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What are the symptoms?

So what is asthma and what are the symptoms? The condition consists of inflammation, tightening and swelling of the airways in the respiratory system, resulting in obstruction of the flow of air to and from the lungs. The symptoms of asthma include breathlessness, wheezing, coughing and chest tightness. Sufferers may also have a blocked nose, frequent colds and hay fever, or rhinitis. The symptoms and their severity are peculiar to the individual, and they vary from season to season and according to the individual’s susceptibility to a wide range of triggers.

An ‘asthma attack’ is the term used to describe an episode of breathing difficulty. In some cases, this may follow exposure to a specific trigger, such as dust, pollen, or certain

Airways narrowing

foods. In other cases there appears to be no particular trigger. Some people have a cough and no wheeze, while others may have a wheeze and very little coughing, but each case is accompanied by some level of breathing difficulty. Symptoms may occur periodically, on a day-to-day or season-to-season basis, or they may be more or less continuous.

A ‘trigger’ is something that makes asthma worse. The most common triggers include (in alphabetical order): allergies; cigarette smoking (and cigarette smoke for nonsmokers); colds and flu; cold air; dust mites; exercise under certain circumstances; moulds; noxious fumes; pollens; stress, and weather types such as fog and damp. In some instances an asthma attack may be triggered by a combination of catalysts. Anxiety can be caused by the variations on the asthma theme, particularly where a child is involved. Sometimes, there may be confusion between doctor and patient when a diagnosis is being made.

There is also a wide variety in the symptoms of asthma. The following is a list of those most commonly experienced by sufferers.

♦ Wheeze

This is a high pitched whistling sound produced when air is forced through narrowed airways. If you blow through a Biro pen when the ink refill is removed, the sound is similar.

♦ Breathlessness

This is the feeling of not being able to take in enough air. There is a need to breathe out while, at the same time, a compulsion to breathe in. If this symptom develops to an extreme level it can be frightening for the sufferer and very distressing for those close to him or her.

♦ Coughing

This may be either a repetitive dry cough or a cough with phlegm, often occurring during the night or early morning. Repetitive coughing can put a strain on the heart and drives sputum deeper into the lungs. Patients with this symptom may feel like they are on a conveyor belt: the more they cough, the more they feel the need to cough again.

♦ Chest tightness

Trapped air in the lungs generates a feeling that the chest is over inflated. This is often described as someone squeezing or sitting on one’s chest.

♦ Frequent yawning

When asthma symptoms are at their worst, sleep is interrupted by difficult periods of breathing which contributes to tiredness.

Non-asthmatics can, of course, observe these symptoms, but they will not appreciate the feelings of tension, panic, uncertainty and helplessness which accompany them, particularly when the asthmatic struggles to breathe. If you are not an asthmatic, imagine trying to breathe while a pillow is being pressed firmly over your face. That feeling you imagine is the feeling someone with asthma has during an attack. In your case, the imaginary pillow can be easily removed to allow you to breathe effortlessly; for an asthmatic, the remedy is not so simple.

Given the variety of symptoms and their severity, diagnosing a condition that has no commonly accepted definition is not an exact science. Many asthma symptoms are also the symptoms of other conditions, such as chronic bronchitis or bronchiectasis, for example. Diagnosis has to take into account the chronic nature of asthma and the constriction of the airways due to inflammation by various cells and chemicals. Generally, diagnosis of asthma is based on the following factors.

♦ History of the patient

This includes establishing if the patient has experienced asthma symptoms while at rest, during exercise or after exposure to a known trigger.

♦ Lung function tests

The peak flow meter measures the maximum speed at which the patient can exhale air in one second. A person with asthma usually produces a lower reading, and, generally speaking, a more inconsistent range of results than a person who doesn’t suffer from the condition. Spirometry measures both the speed and volume of air which is exhaled with each breath, thereby providing additional airway obstruction information.

♦ Effect of reliever or steroidal medication

In part, diagnosis of asthma is based on the effects of medication, and whether or not it leads to a temporary reversal of symptoms. Other conditions which demonstrate common asthma-type symptoms, such as emphysema, include irreversible airway obstruction.

♦ Provocation test

The patient inhales a broncho-constricting agent, such as histamine or methacholine. The airways of people with asthma are far more responsive to inhalation of these substances; agents like these will provoke more extensive narrowing of air passages in people with asthma.

♦ Skin tests to determine allergies

A number of common allergens are selected, such as dust mites, pollen or animal dander. One at a time, the allergens are placed on the forearm, and the skin is then gently pierced to allow the substances to penetrate. After fifteen minutes, the skin surrounding this spot may develop a small rash. While this test is not always conclusive, the presence of a rash and the size of the weal indicate an allergy to a specific substance.

♦ Chest x-ray

X-ray is used to rule out other respiratory diseases in a person who has the symptoms of severe chronic asthma. X-ray charts show irreversible damage to the airways, and this aids the diagnoses of other respiratory disorders.

Your respiratory system

Before you commence breathing retraining, it is important for you to have a basic understanding of the roles played by the respiratory system and carbon dioxide in your body. Your respiratory system consists of the parts of your body used for the delivery of oxygen from the atmosphere to your cells and tissues, and for transporting the carbon dioxide produced in your tissues back into the atmosphere. If cells and tissues are to function properly – if you are to live – your body needs the atmosphere’s oxygen. Your nose, mouth, pharynx, larynx, trachea, bronchi and lungs are all part of your respiratory system.

Part of your airways is your nose and mouth. Through them, air enters your body and flows down a flexible tube called the trachea. This tube eventually divides into two branches called bronchi: one branch enters the left lung and the other branch enters the right. Within your lungs, the bronchi further subdivide into an estimated twenty-five smaller branches called bronchioles. The bronchioles run into alveolar ducts and at the end are small air sacs called alveoli.

Look at it another way. Imagine an upside-down tree. The trachea is the trunk; at the top of the trunk are the two large branches of the bronchi. From each of these large branches grow the smaller branches of the bronchioles. At the end of each smaller branch are the ‘leaves’, the round balloon-shaped sacs called alveoli.

When you breathe in, air enters through your nose or mouth and flows into the trachea, the bronchi, bronchioles and eventually alveoli. The grape-like alveoli – after which they are named – are surrounded by tiny blood channels called capillaries. Oxygen enters the blood by passing through a very thin barrier between the capillaries and air sacs. It is then carried by what is called haemoglobin within

Our lungs

A close-up of Alveoli (air sacs)

the blood to tissues and cells. There are approximately three hundred million alveoli in the lungs, each of which is surrounded by tiny blood vessels.

To put this huge number in context, think of Wimbledon and imagine a tennis court. The area of contact between your alveoli and blood capillaries is equivalent to the size of a tennis court; as you can imagine, this massive area provides scope for an efficient transfer of oxygen from the air to your blood. Carbon dioxide is produced as an end product of the process of breaking down the fats and carbohydrates that you eat, and this gas is brought by your venous blood vessels to your lungs where the excess is exhaled. Crucially, part of your body’s quotient of carbon dioxide is retained when you exhale, and correct breathing results in the required amount of carbon dioxide being retained in your lungs.

There are two main aspects to the way you breathe. Your rate is the number of breaths you take in one minute and your volume is the amount of air drawn into your lungs. Although the two are separate, one generally influences the other.

The volume of air we inhale and exhale is measured in litres, and measurements are usually taken over one minute. In conventional medicine, the accepted number of breaths a healthy person takes in one minute is ten to twelve, with each breath drawing in a volume of 500 millilitres. In a full minute, this provides the body with a total volume of five to six litres. If a person is breathing at a higher rate of twenty breaths, for example, then the volume will also be higher, and vice-versa. To visualise this amount of air, imagine how much air would be contained in a two-litre soft drink bottle.

Where to now?

So, now you know how the respiratory system works, and you or someone close to you has been diagnosed with asthma. Where to now? A lifetime of drug therapy? Or a proven, natural, physiology-based way of reversing what can be a debilitating condition?

A new beginning is emerging in the treatment of asthma, aimed at getting to the root cause of the problem. By addressing the cause rather than the symptoms that are the effect, sufferers finally have the ability to be able to take control of their own condition, naturally and permanently. This new beginning is based on the life’s work of Russian scientist, Professor Konstantin Buteyko. Before we can begin to look at how you can change your own life, we must take a brief look at his.

Over four decades, Professor Buteyko completed pioneering work on illnesses which develop as a result of breathing a volume of air greater than the body requires. His work provided mankind with probably the greatest discovery to date in the field of medicine.

As a medical student, Konstantin observed hundreds of sick patients, and realised that their breathing was closely related to the extent of their illness. The greater the volume of air which a patient inhaled, the greater their sickness, he discovered. This relationship was so precise that he was able to predict accurately the exact time when ill patients would pass away.

Through his research, he devised a breathing programme for his patients based on reducing the amount of air that passed through their lungs. When each patient applied reduced breathing, all their bodily functions including pulse, volume of breathing per minute and blood pressure were monitored. The resulting data enabled him to refine and improve his method. Buteyko’s theory is based on the life force of any organism: breathing.

Like many other revolutionary findings, it can often take many years before a discovery is acknowledged and incorporated into everyday practice. Take Professor Lister, for example. He discovered that many illnesses such as sepsis could be passed by the contaminated hands of a doctor to a patient. Lister tested his hypothesis by disinfecting his hands before each operation and this resulted in a decrease in the death rate of his patients. It took many years for this discovery to be accepted by the medical community; it was only really accepted when patients’ relatives started demanding that doctors disinfect their hands before operating.

Although research conducted in Russia in 1962 proved unequivocally the soundness of Buteyko’s method, it was not until 1983 that the Committee on Inventions and Discoveries formally acknowledged his work. This recognition was backdated to January 29th, 1962. That backdating alone begs the question: if Konstantin Buteyko’s discovery had been acknowledged earlier, how many more ill people would have been helped?

The first trials held in the Western world were at the Mater Hospital in Brisbane in 1995. After three months, the Buteyko group had seventy per cent less symptoms, ninety per cent less need for reliever medication and forty-nine per cent less need for steroids. Furthermore, those who corrected their breathing the most reduced their symptoms and need for medication the most. An article published in Australian Doctor on April 7th, 1995 was headed ‘Doctors gasp at Buteyko success’.

A second trial was conducted at Gisborne Hospital, New Zealand in 2003 and published in the New Zealand Medical Journal. After six months, the Buteyko group showed an 85 per cent reduced need for reliever medication and 50 per cent reduced need for inhaled steroid.

In the forty-odd years since Buteyko’s discovery, it has improved the health and saved the lives of many thousands of people. Now that his enlightening revelation is becoming better known in the Western world, it will improve the health and save the lives of many more. You could be one of them.

Chapter 2 How is your breathing?

‘Habit is either the best of servants or the worst of masters.’

– Nathaniel Emmons

For the vast majority of people, breathing is an everyday fact of life which occurs on a subconscious level. It is something that is all too often taken for granted – until there’s a problem. Yet breathing is the most important physiological function you can exercise control over and this is something that can easily be achieved through increased attention, observation and will-power. With practice both the rate and volume of breathing can be changed for the better and the only prerequisite is to be aware of the existing breathing pattern.

Claude Lum, a noted physician at Papworth University hospital, Cambridge, described hyperventilation, or overbreathing, as a bad habit that has the effect of lowering carbon dioxide levels. It is only necessary to look at examples such as smoking to realise that bad habits are easy to acquire – and not quite so easy to lose. Changing a habit of a lifetime can initially cause disruption to a daily routine and focus attention on the change that is to be made.

While in extreme cases the fight to combat a bad habit can consume every waking minute, acquiring a good habit can inspire a new wave of self-confidence. Once the new habit has been acquired, even one that requires enormous self-discipline and a large helping of patience, it quickly becomes very easy to live with and can help boost selfesteem and self-belief. The investment of time, effort and concentration in the short term will ensure a reward of positive long-term results.

Making the change to a reduced volume of breathing should be treated as simply acquiring a good habit – one that will reap untold health benefits. Ultimately the benefits can include the complete recovery of an individual with asthma.

Many of Professor Buteyko’s patients who were taught the Buteyko Method remained completely free from symptoms of asthma thirty years later. It was as a result of pressure placed on the Soviet authorities by those who recovered that independent trials into Professor Buteyko’s method were conducted. The results of the trials brought about the full recognition and acceptance of the Buteyko system in the Soviet Union.

What is overbreathing?

First, let’s take a quick look at what overbreathing is, and why we do it in the first place. Clinically, overbreathing is known as hyperventilation; put simply, it means breathing more air than the body needs. The standard volume of normal breathing for a healthy adult is three to six litres of air per minute. Scientific research conducted by Professor Buteyko over three decades, along with scientific trials at the Mater Hospital in Brisbane in 1995 demonstrated that people with asthma breathe a volume of ten to twenty litres per minute between attacks, and over twenty litres during an attack.

Overbreathing causes a loss of carbon dioxide from the lungs. This is not a problem if it occurs only for a short time, because breathing will reduce afterwards to restore the carbon dioxide levels. However, breathing more air than we need over a period of time – and time can mean hours, weeks, months or even years – will result in the day-to-day levels of carbon dioxide remaining low constantly. Our respiratory centre becomes accustomed to or fixed at these lower levels of carbon dioxide and determine them to be ‘correct’. Our respiratory centre will therefore instruct us to overbreathe to maintain these low levels of carbon dioxide even though the rest of our bodily organs and tissues are suffering.

Carbon dioxide is very important for normal bodily functioning (for a more detailed explanation, see Appendix 1), it is logical to assume that the body must have some way to prevent losing it. Narrowing of the airways is caused by inflammation, by constriction of smooth muscle and by increased mucus secretion, and is a natural defence mechanism to help maintain the carbon dioxide level. In a person with asthma, this defence mechanism activates when the carbon dioxide level declines too much. Overbreathing also causes cooling and drying of the airways, two effects that have been recognised to play a role in producing asthma symptoms (for a more detailed explanation, see Appendix 2).

People with asthma are better off than anyone else who overbreathes because they are equipped with an instant defence mechanism to prevent the loss of carbon dioxide. People who do not have this defence mechanism suffer from many of the diseases of civilisation for which there is no cure.

It is worth noting that before 1900, people who had asthma often lived longer than the rest of the population and that death from asthma was unknown. ‘Having asthma generally meant having a long life free from many diseases, but nobody could explain why asthma prevented other diseases or why asthmatics lived longer than other people,’ Professor Buteyko noted. At the end of 19th century, Professor of Medicine at Oxford University Sir William Osler, wrote in his Principles and Practice of Medicine textbook: ‘We have no knowledge of the morbid anatomy of true asthma. Death during the attack is unknown.’

Overbreathing resulting from modern living is the cause of breathing-related diseases. Hyperventilation is not just a result of asthma, hyperventilation is the main contributor of asthma.

Professor Buteyko believes that genetic predisposition determines which illnesses people develop from overbreathing. As a result, each person who hyperventilates or overbreathes is affected individually, based on hereditary factors.

Symptoms of hyperventilation

Some of the symptoms of hyperventilation affect:

♦ The respiratory system in the form of wheezing, breathlessness, coughing, chest tightness, frequent yawning, snoring and sleep apnoea.

♦ The nervous system in the form of a light-headed feeling, poor concentration, numbness, sweating, dizziness, vertigo, tingling of hands and feet, faintness, trembling and headache.

♦ The heart, typically a racing heartbeat, pain in the chest region, and a skipping or irregular heartbeat.

♦ The mind, including some degrees of anxiety, tension, depression, apprehension and stress.

♦ Other general symptoms include mouth dryness, fatigue, bad dreams, nightmares, dry itchy skin, sweaty palms, increased urination such as bed wetting or regular visits to the bathroom during the night, diarrhoea, constipation, general weakness and chronic exhaustion.