The standard treatment for asthma is drugs—perhaps just a steroid inhaler to relieve symptoms if you're lucky, or a combination of inhalers, pills and even injections if you're not.
But for naturopath Alison Waring, the key to beating asthma is far more natural and has to do with something we do constantly without a second thought: breathing.
An asthma sufferer herself, Alison is an advanced practitioner of the Buteyko breathing technique (BBT), a method of breathing retraining she uses to overcome her own symptoms as well as help others with asthma and other chronic conditions.
First developed by Russian doctor Konstantin Buteyko in the 1950s, Buteyko breathing is now a popular nondrug therapy all over the world and is even endorsed in the British Guideline on the Management of Asthma as a complementary therapy, which means it can be recommended by nurses and doctors.
At the heart of the method is learning to become more conscious of your breathing—and especially how to slow it down, breathe through your nose rather than your mouth and into your belly rather than your chest.
According to Buteyko, poor breathing patterns such as "overbreathing" and mouth breathing can lead to illness by reducing carbon dioxide levels in the body and thereby starving the tissues of oxygen. Through a series of exercises and techniques, the Buteyko method is designed to retrain the body's breathing patterns to improve health and specific conditions like asthma, rhinitis, sleep apnea and anxiety.
Buteyko breathing forms the basis of Alison's approach to asthma at her practice in York, North Yorkshire, but she also draws on various other natural therapies she is trained in, such as breathing biofeedback, hypnotherapy and emotional release work, as well as her own breathing technique, Dynamic Breath Release (see box, page 71), which she first developed to quickly stop her asthma attacks without medication.
Alison will also take into account environmental factors such as nutrition and sources of stress."It's a truly holistic approach," she says.
"You will definitely get results just by following the breathing exercises alone. But it's far more effective if you come at the condition from all angles."
Steps to better breathing
Taking a full case history is the first thing Alison will do when seeing a client with asthma. "It's important to know how long they have suffered for, how their breathing issues may have developed, what triggers an attack and whether they are medicated or not," says Alison.
Alison will assess the client's breathing with some simple exercises, for example, counting how many breaths they take per minute at rest, or getting them to place one hand on their chest and one on their belly and notice which hand is moving more when breathing.
"The average breathing rate is around 12 to 15 breaths per minute at rest," says Alison. "The Buteyko method aims for closer to six breaths per minute. Slowing the breathing and using the diaphragm to breathe into your abdomen is one of the most important aspects of retraining your breathing."
Alison will also use a biofeedback device called a capnotrainer, which measures the amount of carbon dioxide (CO2) in the outbreath as it comes out of the nose. This allows the client to see on a computer screen how changes in their breathing correspond to changes in CO2 levels.
"Asthma sufferers usually have a lower CO2 level to begin with," says Alison. "As the breathing slows, the CO2 raises a little, enabling better oxygenation of the tissues. This helps to relax airways and blood vessels."
Another area Alison will check and aim to improve is a person's control pause—the length of time you can comfortably pause from the end of your outbreath to your next inbreath. Although it's not recommended in certain cases, ideally the goal is to be able to pause for up to 45 seconds at the end of the outbreath, then be able to immediately resume normal, slow, relaxed breathing.
Also crucial is nose breathing, which helps to "warm and filter the air and allow it to move smoothly into the lungs," says Alison. But it should be quiet—you shouldn't hear your breath or feel it much when you place a finger under your nose.
"Asthma sufferers tend to be less able to maintain nose breathing under stress," says Alison. "Breathing through your mouth rather than your nose causes you to overbreathe—breathe more air than the body needs—and blow out more carbon dioxide than is ideal at rest."
To foster Buteyko breathing—quiet, slow nose breathing, both in and out through the nose, into the abdomen, interspersed with pauses between the breaths—Alison will take clients through a number of exercises (see box, page 71) they will then need to practice for 20 minutes three times a day.
Generally, it will take the body about four weeks to become comfortable with the new breathing techniques, says Alison, but it may take six to 12 months to stabilize health, depending on the severity of the condition.
This should help to keep asthma symptoms under control and reduce the need for medication (which should only be adjusted under a doctor's supervision). In fact, there are several clinical trials on Buteyko to back this up. In one study, Buteyko users halved their use of steroids and reduced their use of beta-2 agonists by 85 percent—results that far exceeded those in the placebo group.1
Alison also teaches a technique called Dynamic Breath Release (see box, left) that can be used if an asthma attack does occur. Plus, she looks at other factors that might be creating unhealthy breathing patterns, for example fear or anxiety surrounding asthma triggers like food or pets, and how to address them with relaxation and breathing techniques. She may additionally recommend dietary changes, such as avoiding mucus-forming foods like dairy.
"It's about looking at all the things that can cause a stress response in the body—the fight or flight reaction that can affect breathing—and seeing what can be changed," says Alison. "There's no single quick fix. I look at the whole person and focus on building health rather than treating disease."
Using this approach, Alison has successfully helped many clients take control of their asthma, whether it's provoked by allergens or exercise.
And Alison herself can now comfortably cuddle up with cats—something she could never do before she retrained her breathing. "My breathing is optimal the vast majority of the time," says Alison. "I don't take medication. But as with most things, you have to maintain the effort to keep seeing results."
Ruth suffered from seasonal asthma that would start in winter and continue until late spring. "It had a significant impact on my life," says Ruth.
"I couldn't exercise outdoors in cold air. In fact, every time I experienced a change in air temperature—for example, when I went outside to put the trash out—I would start coughing and couldn't stop."
Ruth was prescribed a steroid inhaler, but hated using it as she would get the fungal infection thrush at the back of her throat.
Ruth came across Buteyko breathing through her yoga classes, and went to see Alison Waring at her practice in York to learn the technique. "Alison had lots of practical suggestions about how to incorporate Buteyko into everyday life.
"I commute by bike, so Alison suggested I build my 'control pause' by counting the number of lampposts that I passed. Day by day I could see improvements."
Ruth no longer needs to use an inhaler and loves the fact that she can now enjoy cycling and walking on crisp winter mornings without coughing.
Exercises for better breathing
Alison uses a variety of breathing exercises to help clients with asthma and other conditions, and everyone can benefit from improving their breathing, Alison says. Here are two techniques you can try for yourself.
Nip and nod
This is used to help clear the nose to encourage nose breathing.
1) Close each nostril in turn and blow out gently to see if one or both are blocked.
2) If there is a blockage, take a breath in and out through the nose as best you can and, at the end of the outbreath, pinch your nose and nod four times ("nip and nod").
3) Take a couple of recovery breaths through the nose and repeat the nip and nod four times.
4) Repeat this four times or until your nose is clear.
5) If your nose is very congested, you may need to breathe out, nip your nose and blow into your cheeks as though popping your ears to help clear your nose.
Dynamic Breath Release
This is a method Alison developed to ease asthmatic breathing and help cope with an asthma attack.
1) Focus on ujjayi breathing—a yogic technique that involves slightly constricting the back of your throat and making a "haaa" sound as you inhale and exhale, but with your mouth closed. Breathe from your belly rather than your chest.
2) Do this for one minute, then on the outbreath, pause for a couple of seconds or as long as feels comfortable, before resuming the ujjayi breathing.
3) Repeat for three minutes, then on the third pause, use the "sink and drop" technique: focus on your chest and allow it to sink while imagining your head dropping into it and the tension melting away. Think of a warm sensation beginning to expand and open outward through the chest, spreading through the whole body.
4) Continue until you can breathe normally again.
For more information, check out Alison Waring's book, Breathe with Ease (Dot Dot Dot Publishing, 2018), and website, www.breathewithease.co.uk
Alison practices at York Natural Health in North Yorkshire, UK (www.yorknaturalhealth.co.uk), but to find a Buteyko practitioner near you, visit www.buteykobreathing.org or www.buteykoclinic.com