By AJ Fisher, M.S., C.S.C.S.
2021 Sports and Health Sciences Master’s Degree Graduate
and Daniel G. Graetzer, Ph.D.
Faculty Member, School of Health Sciences
It is great news to anyone living with or caring for someone with asthma that symptoms may be alleviated by non-pharmacological treatments, such as breath training and intermittent hypoxic training.
Harvard Medical School notes that asthma treatment guidelines have recently changed to include new advances and best practices. As more contributing factors for asthma are being discovered, more asthma therapies are being used.
Alternative Therapies for Asthma Sufferers
The psychophysiological, biochemical, and biomechanical factors behind asthma are recently being considered in order to develop alternative therapies to alleviate asthma symptoms.
Research into breathing protocols such as the Buteyko method, diaphragmatic breathing, the Papworth technique, forced expiratory technique, and various pranayammas (a type of breathing used during yoga) are all showing promise.
According to Healthline, FEV1 (forced expiratory volume in one second) is the volume of air that can be exhaled in precisely one second. It is commonly measured by a peak flow meter. Both breath volume and speed are determined as an indicator of overall lung health.
Respiratory therapists and physicians utilize continuous FEV1 testing to determine if and how different therapies improve lung function. Asthma patients often have a significantly reduced FEV1.
However, remarkable improvement has been seen with regular breathing protocols such as the Papworth technique, which combines relaxation and breathing exercises.
Hyperventilation’s Role in Asthma
Hyperventilation can be a catalyst or a consequence of asthma, notes HealthPerp. Sometimes, hyperventilation is both, contributing to the vicious hyperventilation cycles of asthma.
From a psychophysiological viewpoint, the autonomic nervous system normally regulates breathing patterns by maintaining a delicate balance between sympathetic and parasympathetic nerve input.
Hyperventilation (rapid breathing) is more associated with sympathetic nerve responses, whereas hypoventilation (slow breathing) is connected with parasympathetic nerves, according to Difference Between.
Asthma is sometimes triggered simply from the patient’s fear of an asthma attack. For example, the brain of an asthma sufferer clearly remembers the post-traumatic stress from previous bouts of asthma.
The “on switch” of sympathetic nerves is similar to a Pavlovian response that can bring on hyperventilation. The hyperventilation, in turn, can trigger an asthma attack due to hypocapnia (low carbon dioxide) in the lungs and excessive air movement, both of which can potentially induce bronchospasms.
Controlling Fear-Induced Hyperventilation and Asthma
Asthma patients can learn to condition their nervous system to recognize the early signs of fear-induced sympathetic nerve overload, a main cause of asthma attacks.
They can be trained to recognize the early onset of potential panic and immediately begin a breathing routine that strategically reduces air volume and slows their breathing tempo.
As a result, they will improve heart rate variability (HRV) by increasing the activity of parasympathetic nerves, observes Medium. That will reduce the risk of panic-induced hyperventilation and a full-blown asthma attack.
Biochemically speaking, learning to control one’s breathing can have a major impact on chemical changes that impact respiration (gas exchange at the cellular level). The dysregulation of carbon dioxide and oxygen, for example, can be the culprit and/or consequence of a hyperventilation-aggravated asthma attack, notes Healthfully.
Breathing Mechanics’ Effect on Hormones
Increased sympathetic nerve activity that coincides with periods of elevated mental and/or physical stress from poor breathing mechanics may affect the body’s chemical messengers, such as hormones.
Changes in the activity of neurotransmitters such as norepinephrine and dopamine and in hormones such as cortisol and adrenaline, according to KenHub, may reduce the severity of asthma attacks.
An asthma patient who has learned through conditioning to increase parasympathetic nerve activity can experience improvement in respiratory function.
In addition, that patient may also experience improvements in the nervous, cardiovascular, musculoskeletal, and immune systems.
Stronger Breathing Muscles Can Also Improve Asthma Symptoms
Biomechanically speaking, strengthening the functional mobility and stability of breathing muscles such as the diaphragm, intercostals, obliques, and pelvic floor – in conjunction with improved awareness of the position of breathing structures – can also improve asthma symptoms, notes Physiopedia. With increased strength and mobility of the diaphragm, an asthma patient’s involuntary slow breathing at rest improves.
Using a proprioceptive device such as the Buteyko Belt or the Ab-Ribbon™ enables ongoing biofeedback regarding the effectiveness of mechanical training of breathing muscles. That information can be valuable in the quest to optimize diaphragmatic breathing protocols.
Because fast breathing with a high volume of air can trigger asthma attacks, the stability and mobility of the diaphragm can potentially lessen attack frequency. Improving the strength of forced exhalation musculature can improve FEV1 scores, using techniques such as Forced Expiratory Technique and the BreathographyTM technique.
The Benefits of IHT and IHE as Asthma Treatments
Intermittent hypoxic training (IHT) and intermittent hypoxic exposure (IHE) also show promise as other non-pharmacological asthma therapies. Both of these therapies involve breathing ambient air with reduced amounts of available oxygen. IHT includes physical exercise whereas IHE assesses the body’s functions at rest.
According to Medic Tests, ambient air contains just under 21% oxygen. However, IHT typically involves air between 9-14% oxygen, depending on the protocol, according to Higher Peak. Physiological mechanisms during hypoxic protocols differ from therapeutic breathing methods, although there are some crossovers.
On the cellular level, IHT and IHE have shown benefits to mitochondria efficiency when they utilize oxygen to extract usable energy from food, which correlates with the tissue hypoxia seen with asthma. Epidemiological studies of acute hypoxic conditioning show a lessening of the extreme hypoxia seen in diseases such as asthma, in addition to other cardiovascular and neurological disorders.
By improving the hypoxia of lung tissue, IHT and IHE have the potential to minimize and possibly even eliminate asthma altogether. According to Pacific College, improvements in nitric oxide (NO) levels using therapies such as Chinese wellness practice of qigong is another way hypoxic training has been shown to reduce asthma severity in some persons.
Sometimes, an asthma diagnosis also includes an assessment of exhaled levels of nitric oxide with the elevations associated with airway inflammation. Hypoxic conditioning directly improves the function of nitric oxide-dependent metabolic pathways as shown by improved nitric oxide levels after hypoxic conditioning.
Increased effectiveness in antioxidant defenses is another benefit of hypoxic conditioning, according to Medical News Today. It is common for the lung tissue of asthmatic patients to have dysregulated patterns of immune activity and excessive free radical production.
High Levels of Free Radicals
High levels of free radicals negatively influence the functional ability of lung epithelium, setting the stage for tissue hypoxia and lung inflammation.
Hypoxic protocols in which lung tissues shift from hypoxic to normoxic (normal oxygen) indicate the increased vigor of antioxidant defenses due to less free radical byproducts to drive lung inflammation.
IHT and IHE also improve both the strength and plasticity (the learning potential) of respiration (oxygen and carbon dioxide exchange at the cellular level). Ventilatory muscles, which increase bulk air flow in and out of the lungs, have been shown to increase in strength with hypoxic training, due to the increased demand and resulting supercompensation in a reduced oxygen environment.
Respiratory Plasticity and the Phrenic Nerve
Respiratory plasticity increases with hypoxic conditioning due to increased activity of the serotonin-dependent phrenic “breath” nerve, according to Science Direct. Cleveland Clinic also notes that the phrenic nerve (whose nerve roots originate at cervical spine nerves 3, 4, and 5) is the main communicator between the brain and the diaphragm.
The cervical spine nerves 3,4, and 5 helps you breathe to stay alive. Victims of traumatic accidents who have nerve injuries that high on the spinal cord often need immediate breathing assistance to survive.
A living C3 quadriplegic is very rare, according to Cleveland Clinic. Often, the reason that a quadriplegic survives was due to breathing assistance, either mouth-to-mouth or with a breathing machine.
For instance, University of Washington defense back Curtis Williams was left paralyzed after damage to his upper cervical vertebrae in a 2020 football game against Stanford. Williams survived what is considered the most serious non-lethal spine injury possible, leaving him paralyzed from the neck down.
Williams received excellent immediate care by sideline physicians using a ventilator. Unfortunately, he died in 2022 at age 24, the first death of a student-athlete due to a sports-related injury in UW history.
Williams’ follow-up care revealed that increasing the learning potential of the phrenic nerve could have profound implications in improving proper breathing mechanics following a traumatic accident. This information also has possible implications for asthma sufferers.
Could Breathing Treatments and Hypoxic Methods, When Combined, Provide Asthma Relief?
Breathing treatments and hypoxic modalities are both beneficial, according to Very Well Health. However, they are also unique in the way they improve asthma symptoms, which leads to the hypothesis that a combination of both techniques may further alleviate asthma attacks and the intensity of suffering.
If both methods are used simultaneously to achieve intermittent hypoxia and elevated levels of carbon dioxide, could they provide a more improved asthma treatment that so many asthmatics hope for?
The improvement of the psychophysiological, biochemical, and biomechanical aspects of asthma could provide the missing link to improving the regulation of nervous, ventilatory, respiratory, musculoskeletal, and immune systems.
Performing slow breathing – such as the type of breathing used in Breathography™ in an intermittent hypoxic environment – has tremendous potential to alleviate asthma and other related conditions.
Perhaps this type of breathing technique may even provide a future cure for asthma. But until more innovative ways to clinically manage asthma are discovered, asthma will remain a common scourge of humanity for patients of all ages.
If you are interested in an online degree programs related to this topic, visit the University’s Health Sciences program page.
About the Authors
Adrienne “AJ” Fisher, M.S., C.S.C.S., earned her bachelor of science and master of science in sports and health sciences from American Public University. She maintained a 4.0 GPA, which earned her an academic scholar award. AJ serves on the University’s Sports and Health Sciences advisory board and is a personal trainer for high-profile celebrities in NYC, L.A., and London. She has also worked with clients such as Adidas, Reebok, and Marvel in movies such as “Black Panther, Wakanda Forever.” AJ runs HYPOXiX fitness programming, which integrates breathing patterns that restore core strength and optimize the nervous system, body composition, and brain function.
Daniel G. Graetzer, Ph.D., received his B.S. from Colorado State University/Fort Collins, a M.A. from the University of North Carolina/Chapel Hill and a Ph.D. from the University of Utah/Salt Lake City. He has been a faculty member in the School of Health Sciences, Department of Sports and Health Sciences, since 2015. As a regular columnist in social media blogs, encyclopedias, and popular magazines, Dr. Graetzer greatly enjoys helping bridge communication gaps between recent breakthroughs in practical application of developing scientific theories and societal well-being.