From the first, the stated purpose of this book was to help the asthmatic patient manage the disease closely, using all of the available, helpful methods of treatment with emphasis thus far on medicines. We have discussed making the correct diagnosis, managing the environment, various medicines, fluid intake, and other side issues.
Now we come to the heart of the matter, a series of exercises that will prevent the onset of an acute episode and shorten an episode of acute or chronic asthma. These exercises, suitable for any age group, will prevent accumulation of air in the lungs and thereby encourage full movement of the muscles involved with breathing. Taking a breath is not something we merely like to do; it is something we have to do to survive. But there are correct, effective ways and incorrect, ineffective ways to breathe. The exercises to follow suggest the best ways.
Breathing will go on whether we want it to or not. To understand this, think about holding your breath under water. After a half minute or so, your body wants to breathe and you struggle to control that normal desire to take a breath. A few seconds later, you succumb to the urge to breathe, opening your mouth wide, exhaling, and then inhaling deeply. Protective chemical reactions account for this urge to breathe. The body senses when it is deprived of oxygen needed for normal metabolism and when there is an accumulation of carbon dioxide in the blood that is regulated by breathing.
Although we can’t make breathing stop completely, it is possible to influence the rate and depth of breathing to some extent. We can breathe more fully if we want to, or a little less fully We can breathe faster if we want to, or a little slower. Try it. Breathe in deeply a few times, then shallowly. Breathe faster, even pant. Breathe slower than usual; that’s harder but possible at least for a half minute or so.
Above all, when breathing, do not try to compete with your autonomic nervous system for control of the process. That’s a no-win project because breathing, along with major bodily functions, will go on automatically as directed by the autonomic (involuntary) nervous system. Go with the flow. You can’t completely overcome the breathing pattern imposed by your nervous system, but you can influence it for the better.
In breathing, the chest acts like a bellows. When a bellows is opened, air is sucked in. When we point a bellows at a fire and push the arms together, air is forced out. Or think about the chest as a doctor’s needle and syringe. When the plunger of the syringe is pulled back, blood is sucked into the chamber. When the plunger is pushed forward, blood is forced out. The lungs work like a bellows or a plunger, expanding to let the air in, contracting to let it out.
Try breathing in front of a mirror for a moment. Use the mirror to look at your chest and upper abdomen while you inhale. With inhaling, the space between each rib increases, collarbones move upward slightly and so do the shoulders. Next, look just below the ribs at your upper abdomen. As you breathe in, that area moves outward because your diaphragm is pushing downward, moving the contents of your abdominal cavity downward and outward. Now lie down on your bed. Note the rise and fall of your abdomen as you breathe in and out. Your abdomen rises as you inhale, falls as you exhale, as the diaphragm contracts and then relaxes. Overweight persons can usually see the motion of the diaphragm, but body fat may obscure the motions of the ribs.
Motion of the diaphragm is the most important means the body uses to push air in and out. Chest muscles are secondary. We can learn to control the movement of the diaphragm to the point where we can change our breathing pattern, modify the flow of air into and out of the chest. When we learn to control motion of the diaphragm, we are said to be using “diaphragmatic breathing.” Singers are taught to control the diaphragm, the better to sing long phrases and to control volume. So are wind-instrument musicians such as players of the clarinet, flute, and trumpet. Swimmers are taught to gulp in a mouthful of air and expel it slowly, moving the diaphragm downward quickly but letting it move upward slowly, another example of diaphragm control.
Some top-notch tennis players grunt each time they hit the ball. Many boxers do the same with each blow they strike. Grunting tightens the abdominal muscles. For tennis players, this adds power to the stroke; for boxers, it braces and protects the abdomen. If you do any heavy lifting while working or exercising, you have probably discovered that grunting helps to strengthen the abdominal muscles and ease the lifting process. In these instances, grunting forces out of the chest any air that may be trapped there.
Why the need to exhale more completely? In asthma, the breathing-out (exhaling) phase is longer than breathing-in (inhaling). This is because spasm of the smooth muscle tubes (bronchi) prevents the free outflow of air from the lungs. As the bronchospasm increases, it becomes harder to exhale completely. This results in air being trapped in the lungs. As air trapping increases, occupying lung space, there is less and less room for air to move in and out. The asthmatic can no longer breathe normally because of air trapped in the lungs. Spasm of the bronchial muscles results in air trapping, which reduces the amount of space in the lungs available for normal interchange of air.
As air is trapped in the lungs, the size of the chest gets bigger. The more air trapping, the bigger the spaces between the ribs become and the lower the diaphragm moves. X rays of the chest will show these changes, but are certainly not required to make the diagnosis. A rough estimate of the change in chest size can be made by using a tape to measure the distance around the chest- Measuring at the nipple line, wrapping the tape around the chest, we can measure the circumference. As air trapping increases, chest measurements (circumference) get larger. By measuring, we can also measure improvement, watching the chest circumference grow smaller. An increase in chest circumference is noticed by a woman when, in an asthma attack, her usually comfortable bra requires loosening. Although chest measurements are helpful, they are not always practical to obtain in an acute attack.
Counting the number of breaths per minute is another useful measure of lung function. Count the number of breaths you take in a minute, which should be about 20. By comparing this normal respiratory rate with that during an asthma attack, a measure of the severity of the episode can be obtained. Someone with asthma will breathe 40, 60, and even 80 times a minute. As the asthma improves, the breathing rate (respiratory rate) moves down toward normal.
Record the patient’s normal chest circumference and normal peak flow rate for comparisons during an asthma attack.
Bronchial dilating medicines as described earlier are available to relax the tight muscular rings of the bronchi. The medicines make it easier to exhale, but they do not by themselves reduce air trapping. Special effort must be made to reduce the amount of air trapped in the lungs. That amount of trapped air is usually in proportion to the time the process has gone on. An acute, short-lived episode of asthma will trap very little air; a chronic, long-standing episode traps much more. Air trapping is a more difficult problem with long-standing asthma. The sicker the patient, the more air is trapped. As lung function improves, air trapping decreases.
Here’s what you can do about trapped air; Learn to control the motion of your diaphragm. In normal, good health, this is very easy to do. It is difficult to learn during a severe asthma attack. So don’t try to begin controlling your diaphragm until you are completely well or only a little sick.
Breathing exercises are not designed to replace use of medicines that relax the bronchial muscles. The exercises take advantage of the relaxation provided by medicines to clear the chest of trapped air. Done regularly for prevention, the exercises will reduce the frequency and severity of asthma attacks.
Before breathing exercises for the chest are begun, it is a good idea to make sure that passage of air through the nose is possible. One reason for this is that for normal breathing, air should pass through the nose and sinuses. It is only with demand for more air, as during exercise, that the mouth opens during breathing. Also, blockage of the nasal airway may be a sign that there is nasal or sinus disease needing treatment. So check to see that your nostrils are clear by breathing through each nostril in turn.
