Dr. Shadman Pandit
The World Asthma Day is an annual event organized by the Global Initiative for Asthma to improve asthma awareness and care around the world. World Asthma Day takes place on the first Tuesday of May. The inaugural World Asthma Day was held in 1998.
The term Asthma comes from the Greek verb ‘aazein’, meaning to pant, to exhale with an open mouth, and a sharp breath. According to recent estimates, asthma affects 300 million people in the world. Although people of all ages suffer from the disease , education and understanding are keys to effective control of asthma, which can be fatal if not managed properly. World Asthma Day educates and raises awareness of the condition in the hope of relieving suffering and reducing deaths.
Asthma is a common chronic inflammatory disease of the airway characterized by variable and recurring symptoms, reversible airflow obstruction and bronchospasm. People suffer from this chronic condition (long-lasting or recurrent) are said to be asthamatic. The inside walls of an asthmatic’s airways are swollen or inflamed. This swelling or inflammation makes the airways extremely sensitive to irritation and increases your susceptibility to an allergic reaction. As inflammation causes the airways to become narrower, less air can pass through them, both to and from the lungs. Chronic inflammation of the airways subsequently results in increased contractibility of the surrounding smooth muscles.
In Asthmatics, dysfunctional breathing pattern is common. Breathing re-education and breathing based therapies have begun to re-emerge as a means of helping asthmatic and others suffering from breathing disorders.
Common signs and symptoms include:
• Breathing difficulty
• Tightness in the chest
• Worsening symptoms at night
• Worsening symptoms due to cold air
• Symptoms while exercising
• Symptoms after exposure to allergens
One of the main ways in which a physiotherapist will work with asthmatics is breathing retraining. There are number of breathing retraining techniques that can be learnt to help prevent and reduce the effects of an asthma attack. Taking fewer, smaller breaths is one example of a popular breathing retraining technique. Although issues and requirements vary from patient to patient, this is a widely applicable technique.
Inspiratory muscle training defined as a course of therapy consisting of a series of breathing exercises, the aim to strengthen the respiratory muscles making it easier for people to breath. Inspiratory muscle training is normally aimed at people who suffer from asthma, bronchitis, emphysema and COPD. When a person is breathing normally, they typically use between 10-15% of his/her lung capacity. However, with inspiratory muscle training a person can typically increase the amount of lung capacity used. Deeper breathing uses a bit more energy but also allows more oxygen to enter the bloodstream with each breath while strengthening the breathing muscles. Strengthening Inspiratory muscles by performing daily breathing exercises for at least six weeks significantly reduces the amount of oxygen these same breathing muscles require during exercise, resulting in more oxygen being available for other muscles. The respiratory muscles need to be trained because during exercise the body’s demand for oxygen increases and our breathing volume or ventilation must also rise and cope with the oxygen increase.
Timing and the rhythm of breathing are also major aspects of breathing retraining. Breathing in through the nose and out the mouth at a slow pace will encourage an efficient, relaxing airflow. These techniques optimize oxygen intake and satisfy the body’s demand for oxygen.
Apart from breathing retraining, physiotherapy can be used to strengthen the body and its ability to breathe in general, thereby reducing the onset of asthma attacks. Many asthmatics will avoid physically exerting activities as they fear it may induce an asthma attack. While this is not a totally unfounded concern, as many activities can bring on such an attack, this reduced physical activity will gradually reduce the body’s breathing ability and worsen the condition. Working closely with a physiotherapist can not only help exercise the body to prevent such deterioration, but also build up the strength of respiratory muscles such as the diaphragm. This is known as respiratory muscle training, and can drastically increase a person’s quality of life, breathing, and physical abilities.
It is important to remember the importance of working with doctors and continuing to take any prescribed medicine, but working with a physiotherapist can reduce a person’s reliance on that medication as well as the frequency and severity of future attacks.
Some instances of breathing exercises are:
• Diaphragmatic breathing: This is a basic and simple breathing technique that maximizes air distribution in your lungs. You can lie down or sit. Concentrate on your breathing. Preferably you should breathe in slowly through your nose. When you inhale your abdomen should go out (not your chest). Exhale slowly with your abdomen going inward. Ideally exhalation should be twice as long as inhalation.
• Physical movement exercises: This type of breathing exercise combines physical elements and breathing elements. Focus on a good posture. Relax (tense all muscles, and then relax, paying particular attention to muscles in shoulders and belly). Concentrate on breathing (close eyes). Focus on breathing while relaxed in rest position. Focus on breathing with shoulder rotation. Focus on breathing with forward curl. Focus on breathing with arm raises.
• Buteyko breathing: This is a breathing technique that teaches asthmatics to consciously reduce either breathing rate or breathing volume. Sit upright, relax. Relax chest and belly muscles while breathing. Focus, close your eyes and look up. Breathe through your nose gently (keep mouth closed). Breathe slowly and shallow. Exhale slowly until you feel there is no air left in your lungs. Hold your breath as long as you can and then return to gentle breathing.
• Pursed lip breathing: This can be used when you are having an asthma attack. Since asthma causes air to become trapped in your lungs, this may help you get more air out and may make breathing easier. This is where you inhale slowly through your nose and then exhale through pursed lips, or exhale slowly as though you were going to whistle. You should exhale twice as long as you inhale. This should be done while using diaphragmatic breathing as described above.
• Progressive relaxation technique: This technique helps to relax all the muscles in your body. Lie down and close your eyes. Concentrate on breathing through your nose. Use diaphragmatic breathing. Tighten muscles of right foot, relax, feel tension, release. Do same for other limbs. When done your body should feel weightless. Stay in relaxed state for as long as you want or need.
Important: Do not stop your inhalers or asthma medication. These breathing techniques do not affect your lung function but used alongside your asthma medication and chest clearance methods they can be effective in helping you to cope better by reducing symptoms and improving your quality of life.
If this article is motivating you to make change, then do something straight away rather than just thinking “that sounds like a good idea, I will start next week”. Sit down, determine how much time you can devote each day and write a plan. Your exercise plan should be written in consultation with your physiotherapist and your respiratory specialist.
Of course, even when you’re exercising and improving your health, the risks don’t go away. When exercising, make sure not only that your medications are close by, but you have an action plan in case you have a flare up. Also stay wary of your triggers, including dust, pollen, pollution, other irritants like chlorine and of course colds or flu’s – as these might be causing a flare-up you could easily blame on the exercise itself. Adjust your plan if these triggers are getting in the way.
Sustainability and avoiding the drop out
It can be easy to find the motivation to start, but many people with asthma or COPD who start exercise often find it too difficult to keep going and dropout. Feeling breathless can trigger anxiety attacks and make us question whether what we’re doing is really helping. What we have to realize is that we are working our muscles and exerting ourselves, so being short of breath is normal in that situation.
It’s all about starting at a pace that you can cope with. Many people set too high an expectation, only to be frustrated that they aren’t getting the results they wanted in the time they expected. It’s a similar story to many who turn up at the gym for the first time at the end of winter and tell their instructor that they want to have a perfect body by summer.
The single most important rule of planning your exercise program is sustainability. Change takes time, commitment and patience, but if we continue to burn ourselves out with unrealistic expectations, eventually we just give up.
Stay strong, stay committed, feel better
Success is guaranteed when failure is not an option. Exercise strengthens our muscles and the stronger our muscles, the less effort we use to breath and the less breathless we become.
Like anything, when it comes down to it, the only that will power your success is you. So get on with it and good luck!
—The author, a Consultant Physiotherapist, MPT (Neuro), MPT(Cardio), can be reached at: