Manage your asthma
A child or adult with asthma has audible and physically noticeable breathing, even when they are at rest. Quite simply they over breathe all the time using their mouth and upper chest. It is these characteristics of an unhealthy breathing habit that the Buteyko method seeks to change. It is all about:
Nasal breathing instead of mouth breathing
Optimal levels of breathing instead of over breathing
Diaphragmatic breathing instead of upper chest breathing
What does your nose do that your mouth doesn’t
As air travels through your nasal airways it passes through tiny hair-like filtering networks called cilia and mucous secretions. These filter, moisten and warm the air before it reaches the delicate tissues that form your respiratory system. This filtering, warming and moistening is the first step in the conditioning stage of the air you breathe in and your first line of defence against harmful bacteria, viruses and allergens (1). What is also important for asthma and allergy sufferers to know is that: Your airways do not like dry cold air they become inflamed and swell up (2) (It is usually then that sufferers reach for steroids). However, the treatment of the air that occurs when you breathe through your nose lessens the chances of this happening.
Your nose is loaded with bitter taste receptors, but they’re not helping you taste or smell lunch. When you breathe in they send a signal to your sinuses to release nitric oxide (3). Nitric oxide (NO) also known as the mighty molecule is very effective at killing off harmful pathogens (4): It is anti-bacterial, anti-viral and anti-fungal. Nitric oxide, however, has another function in respiratory system: it travels with the air you breathe opening up your airways all the way to the endpoint of your respiratory system, your alveoli. This is why it is known as the body’s natural bronchodilator (5).
Keep Calm, Use Your Diaphragm
Mouth breathing is mostly chest breathing. Nasal breathing is mostly diaphragmatic breathing. Why does this matter? Put simply; The diaphragm is the most efficient muscle to breathe with. It is a large, dome-shaped muscle located at the base of the lung which contracts as you inhale and expands as you exhale. Using your diaphragm to breathe allows you to breathe with less effort and stimulates the relaxation response in the parasympathetic nervous system (6). This helps you to achieve the second aim of Buteyko training which is to be calm and breathe less.
When we talk about you breathing less, we mean that you will reduce the volume of air that you will take into and out of your lungs. Simple. Why is a reduction in breathing volume important for people who have asthma and allergies to look into?
The short answer is that your current breathing pattern may be causing you to lose too much carbon dioxide. We cannot inhale carbon dioxide from the atmosphere; it is a by-product of metabolic chemical reactions which are required to supply the body with energy. While it is true that carbon dioxide can be classed as a waste gas, we only exhale CO2 to get rid of the excess and it is vital that a certain amount is retained in the blood for healthy body function (7). The human lungs require 5% CO2 at a partial pressure of 40 mmHg. The air we breathe in contains just 0.04% at a partial pressure of 0.3mmHg. Over breathing or hyperventilating results in the partial pressure of held CO2 being exhaled or ‘washed’ from our lungs. This deficiency of CO2 is called hypocapnia.
Hyperventilation And Symptoms
Doctor Buteyko’s (whom the method is named after) extensive research led him to the conclusion that many chronic conditions, could be scientifically explained, in large part, as being a consequence of hypocapnia. While it was known at the time that hyperventilation caused hypocapnia, he reasoned that if he could retrain patients who hyperventilate so that their breathing was reduced towards an optimal level, then their condition could reverse.
You already that know that oxygen is vital for life, nothing will work in your body without it. What you may not know, especially if you have forgotten all the lessons that you have learnt on the respiratory system at school, is that for optimal delivery of oxygen you need an optimal amount of carbon dioxide (8). It may seem paradoxical but the more you breathe, the harder it is for oxygen to reach the parts of your body that need it.
A Quick Lesson
When we take a breath of air into our lungs, oxygen passes from the lungs to the blood where it is picked up and carried through the blood vessels by a molecule called haemoglobin. This oxygen-rich blood is then pumped by the heart throughout the body so that oxygen can be offloaded to cells for conversion to energy. In order to release oxygen from the blood, however, haemoglobin requires a catalyst which involves an increase in body temperature, along with the presence of carbon dioxide (8). When carbon dioxide levels are less than adequate, the transfer of oxygen from the blood to muscles and organs is limited, leading to poor body oxygenation.
This necessary presence of carbon dioxide was discovered in 1904 by the physiologist and Nobel laureate Christian Bohr, who recognised that CO2 affects the release of oxygen from the blood to tissues and organs. According to the Bohr Effect, when there is sufficient pressure of carbon dioxide in the blood and lungs, pH drops and oxygen is released more readily. Conversely, when carbon dioxide levels are low, haemoglobin molecules are less able to release oxygen from the blood. The way we breathe determines the amount of carbon dioxide present in our blood, and therefore how well our bodies are oxygenated.
What is particularly important for people with asthma to know are the other roles that carbon dioxide has in their body: It relaxes the smooth muscles embedded in the airways, arteries and capillaries, enabling smooth breathing and healthy blood flow. It also inhibits the degranulation of mast cells (9) which results in lower histamine production. Think of histamine as being the messenger, which if you suffer from asthma or allergies goes into overdrive when triggered by a harmless substance like household dust. Chemically, it works in the body by binding with special receptors on protein molecules. When bound to the receptor, a particular effect is produced, such as inflammation or increased mucous production. The reaction a person experiences depends on the amount of histamine released. This varies from individual to individual. One way to control the amount of histamine produced is to take an antihistamine, a better way without all the side effects is to maintain optimal carbon dioxide levels by reducing your breathing.
The Vicious Circle
Asthmatic airways are prone to constriction by a combination of inflammation, constriction of the smooth muscle and increased secretions of mucus. Narrowing of the airways induces a feeling of hunger for air, accelerating the respiratory rate and volume as a compensatory mechanism. The feeling that one is not getting enough air may also encourage a switch from nasal to mouth breathing.
While it is entirely logical that narrowing of the airways (bronchoconstriction) results in an increase to breathing volume, it is important to recognise that increased breathing volume contributes to bronchoconstriction. In other words, there is a feedback loop. The more you over breathe, the more constricted your airways will become, and the more you are constricted the more you will over breathe. Buteyko exercises break this vicious circle.
While most medical textbooks list normal minute ventilation for a healthy adult of between 4 and 9 litres, individuals with asthma demonstrate resting ventilation of between 10 and 15 litres per minute.
Normal breathing during rest involves regular, silent diaphragmatic breaths drawn in and out through the nose. People with asthma on the other hand display habitual oral breathing, regular sighing and sniffing with visible movements from the upper chest. During an exacerbation of asthma, respiratory rate, wheezing and breathlessness all increase relative to severity.
According to researcher Hallani in a 2008 paper published in the European Respiratory Journal, people with asthma tend to switch to oral breathing more than individuals without asthma. This finding is supported by the Kairaitis study which noted that asthmatics are more likely to breathe through their mouth, a factor which contributes to the severity of their symptoms. Mouth breathing also causes a reduction in lung function in mild asthmatics and plays a role in the pathogenesis of acute asthma exacerbations.
A number of researchers have determined an inverse relationship between the length of breath-hold time (after exhalation) and severity of conditions. I.e. the shorter that a person is able to hold their breath for after exhalation, the worse their symptoms are. Over the past fifteen years, Buteyko Clinic international has measured the breath-hold time at rest of thousands of individuals with asthma. Mild asthmatics consistently hold their breath for up to twenty seconds, moderate for fifteen seconds and severe for up to ten seconds. The measurement was applied by the Late Russian Dr Konstantin Buteyko and is known as the Control Pause.
1.Take a small, silent breath in through your nose and allow a small silent breath out through your nose.
2.Hold your nose with your fingers to prevent air from entering your lungs.
3.Start your stopwatch.
4.Hold your breath until you feel the first involuntary movements of your breathing muscles. Your tummy will jerk and the area around your neck may contract.
5.Stop your stopwatch and calmly breathe in.
Learning and practising the Buteyko method will allow you to breathe less through your nose to:
- Filter out triggering allergens, and condition the air that you breathe in before it reaches your lungs
- Sterilise your respiratory system
- Lessen the risk of your airways becoming inflamed
- Open up your airways
- Allow you to calmly breathe using your diaphragm
- Maintain adequate oxygenation of your tissues
- Inhibit the release of histamine
- Break the cycle that exists between bronchoconstriction and hyperventilation
1.O’Meara, T. J.; Sercombe, J. K.; Morgan, G.; Reddel, H. K.; Xuan, W.; Tovey, E. R. (2005). “The reduction of rhinitis symptoms by nasal filters during natural exposure to ragweed and grass pollen”
2. Harvard Medical School Publishing Mouth Breathing Challenges 2019
3. Impact of bitter taste receptor phenotype upon clinical presentation in chronic rhinosinusitis.Division of Rhinology and Sinus Surgery, Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
4.Hou, YC; Janczuk, A; Wang, PG (1999). “Current trends in the development of nitric oxide donors”. Current Pharmaceutical Design. 5 (6): 417–41.
5. Culotta, Elizabeth; Koshland, Daniel E. Jr (1992). “NO news is good news”. Science. 258 (5090): 1862–1864
6. Stress Management and Reduction Journal University of Texas Austin
7. Voet, Donald; Judith G. Voet; Charlotte W. Pratt (2013). Fundamentals of Biochemistry: Life at the Molecular Level (4th ed.). John Wiley & Sons
9.Center for Biomedical & Life Sciences, Missouri State University, Springfield, MO, USA.
There are numerous studies investigating the Buteyko Breathing Method as a treatment for asthma. Most if not all, conclude a significant improvement to asthma control with a number of trials showing a 70% reduction in the need for asthma reliever medication and a 50% reduction in the need for asthma steroid medication within 12 to 24 weeks.
In a paper published in the American Review of Respiratory Disease, researchers studied the beneficial effects of nasal breathing on exercise-induced asthma. The study observed that most asthmatic subjects spontaneously breathe with their mouths open when instructed to breathe ‘naturally’. The authors found that mouth breathing during exercise caused the airways to narrow. In contrast, when subjects were required to breathe only through their nose during exercise, exercise-induced asthma did not occur at all. The paper concluded that “the nasopharynx and the oropharynx play important roles in the phenomenon of exercise-induced bronchoconstriction”.
In another study, researchers Mangla and Menon studied the effects of nasal breathing and oral breathing on exercise-induced asthma. Fifteen people were recruited for the study. As in the previous study, participants were required to breathe only through their nose. The study found that ‘the post-exercise bronchoconstrictive response was markedly reduced as compared with the response obtained by oral (mouth) breathing during exercise, indicating a beneficial effect of nasal breathing’.
That elite athletes with asthma often favour swimming above other forms of exercise is not a coincidence. When swimming, the face is immersed underwater, serving to restrict breathing volume. Although the swimmer draws his or her breath in through the mouth, ventilation is less than when compared to running or cycling. Another beneficial factor from swimming is that the body’s weight on the water exerts gentle pressure on the chest and tummy, which further restricts breathing.
In the words of respiratory consultant Dr Peter Donnelly, ‘In most land based forms of exercise, patterns of breathing are not constrained, ventilation increases proportionately throughout exercise and end tidal CO2 tensions are either normal or low. Therefore, there is no hypercapnic stimulus for bronchodilation and asthmatics have no protection’.
Although the act of swimming is beneficial, spending time in chlorinated pools is not because chlorine can cause damage to lung tissue leading to swimming-related health hazards.
Breathing exercises aimed at normalising breathing volume have been attracting recent attention. The 2012 British Thoracic Society asthma guidelines state that the “Buteyko breathing technique may be considered to help patients to control the symptoms of asthma.