Asthma and Breath Management

Asthma and Breath Management


Breath management techniques are increasingly popular methods for helping asthmatics control symptoms of an asthma attack. Pursed-lip breathing, the Buteyko method, hypnosis and yoga relaxation have all been advocated as drug-free treatments for managing asthma.

Pursed-lip breathing involves relaxing the neck and shoulder muscles, inhaling through the nose, and exhaling through puckered or pursed lips. The Buteyko breathing technique involves slowing the patient’s rate of breathing. Hypnosis and yoga are relaxation techniques aimed at reducing stress and enabling people with asthma to breath better.

Many skeptics claim these techniques have little or no benefit for those with asthma. Independent studies of these methods have failed to demonstrate that these techniques do actually work. Many appear to reveal anecdotal evidence of improvement, but without the physiological evidence to support such claims.

Asthma patients should consult with their physician before trying any of these techniques.

About asthma and breath management

A number of breathing management techniques are promoted as non-drug approaches to managing asthma. The value of breath management in treating or preventing asthma symptoms has been debated within the medical community.

Some experts state flatly that there is no evidence that these techniques have any value for asthmatics. However, many others say techniques such as pursed-lip breathing, the Buteyko method, hypnosis and yoga relaxation can help patients to regulate their breathing, control asthma triggers and limit or reduce asthma attacks.

To date, studies of these techniques have largely failed to show their effectiveness. Although patients often report benefitting from the therapies, physiological evidence generally has not been found to support these claims. As with any recommendation, patients are urged to discuss the technique with their physician.

Known as complimentary medicine, breath management techniques are designed for use alongside prescribed medications. Therefore, patients using breath management techniques should not reduce or stop taking their prescribed asthma medications without instruction from a physician. Doing so could worsen the patient’s symptoms.

Pursed-lip breathing

Pursed-lip breathing is the chief form of breathing control advocated for asthmatics. This technique is often taught to those with respiratory diseases such as chronic obstructive pulmonary disease (COPD). Pursed-lip breathing is designed to control shortness of breath by slowing the pace of breathing and increasing the effectiveness of each breath.

This technique is recommended during the difficult parts of any activity, such as bending, lifting or climbing stairs. Some also advocate using the technique to calm symptoms of an asthma attack. However, as with any recommendation, patients are urged to discuss the technique with their physician.

Pursed-lip breathing involves the following steps:

  • Relax neck and shoulder muscles.

  • Inhale slowly and normally (not deeply) through the nose for two counts, keeping the mouth closed.

  • Pucker or purse lips, as during whistling or when blowing out a candle.

  • Exhale slowly and gently (not forcefully) through pursed lips while counting to four. Exhalation should always take longer than inhalation.

Pursed-lip breathing acts as a “splint.” It creates a back pressure that helps keep the airways open slightly longer to allow more stale air to escape so that more fresh air can replace it. The technique has the following benefits for those with breathing difficulties:

  • Increases the amount of air taken in and let out of the lungs (vital capacity)

  • Releases trapped air from the lungs

  • Extends time airways are open and makes breathing less work

  • Lengthens exhalation time, which slows breathing

  • Moves old air out of and new air into the lungs

  • Improves gas exchange as more oxygen enters the body and carbon dioxide exits

  • Relieves shortness of breath

  • Improves posture

  • Relaxes the body

Patients should practice the technique several times a day until it feels natural. It is important to create a rhythm of inhalation and exhalation, and not to hold the breath. Holding the breath locks up the diaphragm and tightens the muscles of the throat.

Many experts advocate pursed-lip breathing for asthmatics. During an asthma attack, less air reaches the lungs as the airways swell and produce excess mucus. This causes the person to work harder to breathe.

Pursed-lip breathing can make breathing more efficient, minimizing the effort necessary to breathe by emphasizing the use of the diaphragm and the muscles between the ribs instead of chest and neck muscles.

Advocates suggest asthmatics use the technique between two to four times a day. This can include once in the morning, during the late afternoon and at night just before sleep. Once an asthmatic has mastered pursed-lip breathing, it should be put into practice at the first hint of wheeze or when peak flow meter readings drop. Patients should continue to use pursed lip breathing until they no longer feel short of breath.

Patients who master the pursed-lip breathing technique may feel a greater sense of control over their respiratory disorder, according to advocates. This sense of confidence may help relax them during flare-ups, which in itself can lessen symptoms.

However, as with other breathing techniques, there is little hard data to support claims that pursed-lip breathing can improve a patient’s asthma.

Other exercises and techniques

Recently, the Buteyko breathing technique has become popular with some asthmatics hoping to control their breathing. The method involves a system of breathing exercises and behavioral changes.

Developed by a Ukrainian physician, the technique is based on the theory that the symptoms of many respiratory disorders (including asthma) are caused by poor breathing patterns. Buteyko deemed this to be “hyperventilation,” and his technique tries to slow patients’ rate of breathing to help them gain greater ability to control symptoms.

However, many experts are skeptical of the Buteyko technique, particularly the claim that asthmatics need to increase carbon dioxide levels in the body to best metabolize oxygen. Researchers point out that medical evidence indicates that asthmatics already have high levels of carbon dioxide in the blood and there is no solid evidence to support the Buteyko technique claims.

Studies of the Buteyko method to date have proved inconclusive. Many tests have found no improvement in any physiological asthma measures. Yet, there is evidence that some patients using the technique may require fewer medications to control their symptoms.

Other relaxation techniques, such as yoga and hypnosis, also have been suggested to asthma patients as ways to lessen symptoms. These techniques are based on the concept that a relaxed person will be able to control their breathing and breathe better than someone who is nervous and stressed. Stress may be an asthma trigger in some people and relaxation techniques may offer methods to alleviate stress.

Hypnosis, also known as hypnotic suggestion or hypnotherapy, involves placing the patient in an altered state of consciousness. Hypnosis can train a patient’s mind to relax when necessary, and the technique may be used anywhere. Children are especially good candidates for this technique because they tend to be hypnotized more easily than adults. Not all people are susceptible to hypnosis.

An ancient Hindu discipline, yoga promotes increased mental and physical control over the body through a variety of postures and breathing techniques. A main focus of yoga is to control the breath and promote relaxation.

Several yoga-related studies involving breathing exercises known as pranayama, stretches (postures) and meditation have suggested that lung function may improve with the regular use of yoga. Although yoga may be beneficial when it is added to standard treatments for asthma, it is not clear if yoga is more effective than any other form of exercise.

Just as with the Buteyko method, the evidence in support of yoga and hypnosis for asthma control appears to be inconclusive. Though some patients report better quality of life and improved mood after employing these techniques, supporting physiological evidence is lacking. Asthma is a physiological disease of the airways, and is not psychosomatic. No breathing technique or exercise program should be undertaken without consultation with a physician.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to asthma and breath management:

  1. Would I benefit from using a breath management technique? If so, which one?
  2. Do breath management techniques pose any danger to me?
  3. Can you refer me to someone who specializes in teaching pursed-lip breathing, the Buteyko method or yoga?
  4. Can you refer me to a hypnotherapist with training and experience in treating asthmatics?
  5. Will the techniques allow me to reduce the amount of medication I require?
  6. How will I know if the technique is working?
  7. How often will I need to use the technique?
  8. Is my child old enough to use breath management techniques?
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