Our Asthma program by Patrick McKeown includes the following:
- Learning how to unblock the nose
- Switching from mouth to nasal breathing
- Correcting breathing volume to normal levels
- How to breathe correctly during physical exercise
- How to incorporate into your way of life
“Noisy and deep” breathing of an asthmatic had always been considered an outcome of the disease. Nobody could even suspect that “deep breathing” was a contributory cause of bronchial asthma, and increased depth of breathing could provoke the appearance of the symptoms of the disease.
K P Buteyko MD
What causes asthma?
If you ask your doctor what causes asthma, the answer is “I don’t know”. What is known is that asthma is more prevalent in affluent countries. (1-4)
It is generally thought that this is due to the hygiene hypothesis of lower exposure to infection during childhood, which results from improved living standards.
However, “Challenging this hypothesis, there is growing evidence that in many affluent countries the prevalence is higher among those in low socio-economic status. (5-14) These socio-economic differentials in asthma support a role of environmental factors in the development of asthma.” 15
So what are the environmental factors and how do they cause asthma?
As we become wealthier, our lifestyles change and this has a significant affect on the way that we breathe. With modern living we eat more processed foods, overeat, do less physical exercise, experience more stress and have higher temperatures in the home. Jobs in the modern economy tend to be service-based. As a result they entail very little physical activity and many hours of talking. In addition we are subjected to the unhealthy belief that prevails in gyms, sports class, stress counselling and even western Yoga about the benefits of big breathing.
The modern western lifestyle has quite a profound influence on our breathing – IT INCREASES IT.
How does over-breathing contribute to asthma?
Your airways narrow due to a combination of different factors. The most prevalent is inflammation, which is swelling of the inner wall of your airways. Another is constriction by the smooth muscle that surrounds your airways and a third is increased secretion of mucus by goblet cells.
An asthma attack is used to describe a period of breathing difficulty. An attack can range from a few coughs or a mild wheeze to a life-threatening experience.
There are different theories as to why over-breathing causes airways to narrow. One is that airways cool and/or dehydrate from having to condition such a large volume of air. (21-34)
A paper by David and Freed published in the European Respiratory Journal concluded, “repeated dry air challenge in dogs in vivo causes persistent airway obstruction and inflammation not unlike that found in human asthma.” (33)
Professor Buteyko and others point to the loss of Carbon Dioxide (CO2). (35-39)
In a paper entitled The Mechanism Of Bronchoconstriction Due To Hypocapnia In Man, Sterling writes, “hypocapnia (loss of Carbon Dioxide) due to voluntary hyperventilation in man causes increased resistance to airflow”. Furthermore, when subjects inhaled an air mixture containing 5% carbon dioxide “bronchoconstriction was prevented, indicating that it had been due to hypocapnia, not to mechanical factors associated with hyperventilation”41
So what is over-breathing or chronically hyperventilating?
If I told you that you were overeating, you would understand what I mean. Overeating is eating an amount of food greater than that which our body requires.
Likewise, over-breathing means breathing a volume of air greater than that which we require. You might say that you don’t over breathe; but for most people it is hidden.
Listed below is a number of characteristics which are typical of people attending my clinics? How many apply to you?
- Breathing through the mouth
- Hearing breathing during rest
- Regular sighs
- Regular sniffing
- Irregular breathing
- Holding of breath (apnoea)
- Taking large breaths prior to talking
- Yawning with big breaths
- Upper chest movement
- Lot of visible movement
- Effortful breathing
- Heavy breathing at night
Normal Breathing Volume:
The number of breaths per minute during normal breathing is about 10 to 12. Each breath is approximately 500 ml. This provides a healthy volume as described in any University Medical textbook of 5 to 6 litres of air per minute.
Typical Asthmatic Breathing Volume:
The number of breaths per minute of a typical asthmatic is about 15-20. Each breath tends to be larger than normal and can vary from 700ml to 1 litre. This provides a volume of 10 to 15 litres of air per minute. A number of trials found that the average minute volume for asthmatics was 14.1 litres (Bowler 1998), other researchers showed a volume of 15 litres (Johnson et al 1995) and 12 litres (McFadden & Lyons 1968). (16-18)
This heavy breathing does not just happen during a symptomatic period. It is chronic meaning that it takes place every minute, every hour, every day.
People with asthma, COPD and other respiratory complaints breathe two to three times more than required. In food terms, this is the equivalent of eating ten meals per day.
Overbreathing causes those the airways of those with genetic predisposition to bronchospasm to constrict. There is a direct correlation between breathing volume and severity. The heavier one breathes, the greater their wheezing, coughing and breathlessness.
By correcting their breathing volume, asthma as a defence mechanism reverse.
Overbreathing and genetic predisposition;
It can be argued that the same percentage of the population carries the asthma gene today as did years ago. After all, we evolve over thousands of years. While asthma has been around for a long time with first reports dating back to the Ancient Egyptians, it only affected a small percentage of the population until the second half of the twentieth century. For example, the incidence of self reported asthma increased in the US by 74% between 1980 and 1996.19
Modern living has resulted in a profound change to our breathing. The affect that overbreathing has on the individual depends on genetic predisposition.
If you carry the “asthma gene” and you overbreathe, you will develop asthma. On the other hand, if you carry the “asthma gene” but don’t have the habit of overbreathing, you will not develop asthma.
Lastly, when you correct your overbreathing, asthma reverses.
Just a Habit
The good news is that overbreathing is just a habit. The part of your brain (central chemoreceptor) that regulates the amount of air you breathe becomes accustomed to breathing too much.
In a paper entitled Hyperventilation Syndrome and Asthma , Dr Stephen Demeter states “prolonged hyperventilation (for more than 24 hours) seems to sensitize the brain, leading to a more prolonged hyperventilation.”20
Hyperventilation becomes habitual or long term, so even when the primary cause is removed, the behavior is maintained.
Why is Carbon Dioxide so important?
Carbon Dioxide (CO2) is generated as an end product from the oxidising of the fats and carbohydrates you eat. The CO2 is carried by your veins to your lungs, where the excess is exhaled. Breathing a correct volume results in the required amount of CO2 being retained in your lungs. When you overbreathe, too much CO2 is exhaled. The human body requires a certain amount of it for normal functioning.
“Carbon Dioxide is, in fact, a more fundamental component of living matter than is Oxygen.” Yandell Henderson cited in Normal Breathing- The Key to Vital health by Dr. Artour Rakhimov. 40
Carbon Dioxide is not just a waste gas. It is necessary for a number of vital bodily functions including the following;
Transportation of Oxygen
Oxygen is relatively insoluble in blood, so approximately 98% of the gas is carried by haemoglobin molecules. The release of Oxygen from haemoglobin is dependent on the quantity of Carbon Dioxide in your alveoli/arterial blood. If the Carbon Dioxide is not at the required level of 5%, the Oxygen “sticks” to haemoglobin and so is not released to tissues and organs.
This bond was discovered in 1904 by Bohr and is known as the Bohr Effect.
During normal conditions 75% of your intake of Oxygen is exhaled while breathing a healthy volume of 4 – 6 litres per minute. Even during intense exercise, it is estimated that 25% of our intake of Oxygen is exhaled. Breathing a volume greater than normal does not improve the amount of Oxygen in your blood, as it is already 97 – 98% saturated. Instead it lowers CO2 levels, firstly in your lungs, then in your blood, tissues and cells and this reduces the delivery of Oxygen from the haemoglobin within your red blood cells.
The greater the amount of air taken into your body, the less Oxygen is delivered.
To oxygenate tissues and organs, modern man needs to breathe less not more.
Dilation of blood vessels and airways
Carbon Dioxide relaxes smooth muscle which surrounds airways, arteries and capillaries.
For example, each 1mmHg drop (norm is 40mmHg) of arterial CO2 reduces blood flow to the brain by 2%.42 In other words, oxygenation of your brain significantly decreases when you breathe heavily. It is no coincidence that symptoms such as fatigue, brain fog, anxiety and poor concentration etc. are common among asthmatics as chronic overbreathing is contributing to them all.
For those genetically predisposed to asthma, the loss of CO2 from the lungs causes the airways to constrict.
The heavier you breathe- the more you feed your asthma and other hyperventilation-related problems. The calmer and quieter you breathe, the more your blood vessels and airways open.
Overbreathing increases allergic reactions.
Histamine levels increase during prolonged overbreathing. (43-44) Histamine is a substance secreted by mast cells during exposure to an allergen. This substance creates swelling (edema), local inflammation and constriction of the smaller airways (bronchiole). This is especially relevant to people with hay fever (rhinitis) and asthma.
How many of the following symptoms of hyperventilation do you have?
- Respiratory system: wheezing, breathlessness, coughing, chest tightness, frequent yawning, snoring and sleep apnoea.
- Nervous system: light-headed feeling, poor concentration, numbness, sweating, dizziness, vertigo, tingling of hands and feet, faintness, trembling and headache.
- Heart: a racing heartbeat, pain in the chest region, and a skipping or irregular heartbeat.
- Mind: some degrees of anxiety, tension, depression, apprehension and stress.
Other general symptoms include mouth dryness, fatigue, bad dreams, nightmares, dry itchy skin, sweaty palms, cramping, spasm, increased urination such as bed wetting or regular visits to the bathroom during the night, diarrhea, constipation, general weakness and chronic exhaustion.
Cardiologist Claude Lum comments that; “Hyperventilation presents a collection of bizarre and often apparently unrelated symptoms, which may affect any part of the body, and any organ or any system.”45
In the late Professor Buteyko’s words “Exhaling Carbon Dioxide from the organism brings about spasms in bronchi, vessels and intestines etc. This reduces Oxygen supply leading to Oxygen deficiency making one breath heavier, thus completing the vicious circle.”
Practical examples of overbreathing affecting asthma
Exercise causes airway narrowing for an estimated 70-90% of asthmatics.46 In fact, I have yet to see a moderate to severe asthmatic who is not affected by physical exercise. Breathing increases as soon as you commence physical exercise. The heavier your breathing is relative to your metabolic requirements, the greater the degree of airway narrowing.
The second example of overbreathing causing asthma within a few minutes is laughter. We all know a friend or relative who gets into a fit of coughing or wheezing from having a good hearty laugh. As one starts to laugh, large breaths are drawn through the mouth. For some people, 30 seconds of laughter is enough to produce symptoms.
A report published by the America Thoracic Society in May 2005 concluded that laughter causes symptoms among 57% of asthmatics.47 In the same report asthma expert Dr. Garay commented, “Nobody knows how laughter brings on asthma, but it might involve hyperventilation.”
So the question to ask is; if you can take yourself into symptoms from a few minutes of laughter or exercise, does it make sense that if your breathing is 2 – 3 times more than required at all times, then it too will cause symptoms?
Why is swimming beneficial?
For years, medical doctors have been telling their asthma patients that swimming was good for them even though, they may not have exactly known why. The answer is simple; during swimming, your face is under water and this reduces your air intake. Although, you may take a breath in through your mouth every few strokes, your breathing volume is a lot less that if you were running or doing other exercise.
As you exercise, CO2 is produced from metabolic activity. This, combined with the reduced breathing volume from swimming, increases CO2 levels and this in turn dilates your airways. It is unfortunate that asthmatic swimmers are not aware of this and often revert to heavy breathing through the mouth as soon as they leave the water.
“One needs to eat less, breathe less, sleep less and physically work harder to the sweat of one’s brow because this is good. This is a fundamental change, this is true restructuring. This is what we need to do these days.”
Professor Konstantin Buteyko
1) Asher MI, Montefort S, Bjorksten B, Lai CK, Strachan DP, Weiland SK, Williams H, ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys. Lancet. 2006;368:733–743. doi: 10.1016/S0140-6736(06)69283-0.
2) Pediatric Allergy and Immunology 2006 Nov;17(7):533-7.Is affluence a risk factor for bronchial asthma and type 1 diabetes? Tedeschi A, Airaghi L
3) Allergy 2004 Feb;59(2):124-37. Asthma and atopy – the price of affluence? Von Hertzen LC, Haahtela T.
4) Ciba Found Symp. 1997;206:122-34; discussion 134-9, 157-9. Evidence for the increase in asthma worldwide. Woolcok AJ, Peat JK
5) Rona RJ. Asthma and poverty. Thorax. 2000;55:239–244. doi: 10.1136/thorax.55.3.239.
6) Gold DR, Wright R. Population Disparities in Asthma. Annual Reviews Public Health. 2005;26:89–113. doi: 10.1146/annurev.publhealth.26.021304.144528.
7) American Journal of Epidemiology. 2004;160:178–188. European Community Respiratory Health Survey. Socioeconomic status and asthma prevalence in young adults: the European Community Respiratory Health Survey. Basagana X, Sunyer J, Kogevinas M, Zock JP, Duran-Tauleria E, Jarvis D, Burney P, Anto JM,.
8) Eagan TML, Gulsvik A, Eide GE, Bakke PS. The effect of educational level on the incidence of asthma and respiratory symptoms. Respiratory Medicine 2004;98:730–736. doi: 10.1016/j.rmed.2004.02.008. [PubMed]
9) Lindbaek M, Wefring KW, Grangard EH, Ovsthus K. Socioeconomical conditions as risk factors for bronchial asthma in children aged 4-5 yrs. European Respiratory Journal. 2003;21:105–108. doi: 10.1183/09031936.02.00241802.
10) Esaroni G, Farchi S, Davoli M, Forastiere F, Perucci CA. Individual and area-based indicators of socioeconomic status and childhood asthma. European Respiratory Journal. 2003;22:619–624.
11) Oopman LP, Wijga A, Smit HA, De Jongste JC, Kerkhof M, Gerritsen J, Vos AP, Van Strien RT, Brunekreef B, Neijens HJ. Early respiratory and skin symptoms in relation to ethnic background: the importance of socioeconomic status; the PIAMA study. Archives of Disease in Childhood. 2002;87:482–488. doi: 10.1136/adc.87.6.482.
12) Etuveli G, Hurwitz B, Sheikh A. Ethnic variations in incidence of asthma episodes in England & Wales: national study of 502,482 patients in primary care. Respiratory Research. 2005;21:120. doi: 10.1186/1465-9921-6-120
13) lmqvist C, Pershagen G, Wickman M. Low socioeconomic status as a risk factor for asthma, rhinitis and sensitization at 4 years in a birth cohort. Clinical and Experimental Allergy. 2005;35:612–618. doi: 10.1111/j.1365-2222.2005.02243.x.
14) Uran-Tauleria E, Rona RJ. Geographical and socioeconomic variation in the prevalence of asthma symptoms in English and Scottish children. Thorax. 1999;54:476–481.
15) BMC Public Health. 2007; 7: 205. doi: 10.1186/1471-2458-7-205. PMCID: PMC1988821 Ecological study of socio-economic indicators and prevalence of asthma in schoolchildren in urban Brazil Sérgio Souza da Cunha, 1 Mar Pujades-Rodriguez, Mauricio Lima Barreto, Bernd Genser, and Laura C Rodrigues
16) Journal of Applied Physiology; September 1995; 79(3) 892-901; Regulation of ventilatory capacity during exercise in asthmatics. (Johnson, B.D.; Scanlon, P.D.; Beck, K.C..)
17) Medical Journal of Australia; 1998, 169, 575-578; Buteyko breathing techniques in asthma, a blinded randomised controlled trial. (Bowler, S.D.; Green, A.; Mitchell, C.A..)
18) The New England Journal of Medicine; May 9th, 1968; 278 (19) 1027-1032; Arterial Blood gases in asthma. (McFadden and Lyons.)
19) Centers for Disease Control and Prevention. Surveillance for asthma: United States, 1980–1999. MMWR 1998;51:1–13.
20) The American Journal of Medicine; December 1986; Volume 81; p989. Hyperventilation Syndrome and Asthma. (Demeter, Cordasco.)
21) Journal Allergy Clinical Immunology. 1982 Apr;69(4):354-9.Airway cooling in asthmatic and non-asthmatic subjects during nasal and oral breathing. Griffin MP, McFadden ER Jr, Ingram RH Jr.
22) Journal of Applied Physiology 1979 Mar;46(3):484-90.Esophageal temperature during exercise in asthmatic and non-asthmatic subjects. Deal EC Jr, McFadden ER Jr, Ingram RH Jr, Jaeger JJ.
23) The Journal of Clinical Investigation 1978 Feb; 61(2):433-40. Influence of heat and humidity on the airway obstruction induced by exercise in asthma. Strauss Rh, McFadden ER Jr, Ingram RH jr, Deal EC jr, Jaeger JJ.
24) Chest 1988 Jul; 94(1):81-6. Effect of dry warm air on respiratory water loss in children with exercise-induced asthma. Tabka Z, Ben Jebria A, Vergeret J, Geunard H.
25) Medicine and science in sports and exercise 2003 Apr;35(4):608-16. Repeated peripheral airway hyperpnea causes inflammation and remodelling in dogs. Davis MS, Schofield B, Freed AN
26) Journal of Applied Physiology 1986 Jul;61(1):210-4. Reduced hyperpnea-induced bronchospasm following repeated cold air challenge. Haas F, Levin N, Pasierski, Bishop M, Axen K.
27) Chest. 2002;121:1806-1811.) Airway Dehydration* A Therapeutic Target in Asthma? Edward Moloney, MB; Siobhan O’Sullivan, PhD; Thomas Hogan, MD; Leonard W. Poulter, DSc and Conor M. Burke, MD, FCCP why bold??
28) Chen, WY, Horton, DJ (1977) Heat and water loss from the airways and exercise-induced asthma. Respiration 34,305-313
29) Strauss, RH, McFadden, ER, Jr, Ingram, RH, Jr, et al (1978) Influence of heat and humidity on the airway obstruction induced by exercise in asthma. Journal of Clinical Investigation 61,433-440
30) Strauss, RH, McFadden, ER, Jr, Ingram, RH, Jr, et al (1977) Enhancement of exercise-induced asthma by cold air. New England Journal of Medicine 297,743-747
31) Deal, EC, Jr, McFadden, ER, Jr, Ingram, RH, Jr, et al (1979) Hyperpnea and heat flux: initial reaction sequence in exercise-induced asthma. Journal of Applied Physiology 46,476-483 (Journal of Applied Physiology)
32) Anderson, SD, Schoeffel, RE, Follet, R, et al (1982) Sensitivity to heat and water loss at rest and during exercise in asthmatic patients. European Journal of Respiratory Diseases 63,459-471
33) European Respiratory Journal 1999 Jul;14(1):57-62. Repetitive hyperpnoea causes peripheral airway obstruction and eosinophilia. Davis MS, Freed AN
34) American Journal of Respiratory and critical Care Med 2001 Sep 1;164(5):785-9. Repeated hyperventilation causes peripheral airways inflammation, hyperreactivity, and impaired bronchodilation in dogs. Davis MS, Freed AN
35) Applied Psychophysiology Biofeedback 2007 Jun;32(2):99-109. Epub 2007 Jun. Targeting pCO(2) in asthma: pilot evaluation of a capnometry-assisted breathing training. Meuret AE, Ritz T, Wilhelm FH, Roth WT.
36) Respiratory Medicine 2003 May;97(5):501-7. Breathing retraining for asthma. Ram FS, Holloway EA, Jones PW
37) Targeting pCO(2) in asthma: pilot evaluation of a capnometry-assisted breathing training. Applied Psychophysiology Biofeedback. 2007 Jun;32(2):99-109. Epub 2007 Jun 13. Meuret AE, Ritz T, Wilhelm FH, Roth WT
38) Probl Tuberk Bolezn Legk 2005;(2):26-8. [The blood oxygen-transport system and oxygen tissue balance in patients with bronchial asthma (BA) concurrent with carbohydrate metabolic disturbances][Article in Russian]
39) Lancet 1999 Oct 9;354(9186):1283-6. Carbon dioxide and the critically ill–too little of a good thing? Laffey JG, Kavanagh BP
40) Yandell Henderson cited in Normal Breathing- The Key to Vital health by Dr. Artour Rakhimov
41) Clinical Science; 1968; 34, 277-285. The Mechanism of Bronchoconstriction due to hypocapnia in man. (G.M. Sterling.)
42) (Haughe et al 1980 cited in Multidisiplinary approaches to breathing pattern disorders by Leon Chaitow, Dinah Bradley and Christopher Gilbert)
43) European Respiratory Journal 1992; 5: 323-330 The relative contributions of histamine and prostanoids to bronchoconstriction provoked by isocapnic hyperventilation in asthma. JP Finnerty, A Harvey, and ST Holgate
44) (Kontos et al 1972 cited in Multidisiplinary approaches to breathing pattern disorders by Leon Chaitow, Dinah Bradley and Christopher Gilbert)