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Most people do not think about how, or how often, they are breathing. However, for many people, breathing – a fundamental of life – isn’t as easy as it seems for a wide range of reasons. There are many examples of why a person’s breathing may be affected. These can include anything from breathing pattern disorders, such as ‘mouth breathing’ and anxiety or stress, to chronic nasal obstruction and respiratory disease.

So what happens to the body when we breathe? Well, we each have two air passageways to your lungs – the nose and the mouth.

Breathing through your mouth is only necessary when there is nasal congestion (for example due to allergies or a cold), or when exercising, as breathing through the mouth gets oxygen to your muscles faster. 

The correct way to breathe is in and out through your nose. This enables the nasal passages to warm and moisten the air you inhale, and allows the oxygen to reach deep into your diaphragm. The little hairs in your nose, also known as cilia, are one of the biggest air filters in your body, and breathing through your nose also helps your body defend itself from bacteria and allergens such as pollen. Air exhaled through the nose creates a back flow of air (and oxygen) into the lungs. Because we exhale more slowly through the nose than we do though the mouth, the lungs have more time to extract oxygen from the air we’ve already taken in.

The optimum breathing rate is 5.5 breaths per minute. This involves 5.5-second inhales, and 5.5-second exhales deep into your diaphragm. If you breathe too quickly, or only in your chest, your airways cannot absorb oxygen, or participate in gas exchange. Breathing shallowly will mean that only approximately 50% of the breath that is taken in is being used, compared to approximately 85% if breathing properly.

The sacred power of breathing is one that is repeated in many cultures across the world. For example, yoga and meditation both heavily use shamanic breathwork within their practice. The Sanskrit word, ‘pranayama’, is translated to the “expansion or manifestation of energy,” with many people believing that once you have control over pranayama, you can transform yourself physically, emotionally, and spiritually.

Another technique is anapanasati, which is the meditation system taught by the Buddha, in which mindful breathing is used to develop both samadhi (a serene and concentrated mind) and vipassana (see the true nature of existence). 

Concentrated breathwork can relieve stress, anxiety, and over-thinking. It is also a way to improve posture, heart rate variability, remove negative energy or blockages, ease an overstimulated nervous system, and reduce blood pressure by adding more oxygen to the body.

With more oxygen going to the brain, the mind opens up new networks. This raises your level of consciousness. The path to a higher self starts with the physical breath, then control of breath, and finally understanding of breath.

Breathing slower, and with more control has also been shown to reduce the ‘sympathetic’ nature of the nervous system and supports a more calmer and ‘parasympathetic’ state of being.

Depending on the reason for a person’s breathing troubles, there are various avenues for support, education and training to improve breathing. Respiratory physiotherapists, for example, can teach people how to breathe with your diaphragm and provide at-home exercises to help develop healthier breathing habits. 

But even for those without respiratory disease, being conscious of breathing, and practicing controlled breathing techniques, have both been shown to reduce stress, improve sleep, increase alertness and boost our immune system.

Breathlessness and COPD

Chronic obstructive lung disease (COPD) is an umbrella term that covers emphysema, chronic bronchitis and chronic asthma, and affects approximately 15% of New Zealand adults over 40 years of age. The damage to the lungs is most often caused by smoking, exposure to smoke, or exposure to other noxious substances. Unfortunately, the damage is not reversible, and symptoms include coughing, wheezing and shortness of breath. COPD diagnosis is confirmed by spirometry – a test to determine lung function.

The diseases under the COPD umbrella affect the lungs in different ways. Emphysema for example, causes the inner walls of the air sacs to weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream. 

Chronic bronchitis affects the lungs slightly differently, by inflaming and irritating the linings of the airways. Over time, chronic bronchitis causes the lining to get thick and inflexible, making it difficult for your airways to clear themselves of excess mucus and making it hard to breathe.

For those with COPD, breathlessness is one of the most common, and perhaps the most alarming symptom to manage. Sometimes COPD patients may get breathless even from just sitting down and relaxing – it can often seem to come on for no apparent reason or with very little exertion, which has a significant effect on daily life.

COPD patients can also have blood oxygen levels (or saturation) within the normal range, but still experience shortness of breath. It’s easy to assume that being breathless would mean that a person was also short of oxygen, but that’s not necessarily the case for people with COPD. This is because oxygen saturation measures the amount of oxygen in the blood, not the amount of oxygen-rich blood that is being pumped through the body by the heart. Lung disease can cause strain on the heart causing it to pump less effectively. An inefficient heart means that a lesser amount of blood is sent out of the heart to the rest of the body with each beat – this is what leads to the feeling of shortness of breath.

Therefore, having supplemental oxygen is not helpful for patients who are short of breath but have normal levels of oxygen in their blood (oxygen saturation). Oxygen doesn’t reduce the feeling of breathlessness in patients that don’t have low oxygen saturation levels in their blood (known as being hypoxic).

This is why non-pharmacological (non-drug) management strategies are so important for people with COPD to help manage symptoms including breathlessness. Prescription medicines and inhalers are an important part of managing COPD, however, research has shown that most people benefit from pulmonary rehabilitation classes, or by learning breathlessness management strategies – which can have a significant impact on the quality of life.

These strategies are outlined in New Zealand’s first-ever COPD Guidelines which aim to improve the diagnosis and management of COPD in New Zealand. The key non-pharmacological management strategies and recommendations are to stop smoking, continue physical activity, take part in pulmonary rehabilitation classes, learn breathlessness management strategies, and create a healthy lifestyle and living environment. 

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