Providing a clear nasal airway is just the first step toward clearing the lungs. There are some simple exercises you can learn and use to improve your breathing between and during asthma attacks. These are best tried for the first time when there is little or no asthma activity.
Exercise 1
Lie down on your back, fully stretched out.
Rest your hands lightly on your abdomen just below the ribs. You can feel your abdomen rise and fall with breathing. Breathe normally and feel the rise and fall. As your abdomen falls, squeeze with your abdominal muscles to make the fall a little more complete. Try to pull your abdominal muscles toward your back. Repeat this until you feel comfortable with the squeeze and the timing. (Note: In a serious asthma attack, many patients can’t breathe without increasing their discomfort. That’s why we suggest learning breath control when you have little or no chest discomfort. In an episode of severe asthma, you may find that you have to stand while doing the exercises.)
Exercise 2
Now add some leg work. When you have tightened your abdominal muscles as much as you can, bring both knees up against your abdomen. You’ll exhale a little more air. Repeat this until you feel that little extra push when exhaling. Repeat this until you is comfortable doing the exercise.
When practicing, try to lie flat. Raising your head so that you can see the rise and fall of your abdomen makes it difficult to perform the exercises. If you absolutely must watch, prop up your head with a pillow.
Drawing your legs up against your abdomen is another way to increase the pressure there. By tightening abdominal muscles and drawing legs up, the contents of the abdomen are pushed up against the diaphragm. This acts like the piston in a syringe, forcing air out of the chest. Forcing trapped air out is the goal of these exercises.
Exercise 3
Stand up. Repeat Exercise #1 while standing up. Tighten the abdominal muscles at the end of expiration just as you did when on your back.
Exercise 4
While standing, exhale gently, contract your abdominal muscles, and slowly sit on a chair. Take another breath. While seated, exhale gently, bending forward at the waist until your chest lies almost on your thighs.
It is not always possible to find a place to lie down during an asthma attack. In severe asthma, lying down may be uncomfortable. So it is important that you learn to control your diaphragm in both standing and sitting positions.
Exercise 5
While standing, exhale, contract your abdominal muscles and slowly move to a squatting position.
Squatting is another and better way to push the abdominal contents against the diaphragm and squeeze out trapped air. But some older patients or chronically ill patients cannot do this.
The first five exercises are designed to make you realize that your diaphragm is important to proper breathing and to teach you to control it. The next exercises are fine-tuning.
Exercise 6
Inhale with your mouth open. Exhale with your lips puckered as for whistling. Remember to control your diaphragm as you exhale.
This is called “pursed lip” breathing. It is designed to slow the process of exhaling. The bronchial smooth muscle normally relaxes a little with inhaling and contracts a little with exhaling. Pursed lip breathing will gently facilitate the exhaling process and make for a longer period and greater volume of exhaling.
The opposite of this is the grunt. Grunting makes a quick but forceful breathing out. It is effective in preventing air trapping but less helpful once the air is trapped.
Exercise 7
Time your exhaling. Use a stopwatch to see how much time you can use up in exhaling a single breath. Breathe in as fully as possible. Breathe out with pursed lips. DO NOT HOLD YOUR BREATH. This is an exercise in controlled exhaling, not breath holding.
Exercise 8
Use the flame of a candle to make sure you exhale during the whole time. Hold a lighted candle an inch or two away from your lips. Exhaling with pursed lips, make the candle flame flicker. As your skill improves, move the candle farther away from your lips so that you will have to exhale with more force to make the flame flicker. (This is fun for kids. You may want to introduce them to breathing exercises beginning with this. Later, you can start with the first exercise.)
Exercise 9
Take in a full breath. Exhale slowly while counting out loud. You will probably only count to the teens. With practice, you’ll get to 50 or more. Try this in standing and sitting positions.
Exercise 10
Measure your progress with a peak flow meter . Test your peak expiratory flow before and after exercises every day.
Breathing exercises require patience on the part of the patient and, for children, on the part of the instructor. Learning them should not be attempted while an asthma attack is in progress. Instead, breathing exercises should be taught when the patient’s health is stable between asthma episodes.
Exercise 11
Take a full breath and exhale normally.
Take another breath and exhale forcibly, contracting your diaphragm and abdominal muscles. With the next breath, exhale forcibly, contracting your abdominal muscles and diaphragm at the same time, this time ending with a grunt. Finally, with a new breath, exhale forcibly, contract, and, this time, cough.
A cough is a reflex (involuntary) action to clear unwanted material such as mucus or pollutants from the chest. Coughing as a voluntary action will do the same. Since one of the problems in asthma is blockage caused by mucus, an effective cough is needed to clear the airways. Make sure to develop one using the exercise above, tightening your abdominal muscles as you cough.
For children under school age, adding sound to this program helps them to understand what is happening and makes breathing exercises more fun. Any device that makes a noise when used will be helpful. For example, a party “noisemaker” that inflates and makes an audible sound when someone breathes into it is useful. You may have to hunt a little to find one that makes noise and inflates with minimal breathing effort. A kazoo will serve the same purpose, but works only with exhaling. The best gadget of all to help children understand what is requested is a harmonica, also known as a mouth organ Although it costs a little more than the other noisemakers, it can be used to teach breathing in, breathing out, breath control and even pursed lip breathing. To get a single note on a harmonica, pursed lip breathing is required. These toys are not really necessary in the teaching process, but they make it more fun for small children.
Teach them first how to blow into the instrument (for a kazoo, how to hum). Next, how to inhale. Then, how to control the process to prolong both phases of breathing. Introduce the concept of diaphragm control after that. When the child has facility controlling the rise and fall of the abdomen and can synchronize this with using the harmonica, he will have enough control to be useful in managing asthma.
When diaphragm control is effective, a stopwatch or clock can be used to time the length of exhalation. Use a clock with a large face so that the motion of the second hand can easily be seen. Or use a stopwatch that the child can control by a button. The goal is to breathe so gently that the exhaling phase of breathing lasts as long as 30 seconds. The time needed to develop this degree of control will vary with the age and ability of the child, the interest of the parent or other teacher, and the severity of the disease process.
Long-standing, severe asthma provides yet another difficulty. In a patient who has had asthma for more than a day or two, the air trapping may be so bad that breathing is severely limited. He can breathe in very little because so much room in the lung has been taken up by trapped air. His chest is so distended and his diaphragm so low that little air is moved, and he has no strength to improve the situation. Outside help is needed.
Gentle pressure on the chest is that help. Someone is needed to press gently on the chest, in timing with the rapid breathing, to force the trapped air out. Gentle external pressure can be provided by a “bear hug,” or simply by placing a hand on each side of the patient’s chest and pressing gently. This should be continued until the asthmatic can exhale comfortably on his own. This must be done gently as it is quite possible to break the patients rib if the timing is wrong or the pressure is too great. So take special care to time the pressure with the exhaling phase of the patients breathing cycle, and be very gentle.
