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Sidebar: Eucapnic Breathing
Sidebar: Asthma Soothers
Asthma and Children: A New Approach--The Buteyko Method of Eucapnic Breathing
by Rosalba Courtney
Issue 87, March/April 1998
Watching a child struggling for breath is one of the most difficult things a parent goes through. The fear and alarm it causes makes most parents only too willing to resort to the strongest medications to enable their children to live a more active, normal life. Many parents, however, are uneasy with the constant intake of medication and look for alternative ways to reduce, if even slightly, their children's need for bronchodilators and steroid-based drugs.
Article continues below
Asthma is becoming a bigger problem than ever. In the last ten years the rates of asthma throughout the world have doubled. Asthmatics are also sicker than previously, with more episodes of wheezing, breathlessness, and hospitalization. The affluent countries of the world are the ones that have fared the worst. Thirteen percent of the children in America suffer from asthma, while in Australia the rate is 30 percent.1 It seems that even countries with the best medical technology have not yet come up with an answer to asthma. However, a new approach that focuses on breathing may hold some answers.
A research study done in Australia at Brisbane's Mater Hospital recently showed that a simple breathing method was able to reduce the need for asthma symptom-relieving bronchodilator drugs by 90 percent.2 The need for steroid drugs was also reduced by 30 percent over a three-month period. Asthmatics who completed this program reported less asthma on the lower levels of medication, as well as improved well-being and quality of life. Although the asthmatics in this trial were all adults, many children have been learning to breathe in this new way, improving their asthma, blocked noses, and allergies and reducing their reliance on medication.
The method they were testing was developed by Russian Doctor K. P. Buteyko and has been in use in several clinics throughout that country for over 40 years. In 1980, a trial with this breathing method was conducted at the First Moscow Institute of Paediatric Diseases at the direction of the Government Committee for Science and Technology of the Soviet Ministry of the USSR.3 Fifty-two children suffering from moderately severe and severe asthma were tested over three months. All children responded positively to the breathing method, and asthma attacks, rhinitis, and nasal mucus became less frequent and then disappeared. They found that 83 percent of the children were considerably improved, and 17 percent showed some improvement. No children showed lack of improvement. The treatment given consisted of 40 to 90 minutes of breathing training. Then children used the breathing techniques themselves for further periods during the day to relieve their symptoms. After five days, 73 percent of the children discontinued all bronchodilator medication, and 15 percent were able to reduce medication. The breathing method was also used to relieve asthma symptoms: The children were told to take their medication if after ten to 15 minutes they were not able to get rid of their symptoms using the breathing technique alone.
Eucapnic Breathing is a form of breathing that normalizes levels of carbon dioxide by controlling ventilation levels. This breathing method teaches that asthma is made much worse by hyperventilation, or overbreathing. All asthmatics overbreathe, and this leads to a loss of carbon dioxide from the alveoli of the lungs. Carbon dioxide is a bronchodilator of the lungs. When the percentage of alveolar carbon dioxide to oxygen drops too low, the lungs of those prone to asthma respond by creating spasm, thereby increasing mucus production and subsequently lowering oxygen levels.
Well-known triggers of asthma, such as exercise, emotional stress, or excitement, all create hyperventilation in those prone to it. A study published in the Lancet showed that if asthmatics were made to hyperventilate, asthma was produced in two minutes in four out of five people.4 One child in the study invariably developed asthma whenever she was to go to a birthday party. After exercise, asthmatics tend to develop inappropriate postexercise hyperventilation, meaning that exercise itself tends to make them breathe more than is right for them. After exercise a healthy person will quickly get his or her carbon dioxide levels up to normal again by automatically decreasing breathing if carbon dioxide has dropped too low. However, many asthmatics just keep on hyperventilating, developing asthma as a consequence.
When children are having an asthma attack, they often feel fear. The stronger the asthma attack, the more severe the fear. Studies done with children have shown that this fear can make the asthma worse. Children have been brought to the hospital with all the outward signs of severe asthma, but on testing are found only to have mild restriction of the airways. Fear is a major cause of hyperventilation. It is part of our primitive flight or fight response to a perceived threat or danger. Asthmatics are usually already hyperventilating chronically due to the nature of their condition, and any additional hyperventilation has the effect of causing further constriction of airways, adding to the feeling of breathlessness. The breathlessness makes them hyperventilate even more, and a vicious cycle is created.
Most of us believe that to get more oxygen we must breathe more frequently or more deeply. What most people don't realize is that if you are already overbreathing, breathing more will actually decrease the amount of oxygen that is available to essential body tissue like the brain, organs, and muscles. This is because our ability to utilize oxygen is dependent on the levels of carbon dioxide in the blood. A physiological fact called the Bohr effect states that the ability of hemoglobin to release oxygen is dependent on the amount of carbon dioxide in the blood. When carbon dioxide drops too low, due to overbreathing, we feel breathless because of the spasm that develops in the airways and the decreased oxygen available to body tissues.
Another reason that asthmatics have low levels of oxygen is because areas of the lung that are highly ventilated do not have good blood flow moving through the capillaries. These areas of overinflated lung, which can comprise up to 75 percent of lung area, actually create pressure on blood vessels, increasing the resistance to blood flow through these areas of lung. Oxygen is subsequently not picked up by the blood vessels.
Eucapnic Breathing teaches people to decrease their ventilation levels when they are breathless. They are told to breathe small gentle breaths, through the nose, while at the same time keeping the belly and diaphragm relaxed. They are also taught to use posture and small episodes of breath-holding to raise carbon dioxide so that it can act as a local bronchodilator.
Nasal breathing is often a problem for asthmatic children. You can often recognize asthmatic children, with open mouth, long narrow face, and skin pallor. Frequently the muscles of the front of the neck and shoulders are overdeveloped from chronic upper chest breathing. It is essential for these children to learn to breathe through the nose and to stop using the muscles of the neck and upper chest for breathing.
The more you practice mouth breathing, the less you feel able to breathe through the nose-while in fact the nose will actually become more blocked if you breathe through your mouth. Mouth breathing leads to overbreathing and aggravates the loss of carbon dioxide. Also, breathing through the mouth means that the air you breathe is not warmed, humidified, and filtered the way it is when you breathe through your nose. One of the best things we can do for asthmatic children is teach them to breathe through their noses. They will need frequent reminding and at first may not want to do it. When children accustomed to mouth breathing first begin to breathe through the nose, they may feel slightly breathless or even panicky. But if you can get them to persist for a few minutes, perhaps by sitting with them and reading a storybook, the nose will begin to clear, and their breathing will become easier in about three to ten minutes. Breathing through the nose becomes easier because as you reduce ventilation levels and raise carbon dioxide the mucous membranes begin to shrink a little. Also, as carbon dioxide levels begin to increase, the oxygen release to tissues improves as part of the Bohr effect. The more children breathe through their noses, the better their asthma will be.
Nose breathing is particularly important during exercise. This takes a lot more work to achieve but is fundamental to controlling exercise-induced asthma. Even very strenuous exercise can be done while maintaining nasal breathing, once the body is trained to improve the efficiency of oxygen uptake. We should encourage children to exercise with us. And while exercising with them, we can get them used to doing more and more strenuous activity with a closed mouth.
When Eucapnic Breathing is taught in classes, children are also trained to do specific breath-holding exercises tailored to them. Short episodes of breath-holding increase the level of carbon dioxide in the blood, causing the mucous membranes to shrink and making it possible to breathe through the nose. The other major effect of these breath-holding exercises is that they open the bronchi and begin to relieve the asthma spasms. The child is also shown exercises to relax the diaphragm and to avoid breathing with the upper chest. In addition, the child is taught how to react to breathlessness without fear-with small breaths that help to open the bronchi. It usually takes five classes to get a child to begin changing his or her breathing. The classes use lots of games and stories to help children understand how to change their breathing, unblock their noses, and open their breathing passages.
It has been known for a long time that swimming is particularly good for asthmatics. Studies have shown that asthmatic swimmers do not get exercise-induced asthma when they swim and may, in fact, actually experience a bronchodilating effect.5 Olympic swim teams are full of individuals who were asthmatics as children and swam to free up their breathing. Doctors never seemed to know exactly what it was about swimming that led to the improvement, saying that it increased lung capacity somehow or helped asthmatics because it made them breathe humid air. It was also known that to make a big difference to their health, asthmatics had to swim very regularly and for fairly long periods of time.
It is now evident that the reason swimming helps asthma is that during swimming breathing is constrained. Carbon dioxide increases to very high levels when you swim with your face in the water between breaths, while slowly increasing the number of strokes per breath to three, five, or even seven. It is the swimming effect that we use when we do Eucapnic Breathing (despite the fact that it is almost impossible to breathe through the nose while you swim and not drown). While there is not always a swimming pool around when your nose blocks up or you feel an asthma attack coming on, you can always do breathing exercises.
Eucapnic Breathing is a new concept in the US, although it has been taught in Russia for 40 years, Australia for seven years, and England for the last two years. In Russia the method is called "Volitional Liquidation of Deep Breathing," while in Australia and England it is most commonly referred to as the Buteyko Method. In these countries over 100,000 asthmatics have gained a sense of control over their condition with something that does not have to be bought in a store and can be carried with them wherever they go.
For More Information
Organizations
American Academy of Allergy, Asthma, and Immunology 800-822-2762 Asthma and
Allergy Foundation of America 800-7-ASTHMA Allergy and Asthma Network Mothers
of Asthmatics, Inc. 3554 Chain Bridge Road Suite 200 Fairfax, VA 22030 800-878-4403
National Asthma Center 1400 Jackson Street Denver, CO 80206 Touch Research
Institute University of Miami School of Medicine Department of Pediatrics
PO Box 016820 (D 820) 1601 N.W. 12th Avenue Miami, FL 33101 305-243-6781
Books
Every Breath You Take, Dr. Paul Ameisen (Lansdowne Australia) PO Box 48 Millers
Point Sydney NSW 2000, Australia
Videotapes Buteyko Asthma Video Sales PO Box 41 Annerley Qld 4103, Australia
Buteyko Breathing Method: The Most Effective Drug-Free Approach to the Management
of Asthma, Emphysema, Bronchitis
Video and Manual -This asthma package is only available in the US through the
Internet: http://www.gil.com.au/com/buteyko
Audiotape and Manual 800-315-5030 Buteyko Breathing System Manual $44.90
Buteyko Breathing System Audio $23.90
Both for $54.85 (includes shipping and handling) 800-315-5030
Classes
Practitioners in US Alive and Well 100 Shaw Drive San Anselmo, CA 94960 415-258-0402
Practitioners in Australia Rosalba Courtney, DO Phone: 61-2-99187422 Fax: 61-2-99187489
E-mail: crthouse@geko.net.au.
Practitioners in England 44-1-71-6375505
Notes
(1.) National Asthma Campaign, National Center for Health Statistics.
(2.) Unpublished research study, "Buteyko Breathing in Asthma," by Dr. Simon Bowler, Dr. Charles Mitchell, Tess Graham, and Amanda Green. Study available from the Department of Respiratory Medicine, Mater Hospital, South Brisbane, Queensland, 4101, Australia. Results are also reported in "Doctors Gasp at Buteyko Success," Australian Doctor Magazine (April 6, 1995): 1-2.
(3.) Unpublished study, translated by Professor L. A. Isaeva, Chair of Childhood Diseases.
(4.) Herbert Herxheimer, "Hyperventilation Asthma," The Lancet 6385 (1946): 83-87.
(5.) E. Regiani, "A Comparison of Various Exercise Challenge Tests on Airway Hyper-reactivity of Atopical Swimmers," Journal of Sports Medicine and Physical Fitness 28 (1988): 394-401.
Rosalba Courtney, DO, is an Australian osteopath, naturopath, California-certified acupuncturist, and chairperson of the Australasian Buteyko Association. She uses this method with asthmatics and to train practitioners
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