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Patrick McKeown Buteyko Clinic International
World Massage Conference Presents:
Buteyko Breathing: Techniques for Self-Care and Vitality
with Patrick McKeown
CHRONIC HYPERVENTILATION SYNDROME
o Da Costa (1871) “Irritable heart”
o Kerr & colleagues (1937) “Hyperventilation syndrome”
o Soley & Shock (1938) discovered HVPT could reproduce symptoms
o Sir Thomas Lewis (1940) “Soldiers heart” & “Effort syndrome”
o Konstantin Buteyko (1957) “Disease of deep breathing”
o Claude Lum (1977) Papworth Method
© 2016 Patrick McKeown
DR BUTEYKO
o 1946- Commenced medical training at
the First Medical Institute of Moscow
o Practical assignment involved
monitoring breathing volume of patients
o Sicker they became- the heavier they
breathe
o 1952- lowered his high blood pressure
by reducing his breathing towards
normal
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
TRAITS OF DYSFUNCTIONAL BREATHING
Dysfunctional Breathing:
no precise definition
Generally includes any
disturbance to breathing including;
hyperventilation/over breathing,
unexplained breathlessness,
breathing pattern disorder,
irregularity of breathing.
© 2016 Patrick McKeown
Hyperventilation- breathing in excess of
metabolic requirements of the body at
that time.
NORMAL BREATHING VOLUME
© 2016 Patrick McKeown
TRAITS OF DYSFUNCTIONAL BREATHING
o Breathing through the mouth
o Hearing breathing during rest
o Sigh regularly
o Regular sniffing
o Taking large breaths prior to talking
o Yawning with big breaths
o Upper chest movement
o Lots of visible movement
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
McArdle William, Katch Frank L, Katch Victor L.
Pulmonary structure and function. In: (eds.)
Exercise Physiology: Nutrition, Energy, and
Human Performance . 1st ed. United States:
Lippincott Williams & Wilkins; Seventh, North
American Edition edition ; (November 13, 2009).
p263
4 -6 liters of air per
minute during rest
NORMAL BREATHING VOLUME
© 2016 Patrick McKeown
Asthma
13 (±2) L/min (Chalupa et al, 2004)
15 L/min (Johnson et al, 1995)
14 (±6) L/min (Bowler et al, 1998)
13 (±4) L/min (Kassabian et al, 1982)
Sleep apnea
15 (±3) L/min (Radwan et al, 2001)
MINUTE VOLUME
© 2016 Patrick McKeown
WHAT CAUSES DYSFUNCTIONAL BREATHING?
o Processed foods / overeating
o Lack of exercise
o Excessive talking
o Stress
o Belief good to take big breaths
o High temperatures of houses
o Asthma – (symptom is big breathing which resets respiratory centre)
o Genetic predisposition/familial habits
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
© 2016 Patrick McKeown
o Faster
o Sigh more (irregular)
o Oral breathing
o Noticeable breathing
o Upper chest breathing
Breathing During Stress
© 2016 Patrick McKeown
o Faster
o Sigh more (irregular)
o Oral breathing
o Noticeable breathing
o Upper chest breathing
Breathing to Evoke Relaxation
o Slow down
o Regular
o Nose breathing
o Soft breathing
o Diaphragm breathing
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
Stress
• High perceived stress which was associated with a 27%
increase in CHD risk in this meta-analysis, could be
thought of as the equivalent of 5 or more cigarettes per
day
Richardson et al. Meta-Analysis of Perceived Stress and Its Association With Incident Coronary
Heart Disease. The American Journal of Cardiology. December 15, 2012;(12)
© 2016 Patrick McKeown
How Should We Breathe?
Breathing is light, quiet, effortless, soft, through the
nose, diaphragmatic, rhythmic and gently paused on
the exhale.
This is how human beings breathed until the
comforts of modern life changed everything,
including our breathing.
© 2016 Patrick McKeown
How Should We Breathe?
Generally speaking, there are three levels of breathing. The first one
is to breathe SOFTLY, so that a person standing next to you does
not hear you breathing. The second level is to breathe softly so that
YOU do not hear yourself breathing. And the third level is to
breathe softly so that you do not FEEL yourself breathing.
Master Chris Pei: Beginners guide to Qi Gong
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
How Should We Breathe?
Breathing is “so smooth that the fine hairs within the
nostrils remain motionless”.
Blofeld J. (1978). Taoism: the road to immortality. Boulder, Shambala.
© 2016 Patrick McKeown
How Should We Breathe?
Professional Hatha yogi
breathing just one gentle breath
per minute for the duration of
one hour.
Miyamura M, Nishimura K, Ishida K, Katayama K,
Shimaoka M, Hiruta S.
Is man able to breathe once a minute for an hour? The
effect of yoga respiration on blood gases. Japanese
Journal Physiology.2002 Jun;(52(3)):313-6
© 2016 Patrick McKeown
PRIMARY STIMULUS TO BREATHE
o The regulation of breathing is
determined by receptors in the
brain which monitor the
concentration of carbon dioxide
along with the pH level and to a
lesser extent oxygen in your
blood.
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
PRIMARY STIMULUS TO BREATHE
o There is a large reserve of
oxygen in the blood stream,
such that oxygen levels must
drop from 100mmHg to about
50mmHg before the brain
stimulates breathing.
© 2016 Patrick McKeown
PRIMARY STIMULUS
o The brain stem is the most primitive part
of the brain. It begins at the base of the
skull and extends upwards 6-8 cm.
o In the lower portion of the brain stem is
the medulla containing the respiratory
center with separate inspiratory and
expiratory centers.
Timmons B.H., Ley R. Behavioral and
Psychological Approaches to Breathing
Disorders. 1st ed. . Springer; 1994
TO BREATHE
© 2016 Patrick McKeown
PRIMARY STIMULUS
o Normal PCO2 is 40mmHg
o An increase of PCO2 above this level
stimulates the medullary inspiratory
center neurons to increase their rate
of firing. This increases breathing to
remove more CO2 from the blood
through the lungs.
Timmons B.H., Ley R. Behavioral and
Psychological Approaches to Breathing
Disorders. 1st ed. . Springer; 1994
TO BREATHE
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
PRIMARY STIMULUS
o The inspiratory center sends
impulses down the spinal cord and
through the phrenic nerve which
innervates the diaphragm, intercostal
nerves and external intercostal
muscles- producing inspiration.
o At some point the inspiratory center
decreases firing, and the expiratory
center begins firing.
Timmons B.H., Ley R. Behavioral and
Psychological Approaches to Breathing
Disorders. 1st ed. . Springer; 1994
TO BREATHE
© 2016 Patrick McKeown
PRIMARY STIMULUS
o On the other hand, a decrease in the
PCO2 below 40mmHg causes the
respiratory center neurons to reduce
their rate of firing, to below normal-
producing a decrease in rate and depth
of breathing until PCO2 rises to normal.
Timmons B.H., Ley R. Behavioral and
Psychological Approaches to Breathing
Disorders. 1st ed. . Springer; 1994
TO BREATHE
© 2016 Patrick McKeown
PRIMARY STIMULUS
o However, breathing more than
what the body requires over a
24 hour period conditions the
body to increased breathing
volume.
TO BREATHE
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
CARBON DIOXIDE:
NOT JUST A WASTE GAS!
© 2016 Patrick McKeown
pH CO2 LINK
© 2016 Patrick McKeown
pH CO2 LINK
Normal pH is 7.365 which must remain within tightly defined
parameters. If pH is too acidic and drops below 6.8, or too
alkaline rising above 7.8, death can result.
Blood, Sweat, and Buffers: pH Regulation During Exercise Acid-Base Equilibria Experiment
Authors: Rachel Casiday and Regina Frey
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
pH CO2 LINK
Carbon dioxide forms bicarbonate through the following reaction:
CO2 + H2O ----- H2CO3 ----- H+ + HCO3
−
CO2 disassociates into H+ and HCO3- constituting a major alkaline
buffer which resists changes in acidity.
© 2016 Patrick McKeown
pH CO2 LINK
If you offload carbon dioxide, you are left with an excess of
bicarbonate ion and a deficiency of hydrogen ion.
During short term hyperventilation- breathing volume sub
sequentially decreases to allow accumulation of carbon dioxide and
normalisation of pH.
© 2016 Patrick McKeown
pH CO2 LINK
However, when over breathing continues for hours/days,
bicarbonate excess is compensated by renal excretion.
Hypocapnia and pH shift are almost immediate; adjustment of
bicarbonate takes time. (hours to days)
Lum LC.. Hyperventilation: the tip and the iceberg. J Psychosom Res..1975 ;(19(5-6):375-83
© 2016 Patrick McKeown
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pH CO2 LINK
Thus the chronic hyperventilator's pH regulation is finely balanced:
diminished acid (the consequence of hyperventilation) is balanced
against the low level of blood bicarbonate maintained by renal
excretion.
Jenny C King Hyperventilation-a therapist's point of view: discussion paper. Journal of the Royal Society of
Medicine. 1988 Sep; 81(9): 532–536.
© 2016 Patrick McKeown
pH CO2 LINK
In this equilibrium small amounts of over breathing induced by
emotion can cause large falls of carbon dioxide and consequently,
more severe symptoms.
Jenny C King Hyperventilation-a therapist's point of view: discussion paper. Journal of the Royal Society of
Medicine. 1988 Sep; 81(9): 532–536.
© 2016 Patrick McKeown
OXYGEN DISSOCIATION CURVE
o Over breathing reduces
the delivery of oxygen
to tissues and organs.
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
OXYGEN DISSOCIATION CURVE
o An exercising muscle is hot and
generates carbon dioxide and it
benefits from increased unloading
of O2 from its capillaries.
West J 1995 Respiratory Physiology: the
essentials. Lippincott, Williams and Wilkins.
© 2016 Patrick McKeown
o A primary response to
hyperventilation can reduce the
oxygen available to the brain by
one half.
CONSTRICTION OF CAROTID ARTERIES
Timmons B.H., Ley R. Behavioral and
Psychological Approaches to Breathing
Disorders. 1st ed. .
Springer; 1994. page 7
© 2016 Patrick McKeown
NITRIC OXIDE:
MOLECULE OF THE YEAR!
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
Breathe Light to Breathe Right
Nitric oxide (NO) is released in the nasal airways in
humans. During inspiration through the nose this NO will
follow the airstream to the lower airways and the lungs.
Lundberg JO. Nitric oxide and the paranasal sinuses. Anat Rec (Hoboken).2008
Nov;(291(11)):1479-84
© 2016 Patrick McKeown
Breathe Light to Breathe Right
Nitric oxide plays an important role in vasoregulation,
homeostasis, neurotransmission, immune defence and
respiration.
Rabelink, A J (1998), "Nobel prize in Medicine and Physiology 1998 for the discovery of the role of
nitric oxide as a signalling molecule", Nederlands tijdschrift voor geneeskunde (1998 Dec 26) 142
(52): 2828–30
Culotta E, Koshland DE Jr.. NO news is good news. Science.1992 Dec 18;(258(5090)):1862-5
© 2016 Patrick McKeown
Breathe Light to Breathe Right
Nitric oxide from the back of your nose and your sinuses
into your lungs. This short-lived gas dilates the air
passages in your lungs and does the same to the blood
vessels.
Roizen, MF, and Oz, MC, 2008. You on a diet revised, The Owners Manual for waist management.
New York. Collins.
© 2016 Patrick McKeown
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Breathe Light to Breathe Right
Since NO is continuously released into the nasal airways
the concentration will be dependent on the flow rate by
which the sample is aspirated. Thus, nasal NO
concentrations are higher at lower flow rates.
Lundberg J, Weitzberg E. Nasal nitric oxide in man. Thorax.1999;(54):947-952
© 2016 Patrick McKeown
NOSE BREATHING
© 2016 Patrick McKeown
Nose Breathing Benefits
o Nose breathing imposes approximately 50 percent more resistance
to the air stream than mouth breathing, resulting in 10-20 percent
more O2 uptake.
o Warms and humidifies incoming air.
o Removes a significant amount of germs and bacteria.
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
Versus Mouth breathing
o Increased risk of developing forward head posture, and reduced
respiratory strength.
o A dry mouth also increases acidification of the mouth and results in
more dental cavities and gum disease.
o Mouth breathing causes bad breath due to altered bacterial flora.
o Proven to significantly increase the number of occurrences of
snoring and obstructive sleep apnoea.
© 2016 Patrick McKeown
Hyperventilation Syndrome
o Cardiovascular: palpitations, missed beats, tachycardia, sharp or
dull atypical chest pain, ‘angina’, cold extremities, Raynaud’s,
blotchy flushing of blush area, capillary vasoconstriction.
o Neurological: dizziness, instability, faint feelings (but rarely fainting)
headache, paraesthesia- (numbness, deadness, uselessness,
heaviness, pins and needles).
Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. .
Springer; 1994
© 2016 Patrick McKeown
Hyperventilation Syndrome
o Respiratory: shortness of breath, irritable cough, tightness or
oppression of chest, air hunger, inability to take a deep breath,
excessive sighing, yawning, sniffing.
o Muscular: cramps, muscle pains- neck & shoulders, stiffness.
o Psychic: tension, anxiety, ‘unreal feelings’, panic, phobias,
agoraphobia.
o Allergies.
Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. .
Springer; 1994
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
Hyperventilation Syndrome
o Gastrointestinal: difficulty in swallowing, globus (having a lump in
ones throat), dry mouth and throat, acid regurgitation, heart burn,
flatulence, belching, air swallowing, abdominal discomfort, bloating.
o General: weakness, exhaustion, impaired concentration, impaired
memory and performance, disturbed sleep, including nightmares,
emotional sweating,
Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. .
Springer; 1994
© 2016 Patrick McKeown
Hyperventilation Syndrome
o According to Lum, hyperventilation ‘fell between the two stools of
medicine and psychiatry’
o The major reason why hyperventilation had not been fully
recognised is that most clients were not taught how to change their
breathing. Effective breathing retraining is required to demonstrate
conclusively that hyperventilation is the cause of the clients
symptoms.
Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. .
Springer; 1994
© 2016 Patrick McKeown
Hyperventilation Syndrome
o Because these patients report symptoms in more than one
system, they are often labelled as hypochondriacs.
Historically, they are often told to relax and take a few deep
breaths!
Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. .
Springer; 1994
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
CONTROL PAUSE (comfortable breath hold time)
MEASUREMENT
o Take a small silent breath in through your nose.
o Allow a small silent breath out through your nose.
o Hold your nose with your fingers to prevent air from entering
your lungs.
o Count the number of seconds until you feel the first distinct
desire to breathe in.
© 2016 Patrick McKeown
MEASURING HOW BIG YOU BREATHE
Breath holding as one of the most powerful methods to induce
the sensation of breathlessness, and that the breath hold test
‘gives us much information on the onset and endurance of
dyspnea.
Nishino T. Pathophysiology of dyspnea evaluated by breath-holding test: studies of furosemide
treatment. Respiratory Physiology Neurobiology.2009 May 30;(167(1)):20-5
© 2016 Patrick McKeown
MEASURING HOW BIG YOU BREATHE
Eighteen patients with varying stages of cystic fibrosis
were studied to determine the value of the breath hold time
as an index of exercise tolerance.
Barnai M, Laki I, Gyurkovits K, Angyan L, Horvath G. Relationship between breath-
hold time and physical performance in patients with cystic fibrosis. European Journal
Applied Physiology.2005 Oct;(95(2-3)):172-8
© 2016 Patrick McKeown
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MEASURING HOW BIG YOU BREATHE
‘that the voluntary breath-hold time might be a useful index
for prediction of the exercise tolerance of CF patients’.
Barnai M, Laki I, Gyurkovits K, Angyan L, Horvath G. Relationship between breath-
hold time and physical performance in patients with cystic fibrosis. European Journal
Applied Physiology.2005 Oct;(95(2-3)):172-8
© 2016 Patrick McKeown
MEASURING HOW BIG YOU BREATHE
Breath hold time varies inversely with the magnitude of
dyspnea when it is present at rest.
Rev Invest Clin. 1989 Jul-Sep;41(3):209-13. Rating of breathlessness at rest during
acute asthma: correlation with spirometry and usefulness of breath-holding time.
Pérez-Padilla R, Cervantes D, Chapela R, Selman M.
© 2016 Patrick McKeown
Rhinitis
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
RHINITIS COMORBIDITY EFFECT
o rarely found in isolation
o asthma, rhinosinusitis,
o more than twice as likely to suffer
problems sleeping due to their
nasal allergy symptoms.
Hadley JA, Derebery MJ, Marple BF.
Comorbidities and allergic rhinitis: not just
a runny nose. J Fam Pract. 2012 Feb;6:11-5.
© 2016 Patrick McKeown
RHINITIS ASTHMA
o We speculate that asthmatics
may have an increased
tendency to switch to oral
breathing, a factor that may
contribute to the pathogenesis
of their asthma.
Kairaitis K, Garlick SR, Wheatley JR, Amis TC
Route of breathing in patients with asthma.
Chest. 1999 Dec;116(6):1646-52.
© 2016 Patrick McKeown
RHINITIS
ASTHMA
Laffey, J. & Kavanagh, B.
Hypocapnia, New England
Journal of Medicine. 4 July 2002. © 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
RHINITIS SLEEP APNEA
o Open-mouth breathing during sleep is a
risk factor for obstructive sleep apnea
(OSA) and is associated with increased
disease severity and upper airway
collapsibility.
Kim EJ, Choi JH, Kim KW, Kim TH, Lee SH, Lee HM, Shin C, Lee
KY, Lee SH. The impacts of open-mouth breathing on upper airway
space in obstructive sleep apnea: 3-D MDCT analysis. Eur Arch
Otorhinolaryngol. April 2011, Volume 268, Issue 4, pp 533-539
© 2016 Patrick McKeown
RHINITIS SLEEP APNEA
o Treatment of pediatric obstructive-sleep-apnea
(OSA) and sleep-disordered-breathing (SBD)
means restoration of continuous nasal
breathing during wakefulness and sleep.
Guilleminault C, Sullivan S. Towards Restoration of Continuous Nasal
Breathing as the Ultimate Treatment. Goal in Pediatric Obstructive Sleep
Apnea. Enliven: Pediatrics and Neonatal Biology. Sept 1st 2014
.
© 2016 Patrick McKeown
RHINITIS SLEEP APNEA
o The case against mouth breathing is growing,
and given its negative consequences, we feel
that restoration of the nasal breathing route as
early as possible is critical.
Seo-Young Lee* , Christian Guilleminault, Hsiao-Yean Chiu,**, Shannon S.
Sullivan. Mouth breathing, “nasal dis-use” and pediatric sleep-disordered-
breathing. Sleep and Breathing (2015) Stanford University Sleep Medicine
Division, Stanford Outpatient Medical Center, Redwood City CA
.
© 2016 Patrick McKeown
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RHINITIS SLEEP APNEA
o In fact restoration of nasal breathing during
wake and sleep may be the only valid
“complete” correction of pediatric sleep
disordered breathing…
Sleep and Breathing (2015) Mouth breathing, “nasal dis-use” and
pediatric sleep-disordered-breathing. Seo-Young Lee* , Christian
Guilleminault, Hsiao-Yean Chiu,**, Shannon S. Sullivan. Stanford
University Sleep Medicine Division, Stanford Outpatient Medical Center,
Redwood City CA
.
© 2016 Patrick McKeown
RHINITIS ADHD
o Sleep disturbances, poor school
performance, and hyperactivity are
all mental complications seen in
many children related to their nasal
allergies.
Blaiss MS. Pediatric allergic rhinitis: physical and mental
complications. Allergy Asthma Proc. 2008 Jan-Feb;29(1):1-6.
© 2016 Patrick McKeown
RHINITIS ADHD
o Most children with ADHD displayed symptoms and
skin prick test results consistent with allergic rhinitis.
Nasal obstruction and other symptoms of allergic
rhinitis could explain some of the cognitive patterns
observed in ADHD, which might result from sleep
disturbance known to occur with allergic rhinitis.
Brawley A, Silverman B, Kearney S, Guanzon D, Owens M, Bennett H,
Schneider A. Allergic rhinitis in children with attention-deficit/hyperactivity
disorder. Ann Allergy Asthma Immunol. 2004 Jun;92(6):663-7.
© 2016 Patrick McKeown
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RHINITIS ADHD
o Many of these children are
misdiagnosed with attention deficit
disorder (ADD) and hyperactivity.
Jefferson Y. Mouth breathing: adverse effects on
facial growth, health, academics, and behavior.
Gen Dent. 2010 Jan-Feb;58(1):18-25.
© 2016 Patrick McKeown
RHINITIS CRANIOFACIAL
o Mouth breathers demonstrated
considerable backward and
downward rotation of the mandible,
increased over jet, increase in the
mandible plane angle (longer face)
Harari D et al. The effect of mouth breathing versus nasal
breathing on dentofacial and craniofacial development in
orthodontic patients. The American Laryngological,
Rhinological, and Otological Society, Inc. 2010
Oct;120(10):2089-93.
© 2016 Patrick McKeown
RHINITIS CRANIOFACIAL
o Children with obligate mouth-breathing
due to nasal septum deviations show
facial and dental anomalies in
comparison to nose-breathing controls.
D'Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi
N, Manzini M. Craniofacial growth in children with nasal
septum deviation: a cephalometric comparative study. Int
J Pediatr Otorhinolaryngol. 2010 Oct;74(10):1180-3.
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
RHINITIS CRANIOFACIAL
• Ten-year-old boy is a nose breather
and has a good-looking, broad face
with everything in proportion.
Photograph from Dr John Mew
© 2016 Patrick McKeown
RHINITIS CRANIOFACIAL
• On the boy’s fourteenth birthday,
he was given a gerbil as a present.
Soon after, his nose began to
block, causing him to breathe
through his mouth.
Photograph from Dr John Mew
© 2016 Patrick McKeown
RHINITIS CRANIOFACIAL
Three
years
later
Photographs from Dr John Mew © 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
Breathing and Vocal Dysfunction
o Speech is the culmination of two
essential human functions: breathing
and communication.
o Must consider all the factors in relation
to one another. A disturbance in one
area will upset the balance necessary
to maintain healthy phonation.
Daphne J Pearce in Timmons and Ley
© 2016 Patrick McKeown
Breathing and Vocal Dysfunction
o Is there frequent throat clearing,
excessive phlegm?
o Does the patient pause when speaking?
o Are the pauses appropriate to place in
utterance and frequency?
o Does the vocal pitch appear appropriate
for the patients age and sex?
Daphne J Pearce in Timmons and Ley
© 2016 Patrick McKeown
Breathing and Vocal Dysfunction
o Is the voice hoarse, creaky or breathy?
o Does the voice fade or appear to fatigue?
o Is there limited ability to sustain
phonation, hold a note?
Daphne J Pearce in Timmons and Ley
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
Breathing and Vocal Dysfunction
o Dysphonia
Excessive Breathing Volume:
– Dries out the vocal folds resulting
in phlegm
– Results in poor breathing pattern
and breath management for
speech/singing
o Dysphagia
– Overbreathing dries the upper
airways leading to inflammation
– Important to slow down and be
more mindful when eating
Golan Hadas © 2016 Patrick McKeown
o ANS is to maintain homeostasis (i.e., an optimal or ideal
physiological and emotional balance), and in doing regulates and
coordinates many bodily activities such as digestion, body
temperature, blood pressure and is associated with aspects of
emotional behavior.
(Andreassi, 2000, p 35)
Autonomic Nervous System
STUTTERING
© 2016 Patrick McKeown
o Parasympathetic branch is thought to foster calm physiological
states that promote growth, restoration, and repair
(Andreassi, 2000)
Autonomic Nervous System
STUTTERING
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
o Sympathetic nervous system activity is associated with “fight or
flight” or “mobilization behaviors,” and is typically activated during
periods of stress or challenge
(Porges, 2007)
Autonomic Nervous System
STUTTERING
© 2016 Patrick McKeown
o Children who stutter have a physiological
state characterized by a greater
vulnerability to emotional reactivity (i.e.,
less parasympathetic tone) and a greater
mobilization of resources in support of
emotional reactivity (i.e., more
sympathetic activity) during positive
conditions.
Autonomic Nervous System
STUTTERING
Jones RM, Buhr AP, Conture EG, Tumanova V, Walden TA, Porges SW J
Fluency Disord. Autonomic nervous system activity of preschool-age
children who stutter. J Fluency Disord 2014 Sep;41:12-31.
© 2016 Patrick McKeown
Autonomic Nervous System
o Controlled breathing activates the parasympathetic nervous
system, promoting homeostasis and assists recovery and
restoration of function in body systems disturbed by stress.
(Recordati and Bellini 2004)
STUTTERING
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
o Regular practice of slow controlled breathing has also been
shown to increase basal parasympathetic activity and
reduce sympathetic activity.
(Pal, Velkumary et al. 2004)
STUTTERING
Autonomic Nervous System
© 2016 Patrick McKeown
o Singers, actors and public speakers are especially at
risk. "Stage fright" is often a panic attack which may cause
or be caused by hyperventilation. Most theatres in London's
West End recognise the phenomenon and keep paper
bags handy.
Judith Perera. THE HAZARDS OF HEAVY BREATHING. New Scientist. December
3rd 1988
Talking & Breathing
© 2016 Patrick McKeown
o All subjects ventilated more during speaking than during
quiet breathing, usually by augmenting both tidal volume
and breathing frequency…. These findings have clinical
implications for the respiratory care practitioner and the
speech-language pathologist.
Hoit JD1, Lohmeier HL.. Influence of continuous speaking on ventilation.. J Speech
Lang Hear Res. .2000 Oct;43(5):1240-51
Talking & Breathing
© 2016 Patrick McKeown
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Patrick McKeown Buteyko Clinic International
o A study to investigate the effectiveness of the
Buteyko technique on the nasal symptoms of
patients with asthma.
Adelola O.A., Oosthuiven J.C., Fenton J.E. Role of
Buteyko breathing technique in asthmatics with nasal
symptoms. Clinical Otolaryngology.2013,
April;38(2):190-191
NASAL OBSTRUCTION STUDY
© 2016 Patrick McKeown
NASAL OBSTRUCTION STUDY
© 2016 Patrick McKeown
Adelola O.A., Oosthuiven J.C., Fenton J.E. Role of
Buteyko breathing technique in asthmatics with nasal
symptoms. Clinical Otolaryngology.2013,
April;38(2):190-191
NASAL OBSTRUCTION STUDY
o For example, NOSE evaluation surveys nasal
congestion or stuffiness, poor sense of smell,
snoring, nasal blockage or obstruction, trouble
breathing through the nose, trouble sleeping,
having to breathe through the mouth, unable to get
enough air through the nose during exercise or
exertion and feeling panic that one cannot get
enough air through the nose.
© 2016 Patrick McKeown
29
Patrick McKeown Buteyko Clinic International
o It is important for the entire health
care community (including general
and pediatric dentists) to screen and
diagnose for mouth breathing in
adults and in children as young as 5
years of age.
FINAL WORDS
Jefferson Y. Mouth breathing: adverse effects
on facial growth, health, academics, and
behavior. Gen Dent. 2010 Jan-Feb;58(1):18-
25; quiz 26-7, 79-80.
© 2016 Patrick McKeown
o If mouth breathing is treated early,
its negative effect on facial and
dental development and the
medical and social problems
associated with it can be reduced
or averted.
FINAL WORDS
Jefferson Y. Mouth breathing: adverse effects on facial
growth, health, academics, and behavior. Gen Dent.
2010 Jan-Feb;58(1):18-25; quiz 26-7, 79-80.
© 2016 Patrick McKeown
That’s all folks! Copyright Patrick McKeown, 2015
© 2016 Patrick McKeown
30
Patrick McKeown Buteyko Clinic International
www.buteykoclinic.com
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