Pulse and control pause
Buteyko breathing is a program of breath retraining aimed at reversing chronic hyperventilation on a permanent basis. While the exercises are very simple, it is important to follow them exactly as they are written in order to experience maximum benefits.
With breath retraining, there are two measurements that are used to monitor asthma severity and progress. These are the pulse, which is a measurement of the number of heart beats taken usually over a period of one minute, and the control pause [CP], which is the length of time for which you can comfortably hold your breath.
The peak flow meter will be a familiar piece of equipment to many people with asthma. However it is not used as a measurement in Buteyko breathing. If peak flow measurement is part of your asthma management, continue to use it. However, after taking a reading from your peak flow meter, hold your breath for three to five seconds and reduce your breathing for a while to replenish any loss of carbon dioxide.
Pulse
Everyone should be able to measure their pulse but it is especially important that asthmatics are able to do so. The pulse should be taken before and after each half-hour set of breathing exercises. When these exercises are performed correctly, with relaxation and reduced volume of breathing, the pulse at the end of exercise will be lower than at the start. Reducing breathing relaxes the smooth muscle of the arteries which results in less pumping work for the heart.
However, if breathing exercises are practised with too much effort or tension, the pulse will actually increase. It is important to spend time practising all breathing exercises with relaxation of muscles, even those involving physical activity.
It should also be noted that the pulse rate will vary throughout the day, depending on factors such as diet, eating patterns and activity levels.
As mentioned above, the pulse is measured by counting the number of heartbeats per minute. Another option is to measure the number of beats over thirty seconds and multiply by two. Measuring for fifteen seconds and multiplying by four leaves too much room for error and is not advisable. When measuring heartbeats, make sure to measure your pulse and not to count the number of seconds on your clock or watch.
Measuring the pulse.
Locate the pulse about one inch up from the wrist and about one centimetre inwards on the thumb side of the hand. Place two fingers from the free hand onto the groove or channel in this area of the wrist where the slight throb of the pulse can be felt through the fingertips.
If you have difficulty locating the pulse on the wrist then check for it at the carotid artery in the neck.
In general, the lower the resting heart rate, the healthier the individual is. Normal healthy adults will have a pulse rate of 60 to 80 beats per minute at rest. Physically fit individuals will have a lower pulse rate than this, although some individuals have a naturally low pulse rate.
If the pulse rate is greater than 90 and less than 110 beats per minute at rest, the asthma is uncontrolled and a visit to a doctor is necessary. If the pulse rate is greater than 110 beats per minute at rest, asthma is acute/severe and medical attention is necessary.
The normal pulse range for a child is higher than that of an adult. A child’s pulse can vary from 60 to 100 beats per minute which decreases as the child gets older.
With both children and adults, an upward trend in the pulse or an increase of twenty percent over 24 hours while taken at rest, are signs that asthma is deteriorating. Practising breathing exercises intensively will bring down the pulse and if necessary a doctor should be consulted to increase the dose of preventative medication.
It is advisable to note that the aforementioned pulse rate measurements must be only taken after resting for half-an-hour as the pulse rate increases considerably with physical activity.
The maximum recommended pulse rate for any individual while participating in physical activity is 220 minus their age. For example, the maximum recommended pulse rate for a twenty-five-year-old is 195 beats (220 minus 25) per minute.
The pulse will vary depending on a variety of factors. It may be adversely affected by, for example, food consumption levels, food allergies, stimulants such as coffee or chocolate, and factors such as excitement, anxiety, excessive talking and, of course, big breathing.
Control pause [CP]
The control pause is a measure of the level of carbon dioxide in the alveoli based on a comfortable breath hold. The control pause and pulse are used together to monitor asthma.
Over time, paying attention to the breathing pattern, your carbon dioxide threshold will adjust to a higher and healthier level. As a result the body becomes less sensitive to carbon dioxide accumulation, which will result in a gradual improvement in the length of time a person can hold their breath. By reducing the volume of breathing, carbon dioxide levels increase and therefore the control pause will increase.
Through overbreathing, the carbon dioxide level will decrease and therefore the control pause will decrease. The control pause will also decrease if medication is reduced too drastically.
The control pause is consistent and is a very good indicator of progress and of the current condition of the asthma, because of this it is essential to learn how to measure it correctly. Bear in mind that the control pause is only a measure; it is not an exercise to increase the level of your carbon dioxide.
The control pause enables the measurement of carbon dioxide in the alveoli without the need for any equipment other than a stopwatch or a watch/clock with a second hand.
Measuring your control pause
• Sit in an upright chair and adopt a good posture. Relax your shoulders and rest your lower back against the back of the chair.
• Do not change your breathing before taking your CP. Take a small breath in (two seconds) and a small breath out (three seconds). Hold your nose on the ‘out’ breath, with empty lungs but not too empty. Holding your nose is necessary to prevent air entering into the airways.
• Count how many seconds you can comfortably last before you need to breathe in again. Hold your breath until you feel the first need to breathe in. Release your nose and breathe in through it.
• Your first intake of breath after the CP should be no greater than your breath prior to taking measurement; you should not hold your breath for too long as this may cause you to take a big breath after measuring the CP.
Diagram Measuring the control pause (a).
Points to bear in mind
There are a number of important points to bear in kind when measuring your CP. Breathe normally before taking your CP. Try not to take a big breath before you start as this will give an inconsistent reading.
If you have just completed breathing exercises, wait two or three minutes. Measuring your CP directly after exercises will give an inaccurate reading due to an existing air shortage from the exercise.
Do not breathe all the air out of your lungs because this will be very uncomfortable and will result in a reduced CP. Also do not try to hold your breath for too long as this will give an incorrect reading. The CP is a measurement of your progress only: it is not an exercise to see how long you can hold your breath before you burst!
Hold your breath only until you feel the first urge to breathe in. You may not like the result but it is the correct one and that’s what you need to know. You can then take steps to correct it and gauge your progress with confidence.
It does take some practice before you become consistent in measuring your control pause. The measure is subjective because it is difficult to know what the first urge is. At first, it is very easy to push a little too hard and this is the case when the breath after taking the CP is greater than before.
With practice, the control pause will become more consistent. A reading of the level of carbon dioxide in the alveoli will be achieved with a correct control pause.
Diagram The control pause (b).
Carbon dioxide level
The level of carbon dioxide in the body determines the length of time the breath can be held: a higher level of carbon dioxide corresponds to a longer breath hold. The table below was developed by Professor Buteyko after he had measured the breath-holding ability of literally thousands of patients and matched it to their carbon dioxide levels. The figures are consistent and show the level of carbon dioxide based on the length of the control pause.
CO2 in alveoli [%] Control pause [sec]
Perfect Health 6.5 60
6.0 50
Asthma Free 5.5 40
5.0 30
4.5 20
4.0 10
3.5 5
Death
If the control pause is eight seconds, then there is a little less than four per cent carbon dioxide in the alveoli. If the control pause is fifteen seconds, the carbon dioxide is between four and four-and-a-half per cent. The aim is to increase the level of carbon dioxide to at least five-and-a-half per cent giving a control pause of forty seconds.
With continuous practice of exercises, the respiratory centre will become accustomed to a higher concentration of carbon dioxide. Remember, it is the level of carbon dioxide that determines the need to breathe.
Low control pause
A low control pause means the body’s respiratory centre has become fixed at a low level of carbon dioxide and therefore will send instructions to breathe a large volume of air in order to maintain this level. By commencing breathing exercises, an attempt is made to break this pattern by deliberately reducing the volume of air inhaled.
Regular practice of exercises and increased observation of breathing will help the respiratory centre to become fixed at a higher level of carbon dioxide. Just as it took time for the respiratory centre to become accustomed to a low level of carbon dioxide, it will also take time for it to become accustomed to a new higher, and healthier, level.
The increase in CP is dependent on a variety of factors: the severity of the asthma, age, how much the breathing exercises have been practised and how much attention has been given to the breathing. The more attention to, and observation of, breathing the better.
The control pause is an accurate measure of the level of carbon dioxide in the alveoli. It therefore gives a very good indication of the state of a person’s asthma and in fact, of health generally. If the control pause is increasing then the asthma is improving. If the control pause is decreasing the individual’s asthma is getting worse.
A decreasing control pause is advance warning of an imminent attack. If the trend is for the control pause to decrease over a number of days, then it is important to take control of the condition by reducing the breathing to raise carbon dioxide levels. If it is not proving possible to increase the CP by breathing exercises, then it may be necessary to increase the level of preventative medication that has been prescribed.
A change in CP will often be noticed simply from observing reactions to various daily activities. It is possible to determine from the CP whether something is or is not good for asthma.
For example, if the CP has decreased following exercise, that person has been deep breathing during the exercise, so it would be important to change the way exercise is carried out. If the CP decreased following a large steak then eating large quantities of meat may not suit that individual or it may be that too much was eaten at one sitting. If the CP consistently drops at work then stress may be a factor or a reversal to mouth breathing may have occurred while concentrating on work. The CP gives excellent feedback and enables everyone to turn detective and determine whether something is a help or a hindrance to their asthma.
To determine whether breathing exercises are being practised correctly, it is necessary to measure the CP at the start of each exercise and several times during it to ensure that overbreathing is not occurring. The aim of breathing exercises is to reduce breathing volume, which will reset the carbon dioxide threshold and therefore the CP. The breathing exercises are being performed correctly when the CP increases a little between each set of exercises. Breathing exercises are being performed incorrectly when the CP is decreasing between each set. The pages towards the back of this book contain detailed exercise programs.
If it is proving impossible to influence the CP, then the exercises are not being done correctly and it would probably be better to stop doing the exercises and learn how to do them properly from an experienced practitioner.
From week to week, there should be a noticeable improvement in the control pause. The body will become conditioned to a higher level of carbon dioxide when breathing exercises are practised correctly. This will be reflected in a higher control pause. As far as Buteyko breathing is concerned, the control pause is the most important measurement of an individual’s asthma.
Measuring the CP in the morning before breakfast gives the most important measurement of the state of a person’s asthma. In the depths of sleep, breathing is a subconscious activity that cannot be interfered with. For this reason, the morning CP will give a true measurement of the level of carbon dioxide.
During the day, the CP will change depending on factors like eating, stress and talking, and on how the breathing changes. If the control pause is thirty seconds during the day and only ten seconds in the morning then the true control pause is ten seconds.
Peak flow meter
The peak flow meter, as used in conventional management, involves taking deep inhalations followed by large exhalations to measure the forced expiration of air in one second. This is an act of hyperventilation, and it can cause the airways to go into spasm, leading to inconsistent and inaccurate readings of the severity of asthma. In addition, blowing into a peak flow meter a number of times consecutively may be enough to start an attack. It is possible to continue to use your flow meter alongside the CP if desired. After taking a peak flow reading, the breath should be held for three to five seconds and the breathing reduced for three minutes to reverse the act of hyperventilation.
Scientists at Brunel University have recently devised a new product which allows people with asthma test their condition while they breathe normally. This device is based on capnography and measures the rate of change of carbon dioxide in exhaled air against time with normal breathing. Measurements are reliable and simple to take allowing asthmatic patients to accurately monitor their condition. It is worth noting that this device recognises the importance of correct carbon dioxide levels. Overtime, it may help change the current understanding regarding the significance of carbon dioxide.