The following are my thoughts on the importance of addressing the breathing techniques of those of us who have COPD. This aspect of our treatment is, unfortunately and sadly, highly neglected by our medical community. It deals in general terms and not all aspects of it will apply to all COPD’ers, as we are all different. I have tried to keep it simple, yet provide some of my insights, (Right or wrong!) into our breathing distresses.
For “normal people”, breathing is as easy as inhaling and exhaling, without consciously giving their breathing any thought at all. For the vast majority of us with COPD, breathing can sometimes be an adventure, and for some of us, most of the time it is an adventure. It is my belief, that anyone who deals in the care of COPD’ers in their later stages should try a little experiment as suggested by Dr. Rick Hodder, a noted Canadian respirologist, in his book, “Every Breath I Take – A guide to living with COPD”. Quote: “Take in a deep breath but don’t exhale. Take in another and another. You’re hyper inflated. Hold it! Now run upstairs. You’ll soon appreciate what it feels like to have COPD or asthma.”
We as COPD’ers have to deal with our breathing on so many levels:
(1). The psychology of breathing - How stress and anxiety affect our breathing.
(2). Dealing with Shortness of Breath (SOB)
(3). Learning to purse-lip breathe (PLB).
(4). How we breathe. Are we shallow breathers or diaphragm breathers?
(5). Inspiration. (Inhaling)
(6). Learning to exhale properly.
(7). Learning to relax our auxiliary breathing muscles
(8). Learning to pace ourselves so we don’t become (SOB).
(9). The importance of proper nutrition and proper exercise in combating SOB
(10). Pulmonary Rehab
Anxiety - Why do we become short of breath? In a nutshell and very simplified, in most of us COPD’ers, our DLCO or diffusion rate is compromised so that our lungs are no longer able to efficiently exchange O2 and CO2. The O2 in our blood may drop and the CO2 level increases. Our brain signals our lungs and heart to speed up and try to get our level back in balance. We then become short winded. Then anxiety kicks in. When we become anxious, our body releases adrenaline which causes our heart to beat even faster. The brain then tells the lungs that the heart is working harder and needs more oxygen. So we start to breathe faster and harder. The brain then tells the heart that the lungs need more blood to process, and so the heart starts to beat faster again. And so on, and so on, until we are uncontrollably Short Of Breath. We are then hyperventilating, breathing too fast and too shallow.
Pursed-Lip Breathing - What is Pursed Lip Breathing (PLB)? PLB is the first line of defense used by most COPD’ers when trying to recover from shortness of breath. It involves breathing in through the nose and exhaling with the lips pursed as if you were going to whistle. How hard do you blow out? I find that blowing out with the same force that you would use to cool hot soup on a spoon to be the perfect force. Blow hard enough to cool it but not hard enough to blow it off the spoon. Many sites advocate blow like you were blowing out a candle, but I find that if I simulate blowing out a candle, I tend to puff, instead of a slow exhale and I tend to exhale with too much force and find it harder to relax. How does PLB help? When we PLB properly we create a back pressure in the mouth and throat and this back pressure actually blows the airways open. Now that we can breathe in easier we have to concentrate and breathe out for at least 4 seconds or longer if possible. This helps expel CO2 and trapped air and we begin to breathe easier yet. I have been trying something for the last month or so that helps me. It may not help everybody. After I exhale for four seconds or more, I pause and let the body inhale naturally. The reason I pause is two-fold. First of all, it tells me that I am regaining control of my breathing, which allows me to relax easier and secondly, I find that if I consciously try to inhale right away, I will invariably gasp. When I inhale naturally, I make sure I do not try to “top off” the air already in my lungs. “Topping-off” is when we inhale once and then inhale again before we exhale. This will cause you to use your auxiliary breathing muscles in your shoulders and neck. This will in turn cause you to expend more energy and use up more oxygen. Also with the pausing after exhaling, I would suspect that it gives the lungs a little more time to exchange gases, (CO & CO2). Now that we are breathing rather easily, the anxiety subsides and all is well in our wonderful little worlds. Practicing these techniques is very important so as to be completely trained on how to recover from being Short Of Breath.
Diaphragm Breathing – Your diaphragm is a large muscle separating your lungs from your abdomen. Your diaphragm can work hard and never get tired. Some people breathe using their chest muscles instead of their diaphragm. This takes extra effort and can cause fatigue and tension. Test yourself to see whether you breathe correctly through your diaphragm:
1. Sit upright and relax your shoulders
2. Rest one hand on your chest and the other on your stomach
3. Breathe in deeply through your nose and pay attention to the movement of your hands.
If you use your diaphragm to breathe, the hand on your stomach will move. If you use your chest muscles to breathe, the hand on your chest will move. Try both ways of breathing and feel the difference. If you are a chest breather, practice diaphragmatic breathing for a few moments several times a day, and soon it will become automatic. If your neck and shoulder muscles are constantly sore after a bout of SOB, then you are a chest breather and you have to learn to diaphragm breathe.
I can’t begin to tell you the difference that diaphragm breathing has made in my life. I don’t know when it started but I became a shallow breather (chest breather), not using my diaphragm. About eleven months ago I was having a very hard time, being continually SOB. If I went upstairs to the washroom, even using PLB, it would sometimes take me ½ hour to get my breath back. To make a long story short, I learned how to diaphragm breathe and my life turned around 180 degrees! When I go upstairs now I am winded when I reach the top as opposed to severely SOB.
I now know that my last hospital stay for respiratory failure was due mostly from being a shallow breather. I was cleaning out my shed, and because of my low FEV1 (10%) and low DLCO (19%), I would work for 30-40 seconds and then I would have to sit and catch my breath. I would PLB and huff and puff for 3-5 minutes in order to catch my breath. After doing this for a couple of days, 2 or 3 hours a day, I eventually exhausted my breathing muscles to the point that they were not functioning properly and not able to rid my body of CO2. Eventually this caused respiratory acidosis (lowering of blood pH) which led to a very severe exacerbation and respiratory failure. Now that I know how to diaphragm breathe, hopefully, this will never happen again! My next exacerbation will be infection induced! Probably the most aggravating thing to me through all of this, is that I suffered undue breathing hardship for a long, long time because nowhere down the line was my method of breathing ever checked and corrected! I did a lot more panting and sucking for air than I ever had to! Every COPD’er should be individually checked for proper breathing techniques.
Exhaling – A tremendously neglected part of therapy by our medical community! Our problem as COPD’ers is not getting good air (O2) in, it’s getting bad air (CO2) out. Extending our exhale time helps us on two fronts. First of all, it gives our lungs a much better chance of ridding our bodies of CO2. Secondly, I believe extended exhaling is the main reason that I have been exacerbation free for the last 1 ½ years. I realize the immune system helps, but I was getting pneumonia, probably every three months before I learned to breathe and exhale properly. The more stale air you exhale, the more fresh air you can inhale, which gets deeper into the lungs and does not give all the little creepy crawlies a moist, damp environment in which to multiply. Extending our breathing time is not easy because it goes against what our mind is telling us. Our body is telling us to get rid of CO2, but our mind is telling us we need more O2. It’s listening to our mind that causes us to hyperventilate as we gulp for air. The nature of PLB causes us to slow down our exhale as well as opening our airways, but it also restricts the amount of air we can exhale. After 4 or 5 PLB’s we can actually exhale normally. So we should exhale for 4 seconds and then let our lungs refill naturally. That is, do not consciously inhale. I find if I consciously inhale I invariably want to top off my lungs, which increases my O2 input and that is counter-productive. When I was learning to PLB, they all said to breathe in through your nose, although nobody had a definitive answer as to why. Everybody said for added moisture or infection control. I finally found an acceptable answer for myself a few months back. I noticed that when we inhale through our nose, it is very hard to top off the air in our lungs. If we breathe in through our mouth, the tendency is to "top off" our lungs and that is not what we want when we are SOB. So if you mouth breathe, be conscious of “topping off” or breathing in too much air.
Like a number of COPD’ers, I have always had a problem when it came to eating. I could never eat too much for two reasons. One, I would become winded and the other, I would always have that feeling of having a tennis ball stuck in my solar plexus if I ate too much. I would then have an uncomfortable sensation in my chest for hours. It would take 4-6 hours for the unpleasantness in my chest to disappear. I could not eat a meal without stopping and trying to regain my breath or stop eating altogether for that meal.
A couple of months ago I sat down to a supper loaded with turkey, mashed potatoes, carrots, peas, squash, bread dressing and condiments. I ate the whole thing with no SOB and did not have any bloated feeling!
So, what Happened? What Changed? How I breathe while I eat is what has changed. Up till then, I would breathe in as I put some food in my mouth. I would then hold my breath as I chewed the food. Then I would breathe in again; swallow the food and then exhale. In essence, I was inhaling twice for every exhale and “trapping air”. I started to exhale more while I was eating. Now, as I am chewing my food, I very gently exhale for as long as I comfortably can. That’s it! That’s the only change! I can now eat without stopping because I am too SOB or too tired to continue. As a bonus for me I gained 1½ pounds, which is significant for a man who is 5’8” tall and weighs 99 pounds.
It takes a lot of O2 to digest your food, so please do not lie down right after supper as our breathing rate slows down when we sleep and it's harder to get O2 in and CO2 out when we sleep. I hate to break the ladies' hearts, but you should leave the dishes for a few hours, until your meal is digested.
Relaxing – If you exhibit any muscle soreness after a bout of SOB, it is probably because you are either over-breathing or not breathing correctly. With a combination of PLB, diaphragm breathing and exhaling for 4 seconds, you should be able to talk yourself into relaxing all those muscles used to breathe. Something I have used sometimes for the last year or so is to start humming a tune. Myself, I hum to “Amazing Grace”. Humming it right it forces me to extend my exhale, take small inhales and gets my mind off of my SOB and allows me to relax. Relaxation is very important. Pick your own song!
Exertion causes us to be SOB and as COPD’ers we have to learn how to pace ourselves to try and cut down on the episodes of SOB. We also have to exercise regularly to keep our muscles as well toned as possible as well-toned muscles use a lot less O2. Pulmonary rehab is highly recommended for all who have not been there.
As a final note, most of us know how important it is for us to address our breathing problems properly. Unfortunately, the medical community has not seen that need, as yet. We have medicinal therapy, physical therapy, nutritional therapy, but no breathing therapy as such. Somehow we have to reach out to the medical community to see how this can be changed. I presently go to different COPD forums on a regular basis, and it is through these forums that I have developed most of my breathing techniques. Anyone who has COPD should join these forums and learn how to cope with the various aspects of COPD. Many will be surprised how manageable it is. The forums are:
Philip J. Cable
Lower Sackville, N.S.
©Philip J. Cable 2006 - Permission granted to re-produce
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