Shallow-breathing technique can fight asthma: an Alternative Paths column
By Brie Zeltner, The Plain Dealer, January 26, 2010, 9:15AM
Evan Gillespie's asthma was so severe in his adolescence that pre-dawn attacks landed him in the emergency room more than 30 times. He was often in respiratory failure after rescue inhalers failed, his lips turning blue from lack of oxygen as he struggled to take in enough air.
Gillespie, of Chagrin Falls, felt completely helpless.
At 23, his heart stopped beating briefly in the intensive care unit after Gillespie received an accidental overdose of steroid medication to get his breathing under control.
Enough, he decided.
Gillespie, now 31, no longer takes any medication and considers himself cured.
His life changed a year ago, he says, when he discovered the Buteyko breathing method, a shallow-breathing technique developed by Russian physician Konstantin Buteyko in the 1950s.
After searching the Internet for alternative remedies and trying chiropractic and acupressure treatments that didn't offer any relief, Gillespie found YouTube videos of people demonstrating Buteyko.
He decided to give it a try and was surprised to find Carol Baglia, a licensed respiratory therapist and Buteyko instructor, in Cleveland.
"There aren't a lot of people who are certified or qualified to teach it here," says Baglia, despite the method's success in Russia and increasing use in countries including Australia, New Zealand, England and Ireland.
Baglia's involvement with the breathing method started after she developed adult-onset asthma during a high-stress home renovation in 2000. She stumbled upon it the same way Gillespie did, by searching the Internet.
She was so floored by the results -- she has not had any asthma symptoms since starting the Buteyko method -- that she left her accounting career and went back to school to learn respiratory therapy.
Buteyko theory turns conventional thinking about asthma on its head, so the method -- taking fewer small, measured, shallow breaths through the nose -- seems counterintuitive.
During an asthma attack, the airways narrow because of inflammation and muscle spasm, and the normal response is to breathe more heavily, deeply and quickly to pull in more oxygen. In the traditional view of asthma, the inflammation of the airways and muscle spasm cause hyperventilation.
Konstantin Buteyko believed the opposite, that it was chronic hyperventilation that led to asthma.
Buteyko noticed that hyperventilation leads to a lower level of carbon dioxide in the body, because more of the gas is breathed out in every exhalation.
Low carbon dioxide in the tissues can cause muscle spasms, including the ones in the smooth muscles lining the airways that occur during an asthma attack. For Buteyko, hyperventilation caused asthma, not the reverse.
To break the cycle this sets up, the Buteyko method instructs people to take small, slow shallow breaths through the nose only, reducing the amount of carbon dioxide lost. It also teaches users how to increase the amount of time, called a "pause," between breaths.
The goal of the method is to avoid hyperventilation by "resetting" the breathing rate at a naturally lower pace, Baglia says.
"If the breathing is normal all the time, they don't go off into the berserk stage that leads them into feeling suffocated and unable to breathe," Baglia says. "You can't possibly have an asthma attack when you're breathing this way."
Angelo Capistrano, 55, of Cleveland, had his first asthma attack in 2006 after a lung infection. A devoted cyclist, he could no longer ride his bike and was constantly coughing despite using steroid inhalers, Advair and eventually a portable nebulizer.
Three months after starting the Buteyko method and rigorously sticking to only nasal breathing, he started to notice a change in his symptoms.
Nasal breathing, Baglia says, naturally limits the amount of air you can bring in at one time, warms the air and filters it before it enters the lungs.
"Asthmatics have irritable airways, so if you open your mouth and breathe a huge breath and it's cold and dry and dirty, right there the airways are going to spasm," she says. "That's not the way your body was meant to breathe."
Capistrano is now able to ride his bike up to 10 hours a week and still breathes only through his nose. He is also medication-free.
"It's a very amazing tool," he says. "It's the most natural, simple thing, as simple as changing your breathing pattern."
In addition to teaching the prevention of hyperventilation, the Buteyko method also teaches techniques to help calm asthma attacks should they happen.
The night after Gillespie had his first two-hour session with Baglia, he had an asthma attack and was able to breathe his way free of it without using his rescue inhaler.
Six months later, he felt comfortable enough to get rid of all his medications.
Baglia never tells anyone to stop using medications, and Buteyko practitioners recommend that anyone using the technique or making any changes in medications do so in consultation with a doctor.
Don't expect an enthusiastic response, however. The Buteyko method only made it out of Russia, where it is part of the medical school curriculum, in the 1990s, Baglia says.
But compared to most complementary medical therapies, there is a veritable glut of evidence to support its use.
The common thread through most of the trials, many of them randomized and controlled (considered the gold standard for clinical trials) is a significant improvement in asthma symptoms while using less medication, despite no or only small changes in markers of physiology like lung capacity or airway inflammation.
A recent Canadian trial found that the number of patients who achieved good control of their asthma increased from 40 percent at baseline to 79 percent at six months, with a statistically significant reduction in the use of inhaled steroid medications.
The Mayo Clinic recently listed Buteyko as one of the most promising alternative treatments for asthma, and the British Thoracic Society includes the technique in its national guidelines for doctors and gives it a "B" rating, indicating that the current evidence for its use comes from high-quality studies, and is consistent and applicable.
Still, Gillespie's allergist told him that the technique was potentially dangerous because asthma is a potentially lethal disorder and has no cure. He said he didn't support its use.
After sending the doctor some of the studies supporting the safety and efficacy of the method, Gillespie fired him.
"I've been so insecure with my health throughout my life because I've been on so much medication and my asthma still wasn't controlled," he says. "All of a sudden I can not only not have asthma, but it's under my control. I'm not worried about having another asthma attack, ever."
Contact Brie Zeltner: bzeltner@plaind.com or 216-999-4283.
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