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Examining dysfunctional breathing Examining dysfunctional breathing patterns in asthma, craniofacial patterns in asthma, craniofacial development, rhinitis and sleep disordered development, rhinitis and sleep disordered development, rhinitis and sleep disordered development, rhinitis and sleep disordered breathing. breathing. Copyright Patrick McKeown 2015 Copyright Patrick McKeown 2015 Buteyko Clinic International PATRICK MCKEOWN MA ButeykoClinic.com

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Page 1: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Examining dysfunctional breathingExamining dysfunctional breathingpatterns in asthma, craniofacialpatterns in asthma, craniofacialdevelopment, rhinitis and sleep disordereddevelopment, rhinitis and sleep disorderedbreathing.breathing.

Copyright Patrick McKeown 2015Copyright Patrick McKeown 2015

Examining dysfunctional breathingExamining dysfunctional breathingpatterns in asthma, craniofacialpatterns in asthma, craniofacialdevelopment, rhinitis and sleep disordereddevelopment, rhinitis and sleep disorderedbreathing.breathing.

Copyright Patrick McKeown 2015Copyright Patrick McKeown 2015

Buteyko Clinic InternationalPATRICK MCKEOWN MAButeykoClinic.com

Page 2: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

CHRONIC HYPERVENTILATION SYNDROMECHRONIC 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

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

Page 3: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

DR BUTEYKODR BUTEYKO

o 1946- Commenced medical training atthe First Medical Institute of Moscow

o Practical assignment involvedmonitoring breathing volume of patients

o Sicker they became- the heavier theybreathe

o 1952- lowered his high blood pressureby reducing his breathing towardsnormal

o 1946- Commenced medical training atthe First Medical Institute of Moscow

o Practical assignment involvedmonitoring breathing volume of patients

o Sicker they became- the heavier theybreathe

o 1952- lowered his high blood pressureby reducing his breathing towardsnormal

Page 4: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

TRAITS OFTRAITS OFDYSFUNCTIONAL BREATHINGDYSFUNCTIONAL BREATHING

Dysfunctional Breathing:no precise definition

Generally includes anydisturbance to breathing including;hyperventilation/over breathing,unexplained breathlessness,breathing pattern disorder,irregularity of breathing.

Dysfunctional Breathing:no precise definition

Generally includes anydisturbance to breathing including;hyperventilation/over breathing,unexplained breathlessness,breathing pattern disorder,irregularity of breathing.

Page 5: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Hyperventilation- breathing in excess ofmetabolic requirements of the body at thattime.

NORMALNORMALBREATHING VOLUMEBREATHING VOLUME

Hyperventilation- breathing in excess ofmetabolic requirements of the body at thattime.

Page 6: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

TRAITS OFTRAITS OFDYSFUNCTIONAL BREATHINGDYSFUNCTIONAL 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

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

Page 7: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

McArdle William, Katch Frank L, Katch VictorL. 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

o 4 -6 liters of air perminute during rest

NORMALNORMALBREATHING VOLUMEBREATHING VOLUME

McArdle William, Katch Frank L, Katch VictorL. 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

Page 8: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

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)

MINUTEMINUTEVOLUMEVOLUME

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)

Page 9: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

WHAT CAUSESWHAT CAUSESDYSFUNCTIONAL BREATHING?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

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

Page 10: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment
Page 11: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

o Fastero Sigh more (irregular)o Oral breathingo Noticeable breathingo Upper chest breathing

Breathing During StressBreathing During Stress

o Fastero Sigh more (irregular)o Oral breathingo Noticeable breathingo Upper chest breathing

Page 12: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

o Fastero Sigh more (irregular)o Oral breathingo Noticeable breathingo Upper chest breathing

Breathing to Evoke RelaxationBreathing to Evoke Relaxation

o Slow downo Regularo Nose breathingo Soft breathingo Diaphragm breathing

o Fastero Sigh more (irregular)o Oral breathingo Noticeable breathingo Upper chest breathing

o Slow downo Regularo Nose breathingo Soft breathingo Diaphragm breathing

Page 13: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

StressStress• High perceived stress which was associated with a 27%

increase in CHD risk in this meta-analysis, could bethought of as the equivalent of or 5 more cigarettes perday

Richardson et al. Meta-Analysis of Perceived Stress and Its Association With Incident CoronaryHeart Disease. The American Journal of Cardiology. December 15, 2012;(12)

• High perceived stress which was associated with a 27%increase in CHD risk in this meta-analysis, could bethought of as the equivalent of or 5 more cigarettes perday

Richardson et al. Meta-Analysis of Perceived Stress and Its Association With Incident CoronaryHeart Disease. The American Journal of Cardiology. December 15, 2012;(12)

Page 14: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

How Should We Breathe?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 lifechanged everything, including our breathing

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 lifechanged everything, including our breathing

Page 15: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

How Should We Breathe?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

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

Page 16: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

How Should We Breathe?How Should We Breathe?

Breathing is “so smooth that the fine hairs within the nostrils remainmotionless”

Blofeld J. (1978). Taoism: the road to immortality. Boulder, Shambala.

Breathing is “so smooth that the fine hairs within the nostrils remainmotionless”

Blofeld J. (1978). Taoism: the road to immortality. Boulder, Shambala.

Page 17: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

How Should We Breathe?How Should We Breathe?

Professional Hatha yogi breathing just one gentle breath per minute for theduration of one hour.

Miyamura M, Nishimura K, Ishida K, Katayama K, Shimaoka M, Hiruta S. Is man able to breatheonce a minute for an hour? the effect of yoga respiration on blood gases. Japanese JournalPhysiology.2002 Jun;(52(3)):313-6

Professional Hatha yogi breathing just one gentle breath per minute for theduration of one hour.

Miyamura M, Nishimura K, Ishida K, Katayama K, Shimaoka M, Hiruta S. Is man able to breatheonce a minute for an hour? the effect of yoga respiration on blood gases. Japanese JournalPhysiology.2002 Jun;(52(3)):313-6

Page 18: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

PRIMARY STIMULUSPRIMARY STIMULUSTO BREATHETO BREATHE

o The regulation of breathing isdetermined by receptors in thebrain which monitor theconcentration of carbon dioxidealong with the pH level and to alesser extent oxygen in yourblood.

o The regulation of breathing isdetermined by receptors in thebrain which monitor theconcentration of carbon dioxidealong with the pH level and to alesser extent oxygen in yourblood.

Page 19: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

PRIMARY STIMULUSPRIMARY STIMULUSTO BREATHETO BREATHE

o There is a large reserve ofoxygen in the blood stream, suchthat oxygen levels must dropfrom 100mmHg to about50mmHg before the brainstimulates breathing.

o There is a large reserve ofoxygen in the blood stream, suchthat oxygen levels must dropfrom 100mmHg to about50mmHg before the brainstimulates breathing.

Page 20: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

PRIMARY STIMULUSPRIMARY STIMULUS

o The brain stem is the most primitivepart of the brain. It begins at the baseof the skull and extends upwards 6-8cm.

o In the lower portion of the brain stem isthe medulla containing the respiratorycenter with separate inspiratory andexpiratory centers.

TO BREATHETO BREATHE

o The brain stem is the most primitivepart of the brain. It begins at the baseof the skull and extends upwards 6-8cm.

o In the lower portion of the brain stem isthe medulla containing the respiratorycenter with separate inspiratory andexpiratory centers.

Timmons B.H., Ley R. Behavioral andPsychological Approaches to BreathingDisorders. 1st ed. . Springer; 1994

Page 21: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

PRIMARY STIMULUSPRIMARY STIMULUS

o Normal PCO2 is 40mmHg

o An increase of PCO2 above this levelstimulates the medullary inspiratorycenter neurons to increase their rateof firing. This increases breathing toremove more CO2 from the bloodthrough the lungs.

TO BREATHETO BREATHE

o Normal PCO2 is 40mmHg

o An increase of PCO2 above this levelstimulates the medullary inspiratorycenter neurons to increase their rateof firing. This increases breathing toremove more CO2 from the bloodthrough the lungs.

Timmons B.H., Ley R. Behavioral andPsychological Approaches to BreathingDisorders. 1st ed. . Springer; 1994

Page 22: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

PRIMARY STIMULUSPRIMARY STIMULUS

o The inspiratory center sends impulsesdown the spinal cord and through thephrenic nerve which innervates thediaphragm, intercostal nerves andexternal intercostal muscles- producinginspiration.

o At some point the inspiratory centerdecreases firing, and the expiratorycenter begins firing.

TO BREATHETO BREATHE

o The inspiratory center sends impulsesdown the spinal cord and through thephrenic nerve which innervates thediaphragm, intercostal nerves andexternal intercostal muscles- producinginspiration.

o At some point the inspiratory centerdecreases firing, and the expiratorycenter begins firing.

Timmons B.H., Ley R. Behavioral andPsychological Approaches to BreathingDisorders. 1st ed. . Springer; 1994

Page 23: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

PRIMARY STIMULUSPRIMARY STIMULUS

o On the other hand, a decrease in thePCO2 below 40mmHg causes therespiratory center neurons to reducetheir rate of firing, to below normal-producing a decrease in rate and depthof breathing until PCO2 rises to normal.

TO BREATHETO BREATHE

o On the other hand, a decrease in thePCO2 below 40mmHg causes therespiratory center neurons to reducetheir rate of firing, to below normal-producing a decrease in rate and depthof breathing until PCO2 rises to normal.

Timmons B.H., Ley R. Behavioral andPsychological Approaches to BreathingDisorders. 1st ed. . Springer; 1994

Page 24: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

PRIMARY STIMULUSPRIMARY STIMULUS

o However, breathing more thanwhat the body requires over a 24hour period conditions the bodyto increased breathing volume.

TO BREATHETO BREATHE

Page 25: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

CARBON DIOXIDE:CARBON DIOXIDE:NOT JUST A WASTE GAS!NOT JUST A WASTE GAS!NOT JUST A WASTE GAS!NOT JUST A WASTE GAS!

Page 26: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

pH COpH CO22LINKLINK

Page 27: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

pH COpH CO22LINKLINK

Normal pH is 7.365 which must remain within tightly definedparameters. If pH is too acidic and drops below 6.8, or tooalkaline rising above 7.8, death can result.

Blood, Sweat, and Buffers: pH Regulation During Exercise Acid-Base EquilibriaExperiment Authors: Rachel Casiday and Regina Frey

Normal pH is 7.365 which must remain within tightly definedparameters. If pH is too acidic and drops below 6.8, or tooalkaline rising above 7.8, death can result.

Blood, Sweat, and Buffers: pH Regulation During Exercise Acid-Base EquilibriaExperiment Authors: Rachel Casiday and Regina Frey

Page 28: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

pH COpH CO22LINKLINK

Carbon dioxide forms bicarbonate through the following reaction:

CO2 + H2O ----- H2CO3 ----- H+ + HCO3−

CO2 disassociates into H+ and HCO3- constituting a major alkalinebuffer which resists changes in acidity

Carbon dioxide forms bicarbonate through the following reaction:

CO2 + H2O ----- H2CO3 ----- H+ + HCO3−

CO2 disassociates into H+ and HCO3- constituting a major alkalinebuffer which resists changes in acidity

Page 29: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

pH COpH CO22LINKLINK

If you offload carbon dioxide, you are left with an excess ofbicarbonate ion and a deficiency of hydrogen ion.

During short term hyperventilation- breathing volume subsequentially decreases to allow accumulation of carbon dioxide andnormalisation of pH.

If you offload carbon dioxide, you are left with an excess ofbicarbonate ion and a deficiency of hydrogen ion.

During short term hyperventilation- breathing volume subsequentially decreases to allow accumulation of carbon dioxide andnormalisation of pH.

Page 30: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

pH COpH CO22LINKLINK

However, when over breathing continues for hours/days,bicarbonate excess is compensated by renal excretion.

Hypocapnia and pH shift are almost immediate; adjustment ofbicarbonate takes time. (hours to days)

Lum LC.. Hyperventilation: the tip and the iceberg. J Psychosom Res..1975 ;(19(5-6):375-83

However, when over breathing continues for hours/days,bicarbonate excess is compensated by renal excretion.

Hypocapnia and pH shift are almost immediate; adjustment ofbicarbonate takes time. (hours to days)

Lum LC.. Hyperventilation: the tip and the iceberg. J Psychosom Res..1975 ;(19(5-6):375-83

Page 31: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

pH COpH CO22LINKLINK

Thus the chronic hyperventilator's pH regulation is finely balanced:diminished acid (the consequence of hyperventilation) is balancedagainst the low level of blood bicarbonate maintained by renalexcretion.

Jenny C King Hyperventilation-a therapist's point of view: discussion paper. Journal of the Royal Society ofMedicine. 1988 Sep; 81(9): 532–536.

Thus the chronic hyperventilator's pH regulation is finely balanced:diminished acid (the consequence of hyperventilation) is balancedagainst the low level of blood bicarbonate maintained by renalexcretion.

Jenny C King Hyperventilation-a therapist's point of view: discussion paper. Journal of the Royal Society ofMedicine. 1988 Sep; 81(9): 532–536.

Page 32: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

pH COpH CO22LINKLINK

In this equilibrium small amounts of over breathing induced byemotion 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 ofMedicine. 1988 Sep; 81(9): 532–536.

In this equilibrium small amounts of over breathing induced byemotion 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 ofMedicine. 1988 Sep; 81(9): 532–536.

Page 33: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

OXYGENOXYGENDISSOCIATION CURVEDISSOCIATION CURVE

o Over breathing reducesthe delivery of oxygen totissues and organs.

o Over breathing reducesthe delivery of oxygen totissues and organs.

Page 34: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

OXYGENOXYGENDISSOCIATION CURVEDISSOCIATION CURVE

o An exercising muscle is hot andgenerates carbon dioxide and itbenefits from increasedunloading of O2 from itscapillaries.

o An exercising muscle is hot andgenerates carbon dioxide and itbenefits from increasedunloading of O2 from itscapillaries.

West J 1995 Respiratory Physiology:the essentials. Lippincott, Williams and

Wilkins.

Page 35: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

o A primary response tohyperventilation can reduce theoxygen available to the brain by onehalf.

CONSTRICTIONCONSTRICTIONOFOF CAROTID ARTERIESCAROTID ARTERIES

o A primary response tohyperventilation can reduce theoxygen available to the brain by onehalf.

Timmons B.H., Ley R. Behavioral andPsychological Approaches to Breathing

Disorders. 1st ed. .Springer; 1994. page 7

Page 36: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

NITRIC OXIDE:NITRIC OXIDE:MOLECULE OF THE YEAR!MOLECULE OF THE YEAR!MOLECULE OF THE YEAR!MOLECULE OF THE YEAR!

Page 37: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Breathe Light to Breathe RightBreathe Light to Breathe RightNitric oxide (NO) is released in the nasal airways inhumans. During inspiration through the nose this NO willfollow the airstream to the lower airways and the lungs.

Lundberg JO. Nitric oxide and the paranasal sinuses. Anat Rec (Hoboken).2008Nov;(291(11)):1479-84

Nitric oxide (NO) is released in the nasal airways inhumans. During inspiration through the nose this NO willfollow the airstream to the lower airways and the lungs.

Lundberg JO. Nitric oxide and the paranasal sinuses. Anat Rec (Hoboken).2008Nov;(291(11)):1479-84

Page 38: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Breathe Light to Breathe RightBreathe Light to Breathe RightNitric oxide plays an important role in vasoregulation,homeostasis, neurotransmission, immune defence andrespiration.

Rabelink, A J (1998), "Nobel prize in Medicine and Physiology 1998 for the discovery of the role ofnitric oxide as a signalling molecule", Nederlands tijdschrift voor geneeskunde (1998 Dec 26) 142(52): 2828–30Culotta E, Koshland DE Jr.. NO news is good news. Science.1992 Dec 18;(258(5090)):1862-5

Nitric oxide plays an important role in vasoregulation,homeostasis, neurotransmission, immune defence andrespiration.

Rabelink, A J (1998), "Nobel prize in Medicine and Physiology 1998 for the discovery of the role ofnitric oxide as a signalling molecule", Nederlands tijdschrift voor geneeskunde (1998 Dec 26) 142(52): 2828–30Culotta E, Koshland DE Jr.. NO news is good news. Science.1992 Dec 18;(258(5090)):1862-5

Page 39: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Breathe Light to Breathe RightBreathe Light to Breathe Right

Nitric oxide from the back of your nose and your sinusesinto your lungs. This short-lived gas dilates the airpassages in your lungs and does the same to the bloodvessels.

Roizen, MF, and Oz, MC, 2008. You on a diet revised, The Owners Manual for waist management.New York. Collins.

Nitric oxide from the back of your nose and your sinusesinto your lungs. This short-lived gas dilates the airpassages in your lungs and does the same to the bloodvessels.

Roizen, MF, and Oz, MC, 2008. You on a diet revised, The Owners Manual for waist management.New York. Collins.

Page 40: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Breathe Light to Breathe RightBreathe Light to Breathe Right

Since NO is continuously released into the nasal airwaysthe concentration will be dependent on the flow rate bywhich the sample is aspirated. Thus, nasal NOconcentrations are higher at lower flow rates.

Lundberg J, Weitzberg E. Nasal nitric oxide in man. Thorax.1999;(54):947-952

Since NO is continuously released into the nasal airwaysthe concentration will be dependent on the flow rate bywhich the sample is aspirated. Thus, nasal NOconcentrations are higher at lower flow rates.

Lundberg J, Weitzberg E. Nasal nitric oxide in man. Thorax.1999;(54):947-952

Page 41: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

NOSE BREATHINGNOSE BREATHINGNOSE BREATHINGNOSE BREATHING

Page 42: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Nose Breathing BenefitsNose Breathing Benefitso Nose breathing imposes approximately 50 percent more resistance

to the air stream than mouth breathing, resulting in 10-20 percentmore O2 uptake;

o Warms and humidifies incoming air;

o Removes a significant amount of germs and bacteria;

o Nose breathing imposes approximately 50 percent more resistanceto the air stream than mouth breathing, resulting in 10-20 percentmore O2 uptake;

o Warms and humidifies incoming air;

o Removes a significant amount of germs and bacteria;

Page 43: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Versus Mouth breathingVersus Mouth breathingo Increased risk of developing forward head posture, and reduced

respiratory strength;

o A dry mouth also increases acidification of the mouth and results inmore 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 ofsnoring and obstructive sleep apnoea

o Increased risk of developing forward head posture, and reducedrespiratory strength;

o A dry mouth also increases acidification of the mouth and results inmore 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 ofsnoring and obstructive sleep apnoea

Page 44: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

Hyperventilation SyndromeHyperventilation Syndromeo Cardiovascular: palpitations, missed beats, tachycardia, sharp or

dull atypical chest pain, ‘angina’, cold extremities, raynauds, blotchyflushing of blush area, capillary vasoconstriction.

o Neurological: dizziness, instability, faint feelings (but rarely fainting)headache, paraesthesiae- (numbness, deadness, uselessness,heaviness, pins and needles).

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. Springer; 1994

o Cardiovascular: palpitations, missed beats, tachycardia, sharp ordull atypical chest pain, ‘angina’, cold extremities, raynauds, blotchyflushing of blush area, capillary vasoconstriction.

o Neurological: dizziness, instability, faint feelings (but rarely fainting)headache, paraesthesiae- (numbness, deadness, uselessness,heaviness, pins and needles).

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. Springer; 1994

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Hyperventilation SyndromeHyperventilation Syndromeo 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

o Respiratory: shortness of breath, irritable cough, tightness oroppression 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

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Hyperventilation SyndromeHyperventilation Syndromeo 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, impairedmemory and performance, disturbed sleep, including nightmares,emotional sweating,

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. . Springer; 1994

o Gastrointestinal: difficulty in swallowing, globus (having a lump inones throat), dry mouth and throat, acid regurgitation, heart burn,flatulence, belching, air swallowing, abdominal discomfort, bloating.

o General: weakness, exhaustion, impaired concentration, impairedmemory and performance, disturbed sleep, including nightmares,emotional sweating,

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. . Springer; 1994

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Hyperventilation SyndromeHyperventilation Syndromeo According to Lum, hyperventilation ‘fell between the two stools of

medicine and psychiatry’

o The major reason why hyperventilation had not been fullyrecognised is that most clients were not taught how to change theirbreathing. Effective breathing retraining is required to demonstrateconclusively that hyperventilation is the cause of the clientssymptoms.

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. . Springer; 1994

o According to Lum, hyperventilation ‘fell between the two stools ofmedicine and psychiatry’

o The major reason why hyperventilation had not been fullyrecognised is that most clients were not taught how to change theirbreathing. Effective breathing retraining is required to demonstrateconclusively that hyperventilation is the cause of the clientssymptoms.

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. . Springer; 1994

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Hyperventilation SyndromeHyperventilation Syndromeo 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 deepbreaths!

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. . Springer; 1994

o Because these patients report symptoms in more than onesystem, they are often labelled as hypochondriacs.Historically, they are often told to relax and take a few deepbreaths!

Timmons B.H., Ley R. Behavioral and Psychological Approaches to Breathing Disorders. 1st ed. . Springer; 1994

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CONTROLCONTROL PAUSEPAUSE (comfortable breath hold time)(comfortable breath hold time)MEASUREMENTMEASUREMENT

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.

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.

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MEASURINGMEASURINGHOW BIG YOU BREATHEHOW BIG YOU BREATHE

Breath holding as one of the most powerful methods to inducethe sensation of breathlessness, and that the breath hold test‘gives us much information on the onset and endurance ofdyspnea.

Nishino T. Pathophysiology of dyspnea evaluated by breath-holding test: studies of furosemidetreatment. Respiratory Physiology Neurobiology.2009 May 30;(167(1)):20-5

Breath holding as one of the most powerful methods to inducethe sensation of breathlessness, and that the breath hold test‘gives us much information on the onset and endurance ofdyspnea.

Nishino T. Pathophysiology of dyspnea evaluated by breath-holding test: studies of furosemidetreatment. Respiratory Physiology Neurobiology.2009 May 30;(167(1)):20-5

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MEASURINGMEASURINGHOW BIG YOU BREATHEHOW BIG YOU BREATHE

Eighteen patients with varying stages of cystic fibrosiswere studied to determine the value of the breath hold timeas 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 JournalApplied Physiology.2005 Oct;(95(2-3)):172-8

Eighteen patients with varying stages of cystic fibrosiswere studied to determine the value of the breath hold timeas 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 JournalApplied Physiology.2005 Oct;(95(2-3)):172-8

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MEASURINGMEASURINGHOW BIG YOU BREATHEHOW BIG YOU BREATHE

‘that the voluntary breath-hold time might be a useful indexfor 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 JournalApplied Physiology.2005 Oct;(95(2-3)):172-8

‘that the voluntary breath-hold time might be a useful indexfor 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 JournalApplied Physiology.2005 Oct;(95(2-3)):172-8

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MEASURINGMEASURINGHOW BIG YOU BREATHEHOW BIG YOU BREATHE

Breath hold time varies inversely with the magnitude ofdyspnea when it is present at rest.

Rev Invest Clin. 1989 Jul-Sep;41(3):209-13. Rating of breathlessness at rest duringacute asthma: correlation with spirometry and usefulness of breath-holding time.Pérez-Padilla R, Cervantes D, Chapela R, Selman M.

Breath hold time varies inversely with the magnitude ofdyspnea when it is present at rest.

Rev Invest Clin. 1989 Jul-Sep;41(3):209-13. Rating of breathlessness at rest duringacute asthma: correlation with spirometry and usefulness of breath-holding time.Pérez-Padilla R, Cervantes D, Chapela R, Selman M.

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RhinitisRhinitisRhinitisRhinitis

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RHINITISRHINITISCOMORBIDITY EFFECTCOMORBIDITY EFFECT

o rarely found in isolationo asthma, rhinosinusitis,o more than twice as likely to suffer

problems sleeping due to theirnasal allergy symptoms.

o rarely found in isolationo asthma, rhinosinusitis,o more than twice as likely to suffer

problems sleeping due to theirnasal allergy symptoms.

Hadley JA, Derebery MJ, Marple BF.Comorbidities and allergic rhinitis: not justa runny nose. J Fam Pract. 2012 Feb;6:11-5.

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RHINITISRHINITISASTHMAASTHMA

o We speculate that asthmaticsmay have an increased tendencyto switch to oral breathing, afactor that may contribute to thepathogenesis of their asthma.

o We speculate that asthmaticsmay have an increased tendencyto switch to oral breathing, afactor that may contribute to thepathogenesis of their asthma.

Kairaitis K, Garlick SR, Wheatley JR, Amis TCRoute of breathing in patients with asthma.

Chest. 1999 Dec;116(6):1646-52.

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RHINITISRHINITISASTHMAASTHMA

Laffey, J. & Kavanagh, B.Hypocapnia, New England

Journal of Medicine. 4 July 2002.

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RHINITISRHINITISSLEEP APNEASLEEP APNEA

o Open-mouth breathing during sleep is a riskfactor for obstructive sleep apnea (OSA) andis associated with increased disease severityand upper airway collapsibility.

Kim EJ, Choi JH, Kim KW, Kim TH, Lee SH, Lee HM, Shin C, LeeKY, Lee SH. The impacts of open-mouth breathing on upper airway

space in obstructive sleep apnea: 3-D MDCT analysis. Eur ArchOtorhinolaryngol. April 2011, Volume 268, Issue 4, pp 533-539

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RHINITISRHINITISSLEEP APNEASLEEP APNEA

o Treatment of pediatric obstructive-sleep-apnea (OSA) and sleep-disordered-breathing (SBD) means restoration ofcontinuous nasal breathing duringwakefulness and sleep.

Guilleminault C, Sullivan S. Towards Restoration of ContinuousNasal Breathing as the Ultimate Treatment. Goal in PediatricObstructive Sleep Apnea. Enliven: Pediatrics and NeonatalBiology. Sept 1st 2014

o Treatment of pediatric obstructive-sleep-apnea (OSA) and sleep-disordered-breathing (SBD) means restoration ofcontinuous nasal breathing duringwakefulness and sleep.

Guilleminault C, Sullivan S. Towards Restoration of ContinuousNasal Breathing as the Ultimate Treatment. Goal in PediatricObstructive Sleep Apnea. Enliven: Pediatrics and NeonatalBiology. Sept 1st 2014 .

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RHINITISRHINITISSLEEP APNEASLEEP APNEA

o The case against mouth breathing isgrowing, and given its negativeconsequences, we feel that restoration ofthe nasal breathing route as early aspossible is critical.

Seo-Young Lee* , Christian Guilleminault, Hsiao-Yean Chiu,**,Shannon S. Sullivan. Mouth breathing, “nasal dis-use” andpediatric sleep-disordered-breathing. Sleep and Breathing(2015) Stanford University Sleep Medicine Division, StanfordOutpatient Medical Center, Redwood City CA

o The case against mouth breathing isgrowing, and given its negativeconsequences, we feel that restoration ofthe nasal breathing route as early aspossible is critical.

Seo-Young Lee* , Christian Guilleminault, Hsiao-Yean Chiu,**,Shannon S. Sullivan. Mouth breathing, “nasal dis-use” andpediatric sleep-disordered-breathing. Sleep and Breathing(2015) Stanford University Sleep Medicine Division, StanfordOutpatient Medical Center, Redwood City CA .

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RHINITISRHINITISSLEEP APNEASLEEP APNEA

o In fact restoration of nasal breathingduring wake and sleep may be the onlyvalid “complete” correction of pediatricsleep 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, StanfordOutpatient Medical Center, Redwood City CA

o In fact restoration of nasal breathingduring wake and sleep may be the onlyvalid “complete” correction of pediatricsleep 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, StanfordOutpatient Medical Center, Redwood City CA .

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RHINITISRHINITISADHDADHD

o Sleep disturbances, poor schoolperformance, and hyperactivity areall mental complications seen inmany children related to their nasalallergies.

o Sleep disturbances, poor schoolperformance, and hyperactivity areall mental complications seen inmany children related to their nasalallergies.

Blaiss MS. Pediatric allergic rhinitis: physical and mentalcomplications. Allergy Asthma Proc. 2008 Jan-Feb;29(1):1-

6.

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RHINITISRHINITISADHDADHD

o Most children with ADHD displayed symptoms and skinprick test results consistent with allergic rhinitis. Nasalobstruction and other symptoms of allergic rhinitis couldexplain some of the cognitive patterns observed in ADHD,which might result from sleep disturbance known to occurwith allergic rhinitis.

o Most children with ADHD displayed symptoms and skinprick test results consistent with allergic rhinitis. Nasalobstruction and other symptoms of allergic rhinitis couldexplain some of the cognitive patterns observed in ADHD,which might result from sleep disturbance known to occurwith 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.

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RHINITISRHINITISADHDADHD

o Many of these children aremisdiagnosed with attention deficitdisorder (ADD) and hyperactivity.

Jefferson Y. Mouth breathing: adverse effects onfacial growth, health, academics, and behavior. Gen

Dent. 2010 Jan-Feb;58(1):18-25.

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RHINITISRHINITISCRANIOFACIALCRANIOFACIAL

o Mouth breathers demonstratedconsiderable backward and downwardrotation of the mandible, increasedover jet, increase in the mandible planeangle (longer face)

o Mouth breathers demonstratedconsiderable backward and downwardrotation of the mandible, increasedover jet, increase in the mandible planeangle (longer face)

Harari D et al. The effect of mouth breathing versus nasal breathingon dentofacial and craniofacial development in orthodontic patients.The American Laryngological, Rhinological, and Otological Society,

Inc. 2010 Oct;120(10):2089-93.

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RHINITISRHINITISCRANIOFACIALCRANIOFACIAL

o Children with obligate mouth-breathingdue to nasal septum deviations showfacial and dental anomalies incomparison to nose-breathing controls.

D'Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, ManziniM. Craniofacial growth in children with nasal septum deviation: acephalometric comparative study. Int J Pediatr Otorhinolaryngol.

2010 Oct;74(10):1180-3.

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RHINITISRHINITISCRANIOFACIALCRANIOFACIAL

• Ten-year-old boy is a nose breatherand has a good-looking, broad facewith everything in proportion.

Photograph from Dr John Mew

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RHINITISRHINITISCRANIOFACIALCRANIOFACIAL

• On the boy’s fourteenth birthday, hewas given a gerbil as a present.Soon after, his nose began to block,causing him to breathe through hismouth.

Photograph from Dr John Mew

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RHINITISRHINITISCRANIOFACIALCRANIOFACIAL

Threeyearslater

Photograph fromDr John Mew

Threeyearslater

Photograph fromDr John Mew

Photograph Dr John Mew

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Breathing and Vocal DysfunctionBreathing and Vocal Dysfunctiono Speech is the culmination of two essential

human functions: breathing andcommunication.

o Must consider all the factors in relation toone another. A disturbance in one area willupset the balance necessary to maintainhealthy phonation.

o Speech is the culmination of two essentialhuman functions: breathing andcommunication.

o Must consider all the factors in relation toone another. A disturbance in one area willupset the balance necessary to maintainhealthy phonation.

Daphne J Pearce in Timmons and Ley

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Breathing and Vocal DysfunctionBreathing and Vocal Dysfunction

o Is there frequent throat clearing, excessivephlegm?

o Does the patient pause when speaking?

o Are the pauses appropriate to place inutterance and frequency?

o Does the vocal pitch appear appropriate forthe patients age and sex?

o Is there frequent throat clearing, excessivephlegm?

o Does the patient pause when speaking?

o Are the pauses appropriate to place inutterance and frequency?

o Does the vocal pitch appear appropriate forthe patients age and sex?

Daphne J Pearce in Timmons and Ley

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Breathing and Vocal DysfunctionBreathing 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?

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

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Breathing and Vocal DysfunctionBreathing and Vocal Dysfunctiono DysphoniaExcessive Breathing Volume:

– Dries out the vocal folds resulting inphlegm

– Results in poor breathing pattern andbreath management for speech/singing

o Dysphagia– Overbreathing dries the upper airways

leading to inflammation– Important to slow down and be more

mindful when eating

o DysphoniaExcessive Breathing Volume:

– Dries out the vocal folds resulting inphlegm

– Results in poor breathing pattern andbreath management for speech/singing

o Dysphagia– Overbreathing dries the upper airways

leading to inflammation– Important to slow down and be more

mindful when eatingGolan Hadas

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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 SystemAutonomic Nervous SystemSTUTTERINGSTUTTERING

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)

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o Parasympathetic branch is thought to foster calm physiological states that

promote growth, restoration, and repair

(Andreassi, 2000)

Autonomic Nervous SystemAutonomic Nervous SystemSTUTTERINGSTUTTERING

o Parasympathetic branch is thought to foster calm physiological states that

promote growth, restoration, and repair

(Andreassi, 2000)

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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 SystemAutonomic Nervous SystemSTUTTERINGSTUTTERING

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)

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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.

Jones RM, Buhr AP, Conture EG, Tumanova V, Walden TA,Porges SW J Fluency Disord. Autonomic nervous systemactivity of preschool-age children who stutter. J FluencyDisord 2014 Sep;41:12-31.

Autonomic Nervous SystemAutonomic Nervous SystemSTUTTERINGSTUTTERING

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.

Jones RM, Buhr AP, Conture EG, Tumanova V, Walden TA,Porges SW J Fluency Disord. Autonomic nervous systemactivity of preschool-age children who stutter. J FluencyDisord 2014 Sep;41:12-31.

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Autonomic Nervous SystemAutonomic 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)

STUTTERINGSTUTTERING

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)

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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)

STUTTERINGSTUTTERINGAutonomic Nervous SystemAutonomic Nervous System

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)

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o Singers, actors and public speakers are especially at risk. "Stagefright" is often a panic attack which may cause or be caused byhyperventilation. Most theatres in London's West End recognisethe phenomenon and keep paper bags handy.

Judith Perera. THE HAZARDS OF HEAVY BREATHING. NewScientist. December 3rd 1988

Talking & BreathingTalking & Breathing

o Singers, actors and public speakers are especially at risk. "Stagefright" is often a panic attack which may cause or be caused byhyperventilation. Most theatres in London's West End recognisethe phenomenon and keep paper bags handy.

Judith Perera. THE HAZARDS OF HEAVY BREATHING. NewScientist. December 3rd 1988

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o All subjects ventilated more during speaking than during quietbreathing, usually by augmenting both tidal volume and breathingfrequency…. These findings have clinical implications for therespiratory care practitioner and the speech-language pathologist.

Hoit JD1, Lohmeier HL.. Influence of continuous speaking onventilation.. J Speech Lang Hear Res. .2000 Oct;43(5):1240-51

Talking & BreathingTalking & Breathing

o All subjects ventilated more during speaking than during quietbreathing, usually by augmenting both tidal volume and breathingfrequency…. These findings have clinical implications for therespiratory care practitioner and the speech-language pathologist.

Hoit JD1, Lohmeier HL.. Influence of continuous speaking onventilation.. J Speech Lang Hear Res. .2000 Oct;43(5):1240-51

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o A study to investigate the effectiveness of theButeyko technique on the nasal symptoms ofpatients with asthma.

NASALNASALOBSTRUCTION STUDYOBSTRUCTION STUDY

Adelola O.A., Oosthuiven J.C., Fenton J.E. Role of Buteykobreathing technique in asthmatics with nasal symptoms. Clinical

Otolaryngology.2013, April;38(2):190-191

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NASALNASALOBSTRUCTION STUDYOBSTRUCTION STUDY

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NASALNASALOBSTRUCTION STUDYOBSTRUCTION STUDY

o For example, NOSE evaluation surveys nasalcongestion or stuffiness, poor sense of smell,snoring, nasal blockage or obstruction,trouble breathing through the nose, troublesleeping, having to breathe through themouth, unable to get enough air through thenose during exercise or exertion and feelingpanic that one cannot get enough air throughthe nose.

Adelola O.A., Oosthuiven J.C., Fenton J.E. Role of Buteykobreathing technique in asthmatics with nasal symptoms. Clinical

Otolaryngology.2013, April;38(2):190-191

o For example, NOSE evaluation surveys nasalcongestion or stuffiness, poor sense of smell,snoring, nasal blockage or obstruction,trouble breathing through the nose, troublesleeping, having to breathe through themouth, unable to get enough air through thenose during exercise or exertion and feelingpanic that one cannot get enough air throughthe nose.

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o It is important for the entirehealth care community (includinggeneral and pediatric dentists) toscreen and diagnose for mouthbreathing in adults and inchildren as young as 5 years ofage.

FINALFINALWORDSWORDS

o It is important for the entirehealth care community (includinggeneral and pediatric dentists) toscreen and diagnose for mouthbreathing in adults and inchildren as young as 5 years ofage.

Jefferson Y. Mouth breathing: adverse effects onfacial growth, health, academics, and behavior. Gen

Dent. 2010 Jan-Feb;58(1):18-25; quiz 26-7, 79-80.

Page 86: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

o If mouth breathing is treated early,its negative effect on facial anddental development and the medicaland social problems associated withit can be reduced or averted.

FINALFINALWORDSWORDS

o If mouth breathing is treated early,its negative effect on facial anddental development and the medicaland social problems associated withit can be reduced or averted.

Jefferson Y. Mouth breathing: adverse effects onfacial growth, health, academics, and behavior. Gen

Dent. 2010 Jan-Feb;58(1):18-25; quiz 26-7, 79-80.

Page 87: Examining dysfunctional breathing patterns in asthma ...and+Theory... · DR BUTEYKO o1946- Commenced medical training at the First Medical Institute of Moscow oPractical assignment

That’s all folksThat’s all folks!!Copyright Patrick McKeown, 2015Copyright Patrick McKeown, 2015

That’s all folksThat’s all folks!!Copyright Patrick McKeown, 2015Copyright Patrick McKeown, 2015