How Asthma Impacts your Breathing
Asthma is a chronic respiratory disease with features of airway inflammation, hypersensitivity and mucus production.
Typically asthma presents with chest tightness, wheeze and often a productive cough. Asthma is a variable disease with common triggers such as allergies, extremes of hot and cold weather, irritants such as smoke or pollution or respiratory viruses like the common cold.
Asthma is usually managed in primary care by the GP and respiratory nurses. Inhalers help with reducing the airways inflammation and targeting the spasm that occurs in the small airways helping them to relax for easier breathing. There are some types of asthma that can be more difficult to manage and don’t respond so well to standard medication regimes and may require specialist care.
I suffered from asthma as a child which was largely triggered by pet and dust allergies. My personal party trick growing up was knowing it was raining before I opened the curtains in the morning depending on how tight my chest felt. I took inhalers until the age of 18. It is believed that lots of children grow out of their childhood asthma. For me, I believe moving out of a home with pets and leaving the pollution of London for the fresh air of the coast played a big role in optimising my respiratory health into adulthood.
Despite not needing to take inhalers for many years now, from time to time my breathing will be triggered especially around dogs and cats. Put me in a room with a golden retriever for too long and I notice how my breathing pattern changes.
Asthma and Breathing Pattern Disorders (BPD)
During an exacerbation of asthma, the work of breathing increases significantly. If the nose is blocked due to allergies or a virus, mouth breathing may increase. To compensate for narrowed airways, the secondary breathing muscles in the neck, shoulders and upper chest get to work dragging air into the tight lungs in an effortful manner. Over time, this ‘emergency’ style of breathing can become the new normal, even when the asthma is back under control through medication. Often asthma sufferers will feel that their symptoms aren’t well controlled and the medication no longer works, but if spirometry testing shows normal values this suggests the breathing pattern may be the problem.
When a breathing pattern disorder develops due to an exacerbation or frequent exacerbations of asthma, this can lead to a pattern of over breathing. When we breathe we breathe in oxygen and breathe out carbon dioxide right. Our normal breathing creates a balance that the body recognises. When a person breathes too much they blow out too much carbon dioxide and re-set their normal levels leaving them stuck in the pattern of over breathing to maintain this new but less effective normal. Persistent mouth breathing leaves the delicate upper airways vulnerable to the effects of dry cold air. By-passing the nasal passages limits the body's ability to warm, humidify and importantly filter the air before it reaches the lungs. The delicate airways, already susceptible to inflammation and hypersensitivity, become stuck in a viscous cycle.
The Role of Respiratory Physiotherapy
Respiratory physiotherapy aims to optimise the breathing pattern to therefore optimise the management of asthma and reduce the risk of exacerbations. The goal is to "retrain" the respiratory system and the primary respiratory muscles.
1. Breathing Retraining
Physiotherapists focus on transitioning the patient from upper-chest, rapid breathing back to relaxed diaphragmatic (belly) breathing. By encouraging a slower respiratory rate, nasal and diaphragmatic breathing, the therapist aims to:
Increase the natural humidification and filtration of air.
Optimise the exchange of oxygen and carbon dioxide.
Reduce the strain on the upper chest.
2. Airway Clearance and Exercise
For asthmatics with high mucus production, physiotherapists teach gentle airway clearance techniques to reduce the incidence of cough which further irritates the upper airway. When we exercise we naturally take bigger breaths which helps to open the airways and move the mucus out of the lungs. Physical activity at the right level is highly recommended for anyone with asthma. Pulmonary Rehab exercises classes run by physiotherapists are the best option for anyone who is unsure of how they can start exercising alongside their respiratory condition.
3. Support with breathing during activity
Many asthmatics can suffer from a condition called Exercise-Induced Bronchoconstriction (EIB) where the airways become tight and sensitive due to the increased ventilation demanded during exercise. This is something that can feel scary and often leads to people with asthma not wanting to exercise. Respiratory physiotherapy can support with learning to breathe better during activity thus improving cardiovascular fitness without triggering an attack.
Why the Distinction between asthma and BPD Matters
A significant number of patients with "refractory asthma" (asthma that doesn't respond to high-dose steroids) actually have undiagnosed BPD. If a doctor only increases the medication, the underlying habit of dysfunctional breathing remains, leaving the patient frustrated and over-medicated. I see the pattern so often where someone with asthma has continually had their steroid inhaler increased but the symptoms aren’t improving. It’s natural to think it must be the asthma itself but it’s so important to explore the whole picture to see how other approaches may help.
Respiratory physiotherapy addresses the mechanics of breathing (the muscles, the technique, the way you breathe), while medicine addresses the plumbing (what’s going in the airways). When used together, they allow you to regain a sense of control over the breathing, reducing the psychological burden of the disease.
Get in touch to see how Breath & Move techniques could help you improve your asthma management.