometimes play a part in causing abnormal breathing, and the symptoms produced by a poor breathing pattern may then augment the symptoms of
sensitivity, creating a vicious circle. Correcting an abnormal breathing pattern, by means of breathing exercises and re-training, can produce remarkable improvements in health
for some people.
Breathing too much
Taking in too much air, often called over-breathing or hyperventilation, is the most common breathing disorder. It can produce a variety of rather strange symptoms (see p. 227)
that are sometimes diagnosed correctly, and treated appropriately, but often get overlooked or misdiagnosed.
The primary purpose of breathing is to obtain oxygen from the air and absorb it into the blood. The lungs are a crucial interface here, a trading post for gases that are
exchanged between the bloodstream and the external air. The delicate, moist membranes that cover the inner surface of the lungs are accessed by millions of tiny thread-like
blood vessels known as capillaries. Oxygen from the air seeps into the blood through the thin walls of these capillaries. At the same time, the lungs clean the blood of carbon
dioxide, a waste gas produced by the body’s metabolism. As oxygen seeps into the blood, carbon dioxide seeps out.
That is the school-textbook view of breathing, and it is correct up to a point. But it is over-simplified and misleading if it simply portrays oxygen as totally
good and carbon dioxide as totally bad. In fact, there is a correct level in the blood for both gases, and too little or too much of either can cause problems.
Carbon dioxide plays an important role in the equilibrium of the blood because, when dissolved in any liquid, carbon dioxide makes a weak acid. So the amount of carbon dioxide
present is crucial in deciding the acidity of the blood. Given that the blood reaches every part of the body, it is not surprising that any changes from its normal composition
have far-reaching effects.
Normally, blood is very slightly acidic, and that is what the body is accustomed to. While some body parts can cope with small changes in the acidity of the blood, other parts
respond very badly. The nerve cells are particularly vulnerable to changes in acidity.
Hyperventilation, or over-breathing, has relatively little effect on the level of oxygen in the blood, which is carefully controlled, but it can lower the level of carbon
dioxide in the blood, thus making it less acid. More commonly, hyperventilation just makes the level of carbon dioxide vary a great deal.
When the carbon dioxide levels in the blood yo-yo about all the time, this has some unpleasant effects. In particular, it disrupts the smooth running of the nerve cells, which
is why many of the symptoms of hyperventilation involve the senses, feelings or behaviour.
The symptoms of hyperventilation can include:
• numbness or pins-and-needles in the hands and feet, occasionally affecting the lips and tongue as well
• difficulty in swallowing
• aching muscles, cramps, tremors and twitches
• sudden loss of strength in the muscles
• dizziness, confusion, unreal or spaced-outfeelings
• blurred vision, ringing in the ears
• headache, migraine
• breathlessness
• aching in the chest
• abnormal heart rhythm
• sensitivity to bright lights and loud noises.
There may also be some severe psychological symptoms:
• panic – a brief but intense state of anxiety
• prolonged anxiety or depression
• hallucinations, although this is rare
• mood swings and phobias, most frequently a fear of dying. The irrational conviction that death is imminent can be overwhelming, even in someone who is young and
apparently in good health.
Each of these symptoms can, of course, be caused in several other ways, but when this whole cluster of symptoms – or a large number of them –occurs together in an individual,
that person is very likely to be a hyperventilator.
When there are short self-contained bursts of hyperventilation, the effects are often described as a panic attack. Doctors usually have no trouble recognising this problem, but
– not surprisingly – are often misled by the sustained psychological symptoms of chronic (long-term) hyperventilation. Many people with chronic hyperventilation are diagnosed as
having some kind of mental illness, and they may go for years without getting the right diagnosis.
Hyperventilation and sensitivity reactions The link between sensitivity reactions and hyperventilation seems to be a complex one. Unfortunately, very little research has been
done in this area, so what follows is based on the case-histories of patients, and the collective experience of doctors, not on hard scientific data.
In some cases, a sensitivity reaction may
directly provoke a change in breathing pattern. This
is what appears to happen for some people with
caffeine sensitivity. Cutting out all caffeine-con-
taining drinks (coffee, tea and colas) seems to put a
stop to the hyperventilation symptoms, because the
multiple symptoms promptly disappear (see p. 235).
In other cases, a severe sensitivity problem such
as multiple chemical intolerance results in an anxious
state of mind, and the anxiety leads to hyperventi-
lation. Hyperventilation, pure and simple, may also
masquerade as chemical intolerance (see p. 236).
Wheezy as a mountain breeze
Ionisers — devices that supposedly turn indoor urban air into a fresh mountain breeze — are often promoted as alternative devices that can clear allergens from the air. They do
remove some allergens, but in the case of asthma, research shows that some ionisers can actually make symptoms worse, by generating ozone which irritates the airways. It is
usually the cheaper ionisers that do this. More expensive models are less likely to produce ozone, but they are unlikely to help either. Several scientific trials show that
ionisers have no significant benefits when used by asthmatics.
Hyperventilation and asthma
While hyperventilation can develop in anyone, asthmatics are particularly vulnerable. During an asthma attack, especially a severe one, developing an abnormal breathing pattern
is an entirely understandable reaction. In an attempt to get more air, you may start breathing more rapidly and taking air into the upper chest, using the accessory muscles of
breathing (see p. 230). These muscles should not normally be used when you are at rest — they exist to give you extra breathing capacity when running fast.
As long as the asthma attack lasts, this forced breathing does no harm, because its effects are cancelled out by the narrowing of the airways. But if this over-breathing
persists after the attack has ended, then too much air is going in and out of the lungs, so carbon dioxide levels in the blood begin to fall.
Simply feeling anxious can also trigger off rapid upper-chest breathing. If you get very worried when an asthma attack starts, you may begin hyperventilating just out of
anxiety.
For asthmatics, in addition to the usual symptoms of hyperventilation (see p. 227) there are some subtle effects of hyperventilation that can make asthma worse:
• The airway muscles (and all other muscles that are not under voluntary control) contract slightly when carbon dioxide levels in the blood fall.
• Mast cells are quicker to degranulate (see box on p.12) when
there is less carbon dioxide, and this triggers allergic symptoms. Just to complicate matters, one of the symptoms of hyperventilation is breathlessness. Sometimes this is the
most prominent symptom in non-asthmatic hyperventilators, and the doctor overlooks the other symptoms and gives a diagnosis of asthma. In such cases, people are told they have
asthma when they are actually suffering from hyperventilation alone.
Testing for hyperventilation
You can do two simple tests for hyperventilation at home, if you think that it could be playing a part in your symptoms. (If you are asthmatic, only do these tests when you have
no asthma symptoms and your peak-flow reading is good. Make sure your reliever inhaler is nearby, in case of a bad reaction to the test.)
The first test should be done when you have some symptoms that might indicate hyperventilation (see p. 227).
Find a clean paper bag and hold it over your nose and mouth while breathing normally. Any symptoms that are due to hyperventilation should clear up, because, by re-Inhaling the
air that you have just breathed out, you will increase the level of carbon dioxide in your blood.
The second test is done when you don’t have any of the symptoms listed for hyperventilation.
Speed up your breathing, and inflate your upper chest with each breath. Do this for a few minutes. Do any of your usual symptoms appear? If they do, this suggests that they may
be caused by hyperventilation.
If either of these tests indicates hyperventilation, make an appointment to see your doctor. It is important that you should have a proper medical diagnosis, so that you get the
right professional treatment.
Treating hyperventilation
If you hyperventilate, you could be taught a more healthy breathing pattern by a physiotherapist — ask your doctor for a referral. Certain complementary therapists, such as
osteopaths and Feldenkrais practitioners, can also teach good breathing patterns, and so can experienced yoga teachers (see p. 224). A teacher or therapist who works at a
relaxed pace, is not too dogmatic, and helps you to find your own way to healthy breathing, is preferable to one who tries to impose a regimented breathing pattern on you.
On the assumption that most hyperventilators don’t just over-breathe, but also breathe with their upper chest and under-use the diaphragm (see pp. 229-230), all these different
practitioners will take a combined approach — tackling both sides of the problem at once. This represents an important difference from the Buteykc, method (see below).
The Buteyko method
The stated aim of the Buteyko method (also called the Buteyko treatment) is to stop people from hyperventilating. However, Buteykc, practitioners do not work with people who
have the symptoms of hyperventilation, as recognised by conventional medicine (see p. 227). Instead they work with asthmatics — any asthmatics, not just those whose symptoms
suggest that they might be hyperventilators.
The rationale for this is the claim, by the originator of the exercises, Professor Konstantin Buteyko, that asthma is actually caused by hyperventilation. (What is more,
Professor Buteyko cites hyperventilation as the cause of no fewer than 150 different diseases, including allergies, eczema, migraines, insomnia, bronchitis, high blood pressure
and haemorrhoids. However, his treatment is only marketed for asthma.)
The claims made for the success of the Buteyko method in treating asthma are startling. According to one training centre, it can get 97% of asthmatics off most of their drugs
and able to control attacks within a week of starting.
Not surprisingly, this is a bit of an exaggeration. But the real achievements of the Buteykc, method are still quite impressive: an Australian research study showed that during
the course of Buteyko lessons, the overall use of reliever inhalers (e. g. Ventolin) fell substantially and remained relatively low three months later. However, the patients’
average peak flow stayed the same, and 15% of those studied were admitted to hospital with a severe asthma attack during the trial. In the eight months that followed, 30% needed
a course of steroid tablets – indicating a substantial worsening in their condition. In other words, the Buteyko method can give some help to many asthmatics, but the claim that
it can get almost everyone off asthma drugs and free of asthma is just hype.
Professor Buteyko’s claim to have discovered the fundamental cause of asthma is clearly untrue. What he seems to have discovered is that there are many more hyperventilators
among asthmatics than was widely realised, and that they generally show no obvious symptoms of hyperventilation. His other important contribution is to suggest that
mouth-breathing may create a lot more problems for asthmatics than previously recognised.
The Buteyko method has three aspects:
• unblocking the nose
• training to breathe through the nose, not the mouth
• training to take fewer breaths and pause between breaths. Unlike other treatments for hyperventilation (both conventional and alternative), the original Buteyko method
pays no attention to teaching asthmatics to breathe with the diaphragm. However, a few Buteyko practitioners are now beginning to incorporate this aspect of treatment.
If you decide you would like to try the Buteyko method, there are several different options. Classes are the most expensive route, with very high fees being charged. There are
video cassettes you can buy, which are less expensive. Alternatively, there are various books, which are much less costly, and which explain how to do the exercises (see p.
255).
Whichever option you choose, it is vital that you get your doctor’s permission before starting. Ensure that your reliever inhaler is in your pocket while doing the exercises,
because they could provoke an asthma attack. Keep taking your preventer drugs regularly throughout the treatment. If you start to feel much better and want to reduce your dose
of preventer, you must talk to your doctor first.
Don’t follow the Buteyko method blindly, because some of the advice given is dangerous. For example, some Buteyko publications advise you to refuse oxygen if you are taken to
hospital with a severe asthma attack. They claim that oxygen levels in the blood are not reduced during a severe asthma attack, but this is just not true. Measurements clearly
show that the level of oxygen
gets very low, and this is frequently the cause of death.
Another very peculiar Buteyko idea is that you should not try to shift mucus from your airways because mucus ‘protects you’ against losing too much carbon dioxide. This too is
dangerous advice. Accumulated mucus narrows the airways, adding to your asthma symptoms, and it can even block a small airway completely. The part of the lung served by that
airway then collapses – a serious complication that no asthmatic would want.
Using the right muscles
Hyperventilation is often linked with an abnormal way of breathing, in which the wrong muscles are used. This is one common pattern that conventional doctors recognise for
hyperventilators:
• The main muscle of breathing – the diaphragm (see below) is not used fully
• The muscles of the upper chest become involved in breathing, even at rest, when they should not be needed
• There are lots of rapid, shallow breaths
• The breathing is quite irregular, with deep, sighing breaths from time to time, or frequent yawning.
Even in those who do not hyperventilate, breathing with the upper chest, and/or neglecting the diaphragm, can become a problem. This pattern of breathing is sometimes linked to
anxiety and emotional problems (see p. 230).
To understand what goes wrong, you need first to know about the healthy way to breathe.
The rib-cage and the diaphragm are the work-horses of breathing. You can feel your rib-cage through your skin, and feel its movements, but the diaphragm is far more
inaccessible. It lies below the lungs, but above the stomach and intestines.
In its contracted state, the diaphragm becomes a thick slab of muscle, with a slight curve, like an inverted saucer. When it relaxes, it becomes far more curvaceous, changing to
a shape like an inverted bell. In this shape, there is less space for the lungs above the diaphragm.
If you are breathing correctly, the diaphragm contracts when you breathe in and relaxes when you breathe out. The contraction lowers the dome of the diaphragm, pulling the base
of the lungs downwards and so making them expand.
Breathing out requires no muscular force whatever, as long
as you are just sitting or walking about (and therefore not breath-
ing hard). The lungs are naturally elastic, like balloons, so they
automatically contract and force out the air, once the diaphragm
relaxes into its bell-like shape and stops pulling them downwards.
While you cannot feel the diaphragm itself, you can feel the
effect of its in-breath contraction. As it contracts, the diaphragm
pushes down on the stomach and intestines, so that your abdomen bulges out a little with each breath. Western women, conditioned to admire an unnatural flat-bellied body shape
(unnatural for a woman, that is), often breathe badly because they are trying to ‘hold the tummy in’. This steely tightening of the muscles across the front of the abdomen
opposes the contraction of the diaphragm, and prevents a natural and relaxed in-breath.
The diaphragm should do virtually all the work of breathing in, when you are not exerting yourself much. The upper part of the rib-cage should hardly expand at all and the
muscles that run between the ribs, the intercostal muscles, should not be working.
When you become more active, and therefore need more oxygen, the upper chest automatically starts to expand with each in-breath. At this point the intercostal muscles become
involved, along with a whole team of other muscles in the chest region —these are known as the accessory muscles of breathing.
The effects of an asthma attack
In the grip of a severe asthma attack, you may well start using the accessory muscles of breathing to try to take in more air. If you have frequent attacks, or if this way of
breathing gets to be a habit and goes on between attacks, then the chest may be distorted by the constant use of the accessory muscles, plus the over-inflation of the lungs.
Severe asthmatics often have high shoulders and a `barrel-chested’ look as a result of this. Hyperventilation may also start in this way.
Observing how you breathe
To discover whether you are breathing with your diaphragm or your upper chest, lie on your back with your left hand on your belly, and your right hand on your upper chest. Just
lie still for a few minutes, let your arms relax, then start to pay attention to your hands. When you breathe in, which hand rises? It should be the left hand, with little or no
movement in the right.
Alternatively, bend over and hold the back of a chair with your hands. Your back, head and arms should form a straight horizontal line, at right angles to your legs. Just stay
quietly in this position for a while. It is very difficult to breathe with the upper chest in this pose, whereas breathing with the diaphragm is easy. If you feel fine in this
position, then you are probably breathing well normally.
Correcting upper-chest breathing
Learning to breathe with the diaphragm is often an important part of correcting hyperventilation (see p. 228). It should also be taught to anyone who has the kind of chest
deformities that develop in severe asthma (see above).
Diaphragmatic breathing, or abdominal breathing as it is sometimes called, should help make you feel more relaxed
because the in-breath can disperse tensions in your abdomen. This is where many people ‘hold on to’ their fears, with chronically tense abdominal muscles. When you start
breathing into this area of tension, it is important to take things gently and not force the breath downwards. Be aware of any resistance to the in-breath in the abdomen, and of
any emotional reactions that occur when you challenge this resistance.
Sometimes breathing in this way for the first time can bring up emotional difficulties that may need careful handling. That is why it may be better to learn abdominal breathing
from someone who has time to deal with such issues, and with whom you feel very comfortable and relaxed — for example, a yoga teacher or an alternative therapist who you like
and trust. Physiotherapists tend to take a very brisk and practical approach to breathing, which may not be entirely appropriate or helpful when habitual ways of breathing are
tied up with emotional problems.
When learning to breathe with the diaphragm, be careful not to get carried away and become a ‘belly breather’, whose every in-breath sends the abdomen bulging out like a
mainsail. The abdominal muscles should oppose the downward movement of the diaphragm to some extent, without being too tense.
Clearing the nose
Breathing through the nose, rather than the mouth, is beneficial for asthmatics, because it cleans and warms the air. It can also help those with chronic sinusitis because it
oxygenates the air in the sinuses, which discourages some of the more troublesome microbes responsible for sinus infections.
This technique for clearing a blocked nose, part of a set of breathing exercises for opera singers, is based on a time-honoured yoga exercise called alternate nostril breathing:
• Sit with your mouth closed.
• Press your right nostril against your nose to close it, using the thumb of your right hand.
• Breathe out through your left nostril.
• Press your left nostril against your nose with the index finger of your right hand, to close it. (The hand makes only a very small movement from side to side.)
• Breathe in through your right nostril.
• Repeat the sequence.
Once you have got the hang of this, do ten fairly rapid breaths, with no pause between out-breath and in-breath. Pause and rest.
Repeat using your left hand, and reversing the flow of the breath: out through the right nostril and in through the left. Again, do ten breaths and then rest.
Alternatively, try the following exercise, which is recommend by Buteyko practitioners for unblocking the nose. This technique has not been tested scientifically, but the
reports of asthmatics who have used it suggest that it often works wonders, even with children who could never breathe through their noses previously:
• Have your reliever inhaler to hand, just in case the exercise brings on an asthma attack.
• Breathe as you do normally, and at the end of a normal out-breath, close your mouth and hold your nose
• Stay like this, without inhaling, for as long as you can without discomfort. Walk around the room while you are doing this or, if you are young and fit, do something
more strenuous – either walk upstairs or squat-then-stand several times.
• When you need to breathe in, keep your mouth shut but release your nose
• Breathe in slowly through the nose
• Repeat the exercise if your nose becomes blocked again.
Special exercises for asthma
In addition to tackling the problem of hyperventilation, if one exists, asthmatics can use other breathing exercises to tackle specific aspects of their asthma.
Clearing mucus from the lungs A physiotherapist can teach methods of clearing mucus from the airways which are suitable for asthmatics. Ask your doctor for a referral. You could
also try the following exercises:
Huffing Take an in-breath, then tighten your abdominal muscles very sharply, to push the air out. Imagine there is a candle in front of you, and you are trying to extinguish it,
but using your belly muscles only. Your out-breath should make a short soft ‘huff’ sound – if it is more of a loud ‘w000sh’, you are contracting the muscles in your chest as
well as those in the belly. Try again, and focus your attention on your belly as you make the out-breath.
The in-breath should be effortless with this exercise – it just bounces back in. Do as many huffs as you can without feeling breathless. Rest and repeat. The aim is to build up
stamina until you can do 30 or more huffs in succession.
Pursed-lips breathing Take a fairly deep in-breath, then purse your lips together. As with huffing, your belly muscles have to do all the work of the out-breath, but in this
exercise they are working against the muscles of the lips. The aim is to divide the out-breath into as many fragments as possible – to push the air out through the lips in a
succession of tiny, forceful blasts.
One objective of these exercises is to encourage mucus to start moving up to the top of the airways. From there, it can be cleared with a little throat-clearing cough. Note that
the mucus will probably take a while to reach the throat – this may happen some time after you do the exercise. For maximum effect, repeat these exercises several times each
day.
Coping with asthma attacks
The crucial thing during an asthma attack is to focus on your out-breath, not your in-breath. Of course this goes against the grain, because you feel so desperate for air, but
remember that the central problem is stale air from your last in-breath, now trapped in your lungs by the narrow airways. If you can focus on exhaling this used air, you will
have more space for fresh air to come in with the next in-breath.
At times when you are not suffering from an asthma attack, it is worth doing some exercises that improve the strength of your out-breath. The key problem during an asthma attack
is that the natural elasticity of the lungs, which should power the out-breath, is not equal to the challenge of pushing out all that air through narrowed airways in a short
space of time. In this situation, contracting your abdominal muscles so that they push upwards and assist in emptying the lungs is helpful.
The two exercises described above for clearing mucus –huffing and pursed-lips breathing – also strengthen those abdominal muscles which can assist you with your out-breath
during asthma attacks.
Strengthening exercises
Several different exercises or pursuits that strengthen the breathing muscles seem to produce an improvement in asthma. The reasons for this are not understood.
Asthmatics who take up a wind instrument, such as the flute, often report that their asthma improves considerably. The same effect has regularly occurred with asthmatics who
undertake classical training in singing. One set of exercises, taught to aspiring opera singers and designed specifically to strengthen the diaphragm, has been scientifically
tested and shown to improve asthma and reduce the need for drugs. These exercises can be learned at home (see p. 255). There are also some mechanical devices which can
strengthen the breathing muscles (see p. 255).