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Office Six Calbro House Tuam Road Galway Tel: 091 756229 Web: www.asthmacare.ie “The Perfect man

Office Six Calbro House Tuam Road Galway Tel: 091 756229 Web: www.asthmacare.ie

“The Perfect man breathes as if he is not breathing” Lao Tzu 500 BC

This training manual is provided with Asthma Care workshop and consultations. If you need further help and tuition, please call us. This is our twelve month follow up support.


Do not alter any medication or treatment without prior consultation and recommendation from a registered physician. This information should only be used in conjunction with Asthma Care program as misinterpretation of information will exacerbate condition.

DIABETICS -PLEASE NOTE Reduction of breathing will result in a decrease of blood sugar level. All diabetics must consult with their doctor or endocrinologist prior to undertaking any breathing retraining. More frequent blood tests and symptoms of hyperglycaemia should be conducted.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor


Table of contents

Asthma Care


Carbon Dioxide


Symptoms of hyperventilation


Why do we overbreathe


Breathing retraining


Using Buteyko Method to reverse hyperventilation


Breathing exercises


Exercise 1. Air shortage by relaxation


Exercise 2. Monitoring air flow


Exercise 3. Physical exercise and sports


Exercise 4. Breath holds


Exercise 5. For children and teenagers


Exercise 6. Overcoming an asthma attack


During sleep


Stop coughing attack


Blowing nose/ sneezing/ speaking


Breathing muscles


Abdominal breathing




Buteyko research results


Diet and asthma




Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor


Asthma Care

It is unknown what causes asthma. Increased pollution, hygiene, PVC windows and increased allergens are often quoted to be the probable causes. While numerous studies have been undertaken to prove the link between these factors and asthma, there has been no conclusive findings to date.

Professor Buteyko

In 1952, a Russian Physician Dr. Konstantin Buteyko discovered from his observations of hundreds of sick patients that their breathing was very related to the extent of their illness. At the time he suffered from malignant hypertension which is a fatal form of blood pressure. He pondered that his deep breathing may be the cause of his illness. He put it to the test by learning to breathe less and in a more shallower fashion. Soon his symptoms decreased and disappeared. He tested his new knowledge on hundreds of patients including asthma sufferers and found that they were over breathing. By teaching these people to breathe less, they too were able to recover from their illness.

Buteyko breathing aims to reverse hyperventilation over the long term. It requires no additional drugs and all patients must remain on their prescribed medication until authorised by a medical doctor to change. The approach as taught by Asthma Care is according to the original and correct Russian Buteyko Breathing Method. It does take longer to achieve results with this approach than with the modified Westernised version of Buteyko. However, results are permanent incorporating better breathing as a way of life.

Volume of Breathing

Normal breathing is breathing a volume of air between three to five litres per minute. Breathing in excess of this volume is over breathing or “hidden hyperventilation” as termed by Professor Buteyko. Hyperventilation means breathing too much air, hyper meaning too much and ventilation meaning inhaled air. Hidden hyperventilation is often not obvious as regular breathing may be interspersed with incorrect breathing, for example periodic sighing or yawning. Scientific research conducted by Professor Buteyko over three decades and scientific trials at the Mater Hospital in Brisbane 1995 demonstrated that people with asthma breathe a volume of ten to twenty litres between attacks and over twenty litres during an attack.

Volume of breathing is measured in litres. To understand this concept, picture a 2 litre bottle of soft drink.

Normal Breathing in a healthy person as advocated by the World Health Organisation and medical doctrine is 3 to 5 litres per minute. This results in a healthy level of 5 to 6.5% carbon dioxide in air sacs within lungs.

Over Breathing is breathing a rate of 5 to 20 litres per minute. A person breathing this volume of air may be functioning quite normal but their body is suffering from various symptoms and illness will often develop over many years.

Severe over breathing is breathing a volume of 20 to 30 litres per minute. This is breathing at a maximum level as in an asthma attack, panic attack etc.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Carbon Dioxide

When human life first began, the level of carbon dioxide of the atmosphere was approximately 20%. Over millions of years with an increasing amount of plant life, carbon dioxide levels continued to reduce to the present day rate of .03%. Carbon dioxide is not just a waste gas, the human body requires a concentration of carbon dioxide which is substantially greater than what is contained in the atmosphere. One of the functions of the alveoli which are air sacs within the lungs is to retain a concentration of 6.5% for normal bodily functioning. Interestingly, the womb contains a concentration of approximately 7% carbon dioxide in order to sustain life.

of approximately 7% carbon dioxide in order to sustain life. 1- nasal cavity 2 - pharynx

1- nasal cavity

2 - pharynx (throat)

3 - alveoli (air sacs)

4 - bronchioles

5- lung

6 - diaphragm

7 - nostril

8 - larynx /voice box

9 - trachea

10 -bronchus

Fig 1-Organisation of the respiratory system. The airways (trachea, bronchi, bronchioles and alveoli) supply oxygen to and remove part of carbon dioxide from the body . Air enters through the nose or mouth, into the trachea, the bronchus, the bronchioles and into the alveoli. The diaphragm (number 6) is the most important breathing muscle. It is a flat sheet of muscle which separates the chest from the gut. We will look more at the diaphragm further on. Cilia which are extremely fine hairs line the airway walls. By beating in an upwards motion they move mucus which traps matter such as dust etc. upward to the pharynx where it is swallowed.

The volume of air that we breathe in, we breathe out. Inhaling a large volume of air results in exhaling a large volume of air. Exhaling a large volume of air causes too much carbon dioxide to be carried out from the alveoli within our lungs and into the atmosphere. This is why the level of carbon dioxide in an over breathing person does not meet the required amount of 6.5%.

Our respiratory centre which is located in our brain instructs us to breathe depending primarily on our level of carbon dioxide, not oxygen. Breathing in excess of normal requirements over a period of time (weeks, months, years) will result in the day to day levels of carbon dioxide being low. Our respiratory centre becomes accustomed or fixed at this

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



lower level of carbon dioxide and determines it to be “correct”. Our respiratory centre will therefore instruct us to overbreathe so as to maintain this low level of carbon dioxide even though the remainder of our bodily organs and tissues are suffering. Habitual over breathing occurs due to many factors of modern living and affluence. These include overeating, oversleeping, processed food, eating too much protein (dairy and meat), the misconception that deep breathing is big breathing, stress, increased temperature and other factors.

Professor Buteyko states that genetic predisposition determines who develops asthma and who develops other diseases of civilisation such as high blood pressure, diabetes, Raynaud’s syndrome and many others. Professor Buteyko believes that people with asthma have a natural defence mechanism to prevent the further loss of carbon dioxide. When carbon dioxide levels go too low, airways become narrow from inflammation, from constriction of smooth muscle, and from increased mucus.

This “defence mechanism” reduces over breathing which helps increase the amount of carbon dioxide retained in the body to more normal levels.

Professor Buteyko is of the belief that people with asthma are better off than the remainder of the population who overbreathe, as they are equipped with an instant defence mechanism to prevent the loss of carbon dioxide. (We shall discuss further on why carbon dioxide is so important.) People who do not have this defence mechanism suffer from an accumulation of disease such as diabetes, arthritis, hypertension, cardiovascular illness etc. It is worth noting that prior to the 1900’s, people who had asthma often lived longer than the rest of the population and that death from asthma was unknown.

of the population and that death from asthma was unknown. Fig 2: Alveoli or air sacs

Fig 2: Alveoli or air sacs are grape like structures located at the end of respiratory branches. They are hollow sacs where oxygen passes through a very thin wall into the network of blood capillaries to be carried to organs and tissues. Carbon dioxide is carried from organs and tissues to the alveoli where part of it is expired. Note that the concentration of carbon dioxide inside the alveoli should be 6.5%. The environment inside the air sacs is moist and warm. It is important to breathe through the nose so that the air we breathe in is conditioned to meet this. There are a total of 300 million alveoli within our lungs.

Bad Breathing resulting from modern living is the cause of breathing related diseases. Hyperventilation is not just a result of asthma, hyperventilation is the cause of asthma.

"One needs to eat less, breathe less, sleep less and physically work harder to the sweat of ones brow because this is good. This is a fundamental change, this is true restructuring. This is what we need to do these days." Professor Konstantin Buteyko

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Why Carbon Dioxide is necessary

As stated earlier, carbon dioxide is not just a waste gas but serves a number of very important functions.

Transportation of oxygen: Because oxygen by itself does not carry well in blood, 98% of oxygen is carried by a Hemoglobin Molecule. The release of oxygen from Hemoglobin is dependent on the quantity of Carbon Dioxide in our alveoli/arterial blood. If the level of carbon dioxide is not at 6.5%, oxygen “sticks” to the hemoglobin and so it is not released to organs especially the brain (which may receive 50% less oxygen) and tissues. This lack of oxygen further stimulates breathing in an already overbreathing person and so perpetuates the cycle.

Blood is already 98% saturated with oxygen at breathing three to five litres of air per minute. Additional breathing as in the case of a person with asthma does not lead to greater amounts of oxygen being added to the blood. Instead due to above, we have less oxygen reaching organs and tissues.

Carbon Dioxide is a smooth muscle dilator of both bronchi and blood vessels. Lack of carbon dioxide causes smooth muscle in blood vessels to constrict. This results in the heart having to pump harder and faster resulting in increased beat and blood pressure. Lack of carbon dioxide in bronchioles causes smooth muscle to constrict. People genetically predisposed to develop asthma have narrowing of the airways.

It is very important that our body stays within normal acid alkali (PH) balance. 1 to 7 is the acid range of PH with 1 being more acid than 7. The alkaline range is 7 to 14 with 14 being more alkaline than 7. Neutral Ph is 7, being neither acid nor alkaline. The human body requires a slightly alkaline PH of 7.4. Shifts from this will result in drastic consequences. Taken from Guyton’s textbook of Medical Physiology, 8th Edition, page 331. “The lower limit at which a person can live more than a few hours is about 6.8 and the upper limit approximately 8.0”. Carbon dioxide is acidic. When carbon dioxide leaves the lungs the body becomes more alkaline leading to various metabolism imbalance which changes immunity responses into allergic ones. Normal PH is very important for proper bodily functioning.

Professor Buteyko believes that inflammation and allergic hyper-responsiveness is caused by an immune system which does not function correctly due to low carbon dioxide. Pollen, dust mites, allergens, stress, and other asthma triggers are not the cause of asthma. They are the trigger of an attack when our immune system is not functioning correctly. In addition the production of cortisol which is our bodies natural steroid is impeded. It is therefore necessary to supplement with synthetic steroid such as Becotide, Flixotide etc.

When carbon dioxide is low, the production of mucus increases.

It is the combination of the above which gives rise to asthma symptoms of chest tightness, coughing, excess mucus production, wheeze, shortness of breath, nasal problems, sleep problems, lethargy. Buteyko cites asthma as the bodies defence to stop and reduce the amount of carbon dioxide being lost. When carbon dioxide increases to normal, the defence mechanism is no longer needed and airways dilate etc. resulting in no asthma symptoms.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Symptoms of hyperventilation

Hyper means too much Ventilation means breathing

The following are the symptoms caused by hyperventilation. Hyperventilation “presents a collection of bizarre and often apparently unrelated symptoms, which may affect any part of the body, and any organ and any system”. Claude Lum

Respiratory System- symptoms of asthma

Shortness of breath- you feel that you need to breathe out and at the same to breathe in. This creates anxiety which will further increase our breathing.

Excessive mucus- mucus is secreted by the goblet cells into the airways. Too much mucus is secreted than what can be removed by the actions of cilia and immune cells.

Long term blocked or runny nose- Our nose is part of the airways. Whatever is arising in our nose also is arising in our lungs.

Sneezing- the airways become extra sensitive and sense harmless particles to be invaders which must be expelled.

Coughing- Many asthmatics have a cough which is repetitive and difficult to control.

Frequent yawning. When asthma symptoms are at their worst, sleep is interrupted with asthma symptoms and difficult periods of breathing. The body and brain also are experiencing a shortage of oxygen which contributes to tiredness. Overbreathing causes sleep apnoea and snoring - both are common among people with asthma.

Symptoms may occur at any time depending on the individual, but are generally more common after exercise and at night time or early morning.

Asthma attack is a vicious circle of hyperventilation, because as your airways narrow, spasm and become blocked by mucus, you feel an increasing need to breathe deeply

Nervous System- Light-headed, poor concentration, numbness, sweating, dizziness, vertigo, tingling of hands and feet, faintness, trembling.

Heart- Racing, pain in the chest region, skipped heart beats

Psychological- Degrees of anxiety, tension, depression, apprehension, stress

General- Mouth dryness, easily tired, bad dreams, nightmares, dry itchy skin, sweaty palms, increased urination, diarrhoea, constipation, general weakness and chronic exhaustion

Why do we overbreathe?

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



It is important to realise that as babies we instictively knew how to breathe correctly using

the diaphragm and inhaling the correct volume of air. As we grew older, various influences changed this correct breathing pattern to incorrect. It is helpful to know the factors which

caused this change.


Misconception of Deep Breathing


is traditionally viewed that deep breathing is very beneficial for fitness and maintenance of

good health in the Western World. The most common instruction during exercise and while stressed is "Take a deep breath". In the Eastern world, shallow breathing and control of breath is very much enshrined in culture and philosophy. Deep breathing has been misinterpreted in the Western world. The correct meaning of deep means breathing using the diaphragm. This is the correct way to breathe. However, most people associate deep with big. Tell people to take a deep breath and instead they will take a big breath often through their mouth and using upper chest muscles. Big breathing is hyperventilating and causes a loss of carbon dioxide.

Throughout this manual I refer to deep breathing meaning the way it is interpreted. Deep

meaning big breathing. Shallow breathing on the other hand means smaller breaths- breaths

of two seconds in, three seconds out. This would provide an average of twelve breaths per

minute which will give the correct volume and respiratory rate (amount of breaths) per minute.

2. Stress

A stress is anything which causes a change to our internal system, something that keeps our

heart beat high or makes us tense. We have evolved over thousands of years and our evolutionary traits have not kept apace with modern development. Our built in response to stress is to physically fight it or run away from danger (e.g. wild animal). We have no inbuilt mechanism for when we are confronted with traffic jams, financial pressures, business pressure, and modern life in general. Instead of releasing our pent up frustration, we voluntary cover up and hide our stress. We are sitting on the outside and running on the inside. This can be very disruptive to our breathing resulting in hyperventilation and illness. Often people develop late onset asthma after dealing with a stressful period in their life.

If you are faced with any stressful situation, monitor your breathing. Bring your attention

inside of your body and focus on your breathing as much as you can. This will greatly help you to stay calm and to have a clear mind so that a solution may be found. Be careful not to overbreathe as it will only increase stress levels.

3. Diet

Protein increases our breathing as our body must convert protein into amino acids before it is absorbed and used. Dairy foods especially milk, beef, pork, chicken, lamb and other protein foods when eaten regularly cause adverse asthma symptoms. It is beneficial to be observant

of your asthma following eating a meal especially one of high protein.

A diet of refined sugar, white bread, jams, coffee, confectionery, canned vegetables, chocolate and other processed foods increases breathing as our bodies have to work harder to expel toxins.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor





Research has demonstrated that mild or cool environments assist in shallow breathing. Having the bedroom window slightly open at night to allow circulation of air is helpful in reducing over breathing.

Being in a hot, stuffy, unaired room will cause over breathing. Also, wearing too much clothing will increase breathing as the body reverts back to panting to help regulate temperature. (look at a dog pant in a hot room) This is especially applicable to children who are often over clothed due to the good intentions of parents. Very cold weather also increases breathing so it is important to wear headgear to reduce the possibility of attack.

5. Lack of physical exercise

Increasing affluence results in children spending more time indoors playing computer games and watching television and less time outdoors. This results in less exercise. Regular exercise for both children and adults increases the production of carbon dioxide from our metabolism.

Swimming is an excellent exercise for asthmatics as increased muscle movement combined with restricted breathing greatly increases carbon dioxide levels within our alveoli. To be healthy, it is necessary to exercise regularly and within our capabilities. Unfortunately in Ireland, children are spending too much time indoors to their own detriment.

6. Over sleeping

Professor Buteyko's research demonstrates that lying down in a horizontal position for a long time causes severe over breathing. Seven to eight hours sleep per night while breathing through the nose is the correct way to sleep. As we fall asleep, breathing gets progressively

With sleeping on our back, there is no restriction to breathing and the lower jaw drops down causing mouth breathing. This is a very bad position to sleep. The best position to reduce breathing is to sleep on our left side in the fetal position or on our tummy. Night time is the worst time for all asthmatics and most asthma attacks occur in the early morning between 3 am and 5 am. If you have symptoms going to bed, it is safer to remain awake or sleep in an upright position.

7. Pollution

When air is not sufficient or is polluted, the body senses that we are not getting enough air and therefore we breathe more to compensate. Pollution itself is not to blame for the rise of asthma despite numerous studies and claims. Rates of asthma continue to be far less in very polluted Asian cities such as Bangkok etc. The rate of asthma in former East Germany was much lower than in West Germany prior to unification, despite the fact that pollution levels were far higher in East Germany. Other countries such as New Zealand which have very low pollution levels have the third highest incidence of asthma in the world. Ireland does not have a pollution problem and yet our rate of asthma is the forth highest in the world.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Breathing Retraining

Patience, concentration and regular practice of breathing exercises are required to reverse a lifetime of bad breathing and to condition your breathing to a more healthier level.

The three basic steps involved with breath retraining are;


Becoming more aware of bad breathing


Learning to breathe through your nose only


Using Buteyko method to reverse hyperventilation

Become very aware of your breathing. Listen to and observe your breathing in different situations and try to notice when you take deep breaths. This will be when you sigh, yawn, before a cough, sneeze, under stress, after eating, in bed, when excited, talking, laughing, walking, exercising and other activities. If you can hear yourself breathe or if you can see the rise and fall of your chest while you are at rest, then you are over breathing. Relax and reduce your breathing immediately. It helps to become aware of your own bad breathing by listening to other people huffing and puffing in the shopping mall, at the bus stop, at work etc.

Learning to breathe through your nose. Breathing through your nose is the correct way to breathe. Your nose, throat and sinus cavity are part of your airways. If you experience a blockage in any of these areas, it is because your bodys defence mechanism has been activated to stop the further loss of carbon dioxide. Your nose becomes blocked because of over breathing. Initially when you first began to experience a slightly blocked nose, you unconsciously switched from nose breathing to mouth breathing in order to take in more air. This change to mouth breathing further increased the exhalation of carbon dioxide resulting in your nose becoming fully blocked and your airways becoming constricted etc. Learning to breathe through your nose is a very important step on the path to correct breathing.

is a very important step on the path to correct breathing. Fig 3: All exercises will

Fig 3: All exercises will have a diagram using the following format

Breathing through your nose serves a number of very important functions

The nose serves to condition cold dry outside air to a more acceptable condition before it is brought to the lungs. Breathing through the mouth is not effective in conditioning inhaled air.

With breathing through the nose:

Inhaled air is brought to the correct temperature before it enters the lungs Air is filtered which helps prevent pollen, dust, bacteria from entering our lungs

Lungs require a warm moist environment. The nose humidifies inhaled air increasing moisture content.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Regulates volume. All mouth breathers overbreathe and thus suffer from symptoms of hyperventilation. Our nose is a smaller channel to breathe through and therefore it helps to reduce volume. (Please note it is possible to overbreathe through your nose but to a lesser extent.)

At any time one nostril is on duty (open), one off duty (partially blocked).


Breathe through your nose at all times

When you are watching television or reading

Doing a gentle exercise. Initially fitness levels will decrease but after a number of weeks

fitness levels will improve considerably Eating




Remember, never breathe through your mouth. Look at animals in the wild. Look at a lion, Zebra, Polar bear, or any other wild animal, their natural instinct is to breathe only through the nose. A domesticated dog or cat may breathe through their mouth as we have influenced their breathing with incorrect diets etc. Humans are the only species who do not know how to breathe correctly.

During the 19th century, it was observed that Indian mothers on reserves of North America paid a lot of attention to their infants breathing. If at any time their baby opened their mouth to breathe, mothers would gently press the lips together to ensure continued nasal breathing. It was noted that the rate of sickness and illness among Indian people in comparison with European settlers was very low.

How to unblock your nose;

Sit down and adopt correct posture- back straight, bottom against back of chair. Normalise / calm your breathing. Take a small breath (two seconds) in through your nose (if possible) and a small breath out (three seconds). If you are unable to take a breath in through your nose, take a tiny breath in through the corner of your mouth. Pinch your nose and hold your breath Keep your mouth closed Gently move your head until you cannot hold your breath any longer When you need to breathe, breathe gently through your nose with your mouth closed.

Avoid taking a deep breath- calm your breathing as soon as possible. If you overbreathe or take a deep breath, you will lose the additional carbon dioxide and your nose will become blocked again. The aim is to trap in that additional carbon dioxide. After some time and with regular practice of breathing exercises, your body will become accustomed to a higher level of carbon dioxide and your nose will continue to remain unblocked.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Continue to do this until you can breathe through your nose. This may take five or six times. If you are having difficulty unblocking your nose while shaking your head, breathe out as above and walk around while holding your breath. Your nose unblocks by doing this exercise due to carbon dioxide quickly increasing in the blood. Even if you have a cold- make sure to breathe through your nose.

if you have a cold- make sure to breathe through your nose. ig:4 Unblocking the nose.

ig:4 Unblocking the nose.

Breathe IN and OUT


Small breath IN


Your nose is a very good indicator of your breathing rate If your nose starts to block it means that you are beginning to hyperventilate.

If you are breathing too deeply through your nose it will become partially blocked. It will not become fully blocked unless you switch to mouth breathing. There is a very logical reason why this happens. As soon as our nose becomes partially blocked, the volume of air inhaled/exhaled is decreased which causes the level of carbon dioxide to increase which will dilate our nasal passages. If you continue to over breathe, your nose will become partially blocked again which will again increase carbon dioxide which will open your nasal passages and so on.

If you can hear yourself breathe through your nose (whistling) then you are breathing too much. Breathing through the nose must be maintained especially at night. If your mouth is dry and your nose is blocked upon awakening in the morning, then you are hyperventilating during your sleep. Please refer to instructions for correct sleeping.

When you first switch from mouth to nasal breathing, it will feel a little strange as there will be a slight air shortage. An air shortage is when your body feels the need to breathe additional air. This is because by switching to nose breathing, the volume of air inhaled has reduced. This is a good sign of progress and the feeling will reduce in a couple of days. Your body may trick you into breathing more by yawning, sighing or the odd mouth breath. Try not to increase your breathing at this point. When you feel the need to deep breathe for example during a sigh, swallow immediately to suppress this feeling.

It takes just a few days for a habitual mouth breather to change breathing to permanent nose breathing. Increased observation of breathing, reduced breathing and nose unblocking exercises are important to make this change.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Nasal Inflammation and Congestion

If you have constant nasal congestion and inflammation, it is helpful to wash out your nose daily with the following and practice breathing exercises to reduce nasal spray dependency.

Dissolve ½ teaspoon of sea salt and ½ teaspoon of bicarbonate (baking soda) in one pint of boiled water and let it cool. A plastic syringe with a rubber bulb can be purchased from your pharmacy. Fill the syringe and squeeze water into one nostril. Sniff water in until it reaches the back of the throat. Spit and repeat with second nostril. This is a very effective natural cleaning remedy.

Using Buteyko Method to reverse hyperventilation

In order to commence Buteyko Breathing Method, it is necessary to learn how to measure your pulse and your control pause. Your control pause is your primary measurement tool and

a very important part of The Buteyko Method. It is an excellent measurement to monitor your asthma condition and progress.

Pulse Rate Everybody and especially people with asthma should be able to measure their pulse. The pulse is to be taken before and after breathing exercise. When breathing exercises are performed correctly with reduced volume of breathing, the pulse at the end of exercise will be lower than at the start. Reduced breathing will relax smooth muscle of blood vessels resulting in the heart having to pump less. The pulse rate varies throughout the day and exercises, meals and other activity will influence it. The pulse is a good measure of the state of your health.

Check for the pulse The pulse is measured by counting the number of beats in one minute. When measuring beats, make sure to measure your pulse and not count the number of seconds on your clock or watch.

The pulse can be found on the thumb side of the wrist. About one inch up from the wrist crease and 1 cm inwards. Measure by placing two fingers of your free hand onto the groove or channel in this area.

If you have difficulty locating your pulse on your wrist then check for it at the carotid artery in the neck. This is located at either side of the Adams apple.

Normal healthy individuals will have a pulse rate of between 60 and 80 beats per minute. Very physically fit individuals will have a lower pulse rate then this. If your pulse rate is

consistently higher than 90 during substantial periods of rest, it is a sign that you are deficient of steroids. If you observe an upward trend of the pulse over a number of hours while at rest,

it is a sign that your asthma is getting worse. Do your breathing exercises intensively to bring

down the pulse. If your pulse is moving towards 100 beats per minute while at rest then consult your doctor. Different foods especially chocolate or stimulants such as coffee dramatically increase the pulse. If you have a food intolerance, your pulse may rise at least 10% following consumption of that food especially when it is eaten on an empty stomach.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



The Control Pause

The control pause and pulse are used together to monitor your asthma. The control pause is a measure of the level of Carbon Dioxide in your alveoli. It is a very good indicator of your progress and asthma condition. Because of this reason it is important to learn how to measure it correctly. The control pause is not an exercise to increase the level of your carbon dioxide.

For this you need a stop watch or watch/clock with a second hand.

To measure control pause

1) Sit comfortably in an upright chair

2) Take a small breath in (2 seconds) and a small breath out (three seconds). Hold your nose on the out breath (with empty lungs but not too empty). You must pinch your nose in order to block the air flow.

3) Count how many seconds you can comfortably last before you need to breathe in again. Hold your breath until you feel a slight desire to breathe in again.

4) Don't push yourself too hard. If you need to take a deep breath after measurement, you have pushed yourself too hard.

5) Remember breathe out and then count seconds.

6) This is for measurement purposes only. Common mistakes include:

Holding the breath after an inhalation

Trying to empty out the lungs completely, this will result in immediate discomfort

Holding the breath for too long (note that this is not a measure of how long you can hold your breath for, it is a measure of how many seconds you can hold your breath until your first urges to breathe again.)

At the start, it is very likely that you will push yourself a little too hard. You will notice this when you have to take a couple of breaths to regain your breath after counting the seconds. It is important that you start your control pause from the same place as this will give consistency of measurement. With practice, your control pause will become more consistent.

practice, your control pause will become more consistent. F ig 5-control pause: normalise breathing, breathe in


ig 5-control pause: normalise breathing, breathe in for two seconds, out for three seconds. Hold breath. Count

seconds until first urges to breathe in. Ensure that breathing is not deeper after completion

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Control Pause Measures

The control pause as taken in the morning before breakfast gives the most accurate measurement of your level of carbon dioxide. Do not eat for two hours before taking control pause as eating will increase the pulse and reduce the control pause.

Most people with asthma will have a control pause of between ten and twenty seconds at the start of learning Buteyko Breathing. This means that their respiratory centre instructs them to breathe a volume of air for between five and six people.

If your control pause is less than ten seconds you have a

Serious hyperventilation problem very severe asthma

12 to 13 seconds Breathing five times normal amount Chronic asthma Nocturnal asthma

Control pause of 20 seconds Breathing three times normal amount Main asthma symptoms will have disappeared Some nocturnal asthma

Control pause of thirty seconds Breathing 1 and half to two times normal amount May have symptoms after exposure to severe trigger

Control pause of 40 to 60 seconds Correct breathing. Your underlying asthma is being treated. Very rarely will have symptoms

Morning control pause of sixty seconds You have no health problems/ diseases of civilisation. For over forty years Professor Buteyko and his associates were unable to find any person with a control pause of sixty seconds who had a disease of civilisation.

You are hyperventilating if your pulse is climbing and control pause falling. If this is happening relax and concentrate on reducing your breathing immediately.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Control Pause Table

This table was developed by Professor Buteyko after measuring thousands of persons breath holding ability/control pause and matching this with their Carbon Dioxide levels. It is the level of carbon dioxide that determines how long you can hold your breath for.

The figures are consistent and show the level of Carbon Dioxide based on the length of control pause. A person with a low level of Carbon Dioxide is able to hold their breath for a less amount of time than a person with a higher level.

CO2 in


alveoli %


























If your control pause is eight seconds, then you have a little less than 4% carbon dioxide in your alveoli. If your control pause is 15 seconds, your carbon dioxide is between 4 and 4.5%. Your aim is to increase this until your control pause is at least 40 seconds and your carbon dioxide is 5.5%.

With continuous practice of exercises, your respiratory centre will become accustomed to a higher concentration of carbon dioxide. You will remember that it is the level of carbon dioxide which determines our need to breathe. A low control pause means our respiratory centre has become fixed at a low level of carbon dioxide and therefore will instruct us to breathe a large volume of air in order to maintain that level. When you commence breathing exercises, you are breaking this pattern by deliberately reducing your volume of breathing.

Regular practice of exercises and increased observation of breathing will help your respiratory centre to become fixed at a higher level of Carbon dioxide. Just as it took time for your respiratory centre to become accustomed to a low level of carbon dioixide, it will also take time for your respiratory centre to become accustomed to a new higher, more healthier level.

It will take at least five weeks to reach a control pause of twenty seconds and six months in order to reach a control pause of forty seconds.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Breathing Exercises

The purpose of all breathing exercises are to train your body to become accustomed to a higher level of carbon dioxide. You will remember that our lungs require a concentration of 6.5% carbon dioxide. Most people with asthma have a concentration of between four and four and a half percent.

Breathing exercises are a time which you set aside during the day to deliberately reduce your breathing to trap in and retain a higher level of Carbon dioxide. Exercise blocks usually take about half an hour and are practised before breakfast, during the day and at evening time. Depending on severity, most people need to do at least two to three sets of a half an hour per day. Exercises should be performed until reduced volume of breathing becomes your way of life and until the control pause will reach at least forty. Reduced breathing has become your way of life when you no longer consciously need to decrease your breathing. At this time, it is an unconscious activity and is incorporated into every activity that you do.

Breathing exercises are very important in increasing the control pause to twenty seconds. Physical activity is to be used in conjunction with breathing exercises to help increase control pause from twenty to sixty seconds.

The purpose of exercises and increased observation of breathing is to substantially decrease asthma attacks occurring in the future and to stop an attack upon first sign of symptoms such as a blocked nose. Over the course of twelve months, the volume of breathing is brought to a more normal leve

the volume of breathing is brought to a more normal leve Fig 6: Breath retraining- reduc

Fig 6: Breath retraining- reducing of volume of air to correct amount of three to five litres per minute. This is corrected over a period of twelve months.

The first exercise involves relaxation of the respiratory muscles to create a little air shortage. The second exercise adopts the same features of the first but introduces use of the finger to monitor volume of air flow to and from the lungs. The third exercise teaches us the correct way to breathe during exercise.

Remaining exercises are specific to different symptoms that people may have. For example coughing, blowing nose and sneezing.

Exercises are to be done regularly and within ones capabilities. An important feature of all exercises is to maintain an air shortage. An air shortage is when you feel the need to take a bigger or extra breath but you do not. The rule to remember with all exercises is that if there is no air shortage, then you are not doing the exercises properly. On the other hand, if you feel too much of an air shortage or suffocation, this will be too stressful and difficult to

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



maintain so breathing will increase. To get the feeling of an air shortage. Breathe out and pinch your nose. Hold your breath for a few seconds after you feel the urge to breathe in. The following diagram illustrates a little air shortage.

The following diagram illustrates a little air shortage. Fig 7: Maintaining a little air shortage. Note

Fig 7: Maintaining a little air shortage. Note that breath is not any deeper on completion of exercise than at the start of exercise.

Exercise one and two are to be practiced half an hour two to three times per day combined with relaxation and observation of breathing for the remainder of the day and night. Do not mechanically reduce your breathing for the remaining day and night as this causes stress and is too difficult to incorporate into your daily life. Relaxation with decreased breathing is good and should be incorporated all the time. For the first couple of months, it is necessary to go to a quiet place where you will have no distrations.

You will not make very much progress if all your exercises are practiced while reading a book, watching TV or driving your car as your concentration will be divided between doing the exercises and the other activity. This is why it is necessary to set the time aside to practice while having no distractions, otherwise you may get poor results. After the first months, it is possible to relax and maintain an air shortage while performing any other activity.

How should I breathe?

The correct way is breathing through your nose at all times with small breaths (two seconds in, two/three seconds out) while using the diaphragm.

The reason why we have asthma is due to big breathing. Big breathing is breathing a volume of air greater than six litres per minute. This is also known as hyperventilation. Deep breathing has been misinterpreted to be big breathing. Ask someone to take a deep breath and

Deep breathing in the correct meaning is breathing using the entire lungs, it is breathing down into the tummy. We are not bringing the air into our tummy. Instead our tummy moves out with each inhalation and moves in with each exhalation because the action of our diaphragm.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Small breaths are also short breaths, breathing in for two seconds, out for three seconds. This lenght of breath is correct, anything greater than this contributes to overbreathing. The first intention of exercise is to learn how to breathe smaller breaths. The second part is to breathe smaller breaths while using the diaphragm.

We know that we are not breathing correctly when we can hear our breathing and we can see a rise and fall of our chest with each breath. we can hear deep sighs regularly or we have sharp inhalations of air prior to talking.

We are breathing correctly when we cannot hear ourselves breathe and we cannot see the rise and fall of the chest we do not have sighs regularly and we do not have sharp inhalations of air prior to talking we will have some movement of our tummies with each breath but this will be very slight.

How much progress can I expect?

Progress is dependent on the extent that you are able to reduce your breathing. The more you can reduce your breathing and increase your control pause, the better your progress. Generally, people make great progress over the first number of weeks. This is interspersed by very good days and very bad days. Over time and with continuance of exercises, very good days will increase in number and very bad days will decrease in number. Very bad days are similar to your asthma before you commenced Asthma Care program. If you have a number of bad days in a row, spend as much time as possible on reducing your breathing. Use the small breath holding exercise (explained further) and perform this about 500 times per day. At the start, a large amount of time needs to be invested, this pays off substantially as the months go by.

After a number of months practise of exercises and with a control of pause of perhaps twenty seconds, you my reach a plateau where there seems to be no improvement in your condition and control pause regardless of the amount of time you spend at exercises. Continue to practice your exercises. Sometimes the control pause can be quite stubborn.

If your control pause is very stubborn, reduce your consumption of food and start to perform physical exercise. This will increase your control pause more quickly.

Reducing your breathing will lead to a reduction of asthma over time. The speed which this occurs depends on your adherence to the lifestyle changes and attention to doing the exercises. Dont’t be too concerned if you have reached a plateau, your progress will continue to increase after you have passed this point.

Nearly all persons with asthma have a relapse of symptoms within the first six months. This can be partly explained by a more relaxed attitude reulting in a decrease of attention to breathing. When this occurs, recommence breathing exercises and become more attentive to breathing. A second relapse is not common as most people will have instilled better breathing from their first relapse.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Exercise 1

Air shortage by relaxing respiratory muscles

Take comfortable correct posture. Become totally aware of breathing, feel the movement of air in and out of your body. Feel the movement of air through your nostrils and to the back of the throat. This has very therapuetic characteristics and is especially useful to control your breathing during a stressful situation.

The correct posture is very important to help reduce your breathing. Sit with back straight with both feet on the ground. Imagine a thread suspended from the ceiling and attached to the top of the back of your head holding you in an upright position. Observe that when you sit with correct posture - your stomach will move more than your upper chest. The stomach moves out with each inhalation (breathing in) and moves in with each exhalation (breathing out) because of the action of the diaphragm which is our main breathing muscle. When we need to breathe in, the diaphram moves slightly downwards (1cm to ten cm) which causes the stomach to move out a little. It is a thin sheet of muscle located at the base of our chest (thorax) and seperates the chest from the gut. It is shaped like the dome of an umbrella. Breathing abdominally using the diaphragm is very important in reducing hyperventilation and is the most energy efficient way to breathe. We will discuss further how to change breathing from upper chest to using the diaphragm.

When we sit slouched, our breathing increases and we tend to breathe more upper chest. If shoulders are hunched up, we increase the volume of the thorax which will increase our volume of breathing. It is very important to relax your mind first by focusing on your breathing, then relax your shoulders by letting them fall to their natural position. Focus on complete relaxation of your body and especially the respiratory muscles which include the chest and stomach. Breathing will automatically decrease. To understand relaxation, clench your fist slowly for five seconds and then relax. Feel the difference between tension and relaxation. To understand tension and relaxation of respiratory muscle tighten the muscles of the upper chest area slowly for ten seconds. Feel the tension of this, then relax fully. Secondly draw in stomach for ten seconds. Feel the tension of this, then relax fully. Feel this relaxation. When your respiratory muscles are relaxed, breathing will decrease automatically. Focus on relaxation of the out breath. When you breathe in, relax all muscles and let the air exhale naturally and without effort. Let the air “fall out of your body effortlessly”. The elastic recoil of the diaphragm, lungs and lower chest wall will result in a very natural and unforced exhalation. This is a very good exercise to do when air becomes trapped in the lungs.

To assist with relaxation, place your two hands on your lap with palms facing upwards. Position your head looking directly in front of you. Do not have your head facing up or facing down as this increases breathing. Close your eyes and let your eyes roll up into the top of your head. Your eyelids may flicker as a result which will indicate that you are doing this correctly. Have jaw relaxed and lips lightly together. Have your tongue lightly touching the roof of your mouth and the back of your top row of teeth.

When you reach a depth of relaxation your breathing will decrease automatically. You will then feel a slight air shortage and this is good. Maintain this feeling of a little air shortage. An air shortage is when you feel the need to breathe a little more but you don’t. (To understand what an air shortage is- hold your breath for a number of seconds, this need for air is an air shortage). A little air shortage is an air shortage within comfortable

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



levels which can be sustained over the long term. If you normally breathe a volume of fifteen litres of air per minute, then a little air shortage would be breathing a volume of thirteen litres of air. If you normally breathe a volume of ten litres of air per minute, then a litle air shortage would be breathing a volume of eight litres of air.

It is the depth of breathing which you are aiming to reduce. Depth of breathing in this situation refers to the lenght of time of each breath. If it is a long breath then it is a deep breath, if is a short breath then it is shallow breathing. Shallow breathing is the opposite to deep breathing. Shallow breathing is small breaths. Deep breathing is big breaths. Shallow breathing using the diaphragm is the correct way to breathe. Shallow breathing is short breaths. Breathe in for two seconds and out for three. Do not be particularly concerned with your respiratory rate (how many breaths per minute) This will increase when the lenght of your breath becomes shorter and that is okay. Your aim is to reduce the volume of air inhaled by doing shallow breathing or small breathing. You know if you are breathing small and using the diaphragm correctly by the movements of your chest and tummy. There should be no movement from your chest and a little movement from your tummy.

Adapt this at all times- when eating, speaking, in emergency crisis. Your breathing is more important than anything else. So pay attention to your breathing at regular intervals throughout the day. Over time, this becomes an unconcious activity and is then something that you automatically do. If you don’t adopt this and continue to overbreathe, you will continue to have unnecessary symptoms which will cause poor quality of life.

Recap of exercise one

Set time aside Adopt correct posture- back straight Tense respiratory muscles and relax Place hands on lap facing upwards Close eyes and roll eyes to top of head Maintain a little air shortage with relaxation Adapt this as a way of life (relaxation and resulting air shortage)

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Exercise 2

This exercise is an extension to the first exercise and is suited to children or people who cannot create an air shortage from relaxation alone. This exercise is also to be performed as part of special exercise practice time that is set aside. It is useful in monitoring the exact amount of air you are breathing over a number of minutes.

Perform all the steps of the first exercise. Instead of closing the eyes with palms on lap facing upwards, concentrate on reducing the amount of air being inhaled onto your finger. Place your finger above your mouth and below your nose. Feel the warm air being exhaled onto your finger. The greater the amount of warm air you feel, the greater your breathing is. Over the course of three to five minutes concentrate on reducing the amount of warm air that you feel on your finger. Create a little air shortage through relaxation and ensure that you do have an air shortage by monitoring air flow with your finger.

When you reduce the depth of your breathing (the length of each breath), your breathing rate may increase (number of breaths per minute). This is normal. Do not be concerned with the number of breaths per minute. Your task is to reduce the depth of breathing which will reduce volume of breathing. The in breath should be no greater than three seconds and the out breath no greater than four seconds. Anything greater than this is deep breathing. Little breaths or short breaths result in a reduction of the amount of air reaching your lungs. This is due to dead space- part of our airways will always contain a proportion (150 ml) of air which never reaches our lungs.

The purpose of formal breathing exercise sessions are to help you adopt into your every day living a smaller volume of air. You know that we are over breathing if we can hear ourselves breathe, can see a noticeable rise and fall of the chest and tummy or can feel a large amount of air on our finger. This rule is applied both during exercise and in every day activity.

The aim of this exercise is to have very little air blowing onto your finger.

Recap of exercise two

Set time aside Relax respiratory muscles Place finger under nose Concentrate on reducing air flow onto finger Small breaths Observe breathing throughout the day

With breathing exercises as above, you will experience mucus travelling from the lower airways to the throat where it can be swallowed to dissolve in the acid of your stomach. This is a direct result of decrease of breathing and happens very shortly after exercise sessions. This is a cleansing reaction and is a good sign that you are doing exercises correctly.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Exercise 3

It is well known that exercise within ones own capabilities is very essential for all asthmatics.

The more physically fit a person is, the more they will be able to cope with additional

demands such as running for a bus etc. All people with asthma who exercise regularly report

a significant improvement in symptoms as a result of exercise. Exercise does not mean pushing oneself to the limit, instead it should be done at a comfortable level.

Exercise is very necessary to help increase the control pause from twenty to sixty seconds. This is very important to remember as it is very difficult to increase the control pause above twenty without physical activity.

People who adopt an exercise routine which is too difficult often give up completely a number of weeks later as they are unable to sustain it. The best way to exercise is to do a little amount of exercise each time but to do it regularly. This should be done according to our own capabilities which will make it more enjoyable and sustainable into the long term.

With exercises, it is very important to have a control pause of at least twenty seconds. If control pause is not twenty, then any exercise that is undertaken must be very gentle and non competitive. Walking while breathing through the nose would be best. When the control pause is less than twenty seconds, it is more difficult to control breathing as the level of carbon dioxide is low.

80% of all asthmatics have exercise induced asthma. Exercised induced asthma occurs shortly after commencing exercise or shortly after completion. When you commence exercise, your breathing rate increases in anticipation of additional physical activity. However, your muscles have not yet begun to produce additional carbon dioxide to counter balance this increase in breathing. The increase of your breathing without a coresponding increase in carbon dioxide production causes a loss of carbon dioxide which results in an attack. To avoid an asthma attack shortly after commencing exercise, warm up very gradually for about fifteen minutes. Gradual warm up results in the metabolism producing extra carbon dioxide while at the same time we can maintain good control of breathing. Observe breathing during warm up and maintain a little air shortage which will trap in some carbon dioxide. Controlling breathing during the early stages of exercise will greatly reduce the possibility of attack.

After completing exercises, the production of carbon dioxide has decreased to a very low level but breathing may have remained the same as during exercise. This would result in the loss of carbon dioxide which will cause an attack. It is very important to normalise breathing immediately after completing exercise. Calm breathing with relaxation and make a conscious effort to reduce panting. Suppress your breathing quickly. Make sure not to blow off all that carbon dioxide through over breathing.

Exercise is very beneficial for people with asthma. Maintaing a little air shortage during exercise will result in an improved control pause. When exercising breathe a little less air than what you need to breathe. If for example you were playing a game of hurling, then do a gentle and gradual warm up first. While waiting for play during the match, breathe very little. When you need to run for the ball- do whatever you need to do. After you have passed the

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



ball, calm your breathing immediately. Calming of the breath can also be done with several small breath holds of a few seconds each. Ensure that you do not breathe deeply during the game and observe your breathing as much as possible.

Walking half an hour per day is the best exercise for people who do not regularly exercise. While walking, reduce breathing. If at any time you feel the need to deep breathe while walking or doing any exercise, then slow down and relax. The most important aspect is never to breathe through the mouth. Instead stop, calm your breathing. Then when you feel ready to walk again, you can start walking. If you have severe asthma and at a maximum can walk twenty steps, then only walk fifteen steps and stop. Reduce your breathing. Never push yourself beyond the point where you cannot regain control of your breathing. To do this would be counter productive and dangerous.

Other important rules to follow regarding exercise:

Measure your control pause before you commence exercise. Then measure your control pause after you have completed exercise and your breathing has calmed down. (for example fifteen minutes later) Your control pause after exercise must be greater than it was before. If it is not, then you are deep breathing during your exercise and so it is important to make sure that you correct your breathing during future activity.

Try to breathe through your nose at all times. Initially your fitness level will be below your normal level when you start breathing through your nose. However, top athletes have shown that within eight weeks, fitness levels will improve substantially by maintaining nasal breathing. Nasal breathing serves greatly to reduce exercise induced asthma.

It may be better not to become involved with competitive sports until you have mastered the breathing exercises correctly and can breathe through your nose at greater levels of exercise. Do not take your reliever medication prior to exercise solely out of habit. A tolerance builds to the reliever medication resulting in more and more puffs needed over time to reduce symptoms. Instead only take the reliever medication if you need it. Never take it if you do not need it.

Exercise is very important to aid in the recovery of your breathing with Asthma Care. It is important to perform exercise in order to increase the control pause from 20 to the desired sixty seconds. Buteyko Technique has been used very sucessfully with Leicester Rugby Team, Australian

Be careful doing exercise if your control pause is less than twenty seconds Exercise is very important to increase control pause above twenty seconds Do exercise regularly and within your capabilities Warm up very gradually and take control of breathing Warm down gradually and take control of breathing Walking or lifting light dumbbells/weights is excellent Reduce your breathing throughout exercise Measure control pause before and after, control pause should be greater after exercise Do not spend fourteen hours of your day sitting down like a lot of unhealthy people Never mouth breathe, instead stop and relax, regain breathing and then start gently

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Exercise 4

Breath Holds

The main focus is to reduce your breathing which will increase your level of carbon dioxide to more normal levels. If for any reason you are unable to formally practice the exercises, then do many breath holds at regular intervals during the day. This is not near as effective as doing shallow breathing with relaxation of the respiratory muscles but will help to conserve carbon dioxide and thus reduce symptoms. If doing this without other breathing exercises, it is necessary to perform from 100 to 500 breath holds per day to receive benefits. As with other exercises, breathe in (two seconds), breathe out (three seconds) then hold breath for four to five seconds, then breathe in and maintain a little air shortage. Continue to breathe for as long as you can with an air shortage.

to breathe for as long as you can with an air shortage. Fig 8: small breath

Fig 8: small breath holds of four to five seconds each

Exercise 5

Especially for children and teenagers -mouse breathing and steps

Children sometimes find it difficult to understand the relationship between their depth of breathing and asthma, so a slightly different approach is used. These two exercises are to be performed alongside other recommendations of Asthma Care program.

Because children usually are not able to create an air shortage with exercise 1 as they have more difficulty deeply relaxing, it is better for them to practice exercise 2 and to do “steps” to increase carbon dioxide levels. Exercise 2 is called “mouse breathing” for children and is breathing as little as possible by placing the finger under the nose. Mouse breathing is breathing like a little mouse, making no sound from breathing and having very little movement from chest and tummy. It is the way a mouse would breathe if it were trying to hide from a big cat who is listening for the mouse. If the cat hears the mouse breathing, the cat will eat the mouse. The second exercise which children make great progress with is called steps. Steps is also helpful as a measurement of progress if the child has difficulty in applying the control pause correctly. Steps is combining muscle activity which will increase carbon dioxide, with holding of the breath which will trap in carbon dioxide.

With steps, the child breathes in for two seconds, breathes out for three seconds and pinches their nose. They walk as many steps as they can until they need to breathe in again. When they breathe in, it must be only through their nose and their breathing must be calmed immediately. Usually the first breath after completing steps will be bigger than normal. Make sure your child reduces or suppresses the second and third breaths. They should breathe like a little mouse when they stop their steps so that the big cat cannot hear them. Steps are performed usually in sets of four and should be done three times per day. Count aloud each step and record so that progress can be monitored. Compare each days steps with past days so that progress can be evaluated. This can be used as a measurement tool if the child is unable

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



to do the control pause correctly. Encourage your child to increase their steps over time. The goal is for children to be able to walk 100 steps without having to take a breath. Steps should be done only walking and not running, however fast walking is fine.

While breathing throughout the day, be observant of your childs breathing. If at any time you can hear your child breathing or see them breathing through their mouth, then remind them to breathe very gently through their nose. Ensure that your child does not let any air sneak in through their mouth. Blame the air for “sneaking” into the childs mouth rather than blaming the child.

Children will always folllow what their parents do, even with breathing. If father is walking around the hosue with his mouth open puffing and panting and being unobservant of his breathing then the child will do likewise. Oftentimes, it is the behaviour of the parents which will slow down the progress of children. Correct breathing is a family affair and it is very beneficial for all family members even if they do not have asthma.

Sometimes children may be able to start an asthma attack in order to get attention from their parents. They unconsciously know that their tantrum or anger (causes deep breathing) will lead to an attack. In this situation, an asthma attack is still serious regardless of how it started. On the first signs of an attack (blocked nose, shortness of breath) have your child breathe like a little mouse and to perform steps. The amount of steps should not be pushed too much (five steps maximum) as a deep breath at the end will be bad for the attack. If the attack is not under control within a few minutes, then take whatever medication is prescribed. If reliever medication is not working correctly within five to ten minutes then seek medical attention immediately.

to ten minutes then seek medical attention immediately. Fig 9: steps- Note that deep breath on

Fig 9: steps- Note that deep breath on completion is calmed immediately

Recap on Exercise for children

Relaxation with correct posture (exercise two) Place finger under nose Breathe very silently like a little mouse Do sets of three minutes according to record chart Be observant of childs breathing all day Ensure they do not breathe through their mouth

With steps - Count aloud and record steps Goal is to reach 100 Breathe out and then do steps Calm breathing immediately

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Exercise 6

Overcoming an asthma attack

Generally an asthma attack which is a period of breathing difficulty does not occur without advanced noticed. In most situations, the person will feel increasing tightness of the airways, increased blocked nose, starting to wheeze etc. When one feels the first symptoms of an attack, it is very helpful to do the following exercises. After the first minutes of an asthma attack, it is very difficult to maintain control of breathing using exercises and medication or medical attention is needed.

Do many small breath holds of 2-5 seconds each. Do not try to hold your breath for longer than a couple of seconds because it would only increase breathing which will increase your attack. After each breath hold, reduce breathing for a few minutes. Then do small breath hold, then reduce breathing etc.

Reduce your breathing when you first observe oncoming symptoms. If you are observant enough, your reduced breathing may be enough to increase the level of carbon dioxide and your attack will pass. Do not have too much of an air shortage as this will cause a pronounced increase of your breathing after you stop doing the exercises.

For most attacks there is a greater difficulty in breathing out than breathing in. Oftentimes, one needs to breathe out while at the same time there is a need to breathe in. To help exhale air which may otherwise become trapped in the air sacs, the following is an effective exercise to practise.

Breathe in gently and hold your breath for a half a second Concentrate on immediate relaxation of the chest, shoulders, stomach. Breathe out effortlessly. Do not force in any way. The elastic tendency of the diaphragm, lungs and ribs will cause a movement of each back to their resting position which will result in the exhalation of air. Breathe in as normal This is helpful to normalise breathing all the time Do this several times over the course of ten minutes or until attack has passed

over the course of ten minutes or until attack has passed Fig 10: Small Breath holding

Fig 10: Small Breath holding during an attack, note difficulty of controlling breathing during an attack, Important to become very relaxed and gently reduce breathing

Often times people realise the benefits from Buteyko Breathing when they use shallow breathing and relaxation to reduce their oncoming symptoms and attack. This is direct evidence of the benefits which will further motivate people to increase their control pause and thereby reduce the occurrence of attack in the future.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor




Breathing exercises will only alleviate asthma when applied during the early stages of attack/wheezing. If an asthma attack has been occurring for more than five minutes- it will be a lot more difficult to control using breathing exercises especially if your normal CP is less than twenty. AFTER FIVE MINUTES OF AN ATTACK TAKE YOUR MEDICATION (IF YOU ARE HAVING A SEVERE ATTACK- TAKE MEDICATION IMMEDIATELY). IF YOU ARE NOT RESPONDING TO MEDICATION WITHIN TEN MINUTES, SEEK MEDICAL ATTENTION IMMEDIATELY.


Recap on Exercise during attack

During early stages- first five minutes Hold breath for two to three seconds each time Do several breath holds until attack has passed

Breathe in for half a second Relax chest and tummy Let air flow out naturally Do not mechanically exhale Do this several times over the first ten minutes

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



During Sleep

Sleep is the most difficult time for asthmatics as risk of attack is greatest. Professor Buteyko believes that the natural position for humans is in an upright position. When we lie down, our breathing increases automatically. This increase in breathing to an already over breathing person will lead to a removal of carbon dioxide which will cause an attack. Most attacks occur between the hours of three and five am. Incidentally four pm in the evening is the best time on average for asthmatics. For this reason over sleeping is not good. At most, people should sleep from seven to eight hours per night and no more. Correct breathing will increase your energy level and reduce fatique so additional sleep will not be necessary.

The difficulty with being asleep is that we have very little control of our breathing during the depths of sleep. Correctly practicing breathing exercises and reducing breathing during the day will help reduce overbreathing at night. In addition, there are a number of measures to take which are necessary to reduce the risk from over breathing at night.

Firstly, be aware of your asthma symptoms prior to going to bed. If you are wheezy or have noticeable symptoms before going to bed, then you will wake up during the middle of the night with an attack. If you have symptoms, it is better to remain awake or to sleep sitting upright. Ensure that you take your steroid medication prior to sleeping. Always do your breathing exercises to reduce your symptoms before going to bed.

Secondly, sleeping on the back is the worst position to sleep as the lower jaw drops down to cause mouth breathing. While sleeping on the back, there is very little restriction to breathing and so we will breathe more deeply. Note that snoring which is also caused by overbreathing is worse while sleeping on the back. Oftentimes when a person is switched to sleeping on their side their snoring will cease. When you sleep on your tummy, the weight of your body on your chest and tummy will restrict over breathing. Professor Buteyko found after years of research that people who sleep on their left side in the fetal position breathe less deeply. The reason for this is unclear but it may be because the heart is postitioned more to the left side. It is also best to sleep on a hard mattress which restricts frontal movement of the body from breathing and which is also good for sleeping posture.

It is most important to breathe only through the nose while sleeping. Mouth breathing will cause a disruptive sleep resulting in waking up in the middle of the night with an attack or feeling very tired and drained in the morning.

To measure whether you are over breathing during the middle of the night measure your control pause before you go to bed and then firstly when you awake in the morning. If your control pause is less upon wakening than before you went to bed it means you have been deep breathing during your sleep.

In order to prevent deep breathing which may cause an attack during sleep, there are a number of recomendations. At the Buteyko centre of Moscow, Luidmilla Buteyko advocates sleeping in an upright position and setting an alarm clock to wake every two hours especially if symptoms are not good. Waking every couple of hours will prevent falling into a deep sleep with uncontrollable breathing. Upon waking every two hours, measure your control pause and do shallow breathing exercises. Only fall back to sleep when your breathing is more under control.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



The second alternative is to have someone watch over you as you sleep for the first couple of nights and until you become more used to breathing through your nose. The role of this person is to gently close your mouth when you begin to mouth breathe or to wake you if your breathing becomes too deep. This may not be very practical and so there is a third alternative.

Although this next option on first hearing it will sound unnatural and strange, It is very effective for maintaining nose breathing during sleep. I have been using this method on an off for a number of years now and find it very beneficial if I am having difficulty breathing through my nose at night. This involves placing a paper tape over the mouth in order to prevent breathing through the mouth. The best tape to use is one inch 3M micropore tape placed in a horizontal position covering the mouth. Before placing, remove as much of the glue on the reverse of the tape by sticking the tape to your hand and pealing it off a number of times. Do this until there is just enough glue to keep the tape in place. Before placing the tape on your mouth, make two tabs by folding part of the tape at either end. This will make pealing the tape off in the morning easier.

Make sure your mouth is completely closed before placing the tape. If your mouth is partially open, then you will be able to breathe through the tape during the night.

If your nose is partially blocked before going to bed, then first clear your nose doing the nose unblocking exercise. While wearing the tape, your nose will never completely block. The reason for this is due to the role of carbon dioxide in dilating the nasal passages. If you are breathing deeply during the night while wearing the tape, then your nose will partially block. This is the bodies defence mechanism to prevent over breathing. When the nose becomes partially blocked, the level of carbon dioxide in the body will increase which will unblock the nose. If you continue to overbreathe, your nose will become partially blocked again which will increase the level of carbon dioixde thus causing the nose to unblock and so on. Remember, your nose only completely blocks when you switch to mouth breathing.

The tape is not to be used on a child less than five years old, the child must be able to remove the tape during the night if they feel they need to. If during the night you are having difficulty breathing while using the tape, then do shallow breathing exercises. Try not to remove the tape as you will begin to mouth breathe during your sleep which will only make your symptoms worse. In order to reduce a possible panic feeling which some people may have, it is beneficial to put the tape on half an hour before going to bed. This is enough time to become used to the tape.

The tape is an option only, which has been used by thousands of people in Australia, New Zealand and the UK. If you feel that the tape is not for you, then here is another alternative to try and prevent mouth breathing during the night. This involves wrapping a scarf from the top of the head and then bringing it around and under the chin. The purpose of the scarf is to hold the mouth closed to prevent mouth breathing. Tie it to ensure that the lower jaw is unable to drop down during the night.

You will know whether you mouth breathe if you wake up during the night breathing through your mouth or if your mouth is dry in the morning. Your mouth should be wet when you wake up in the morning. If you have a tendency to mouth breath during the night, it is important to consider the above to prevent over breathing. Not only will you get a better nights sleep and feel more refreshed in the morning, your asthma will also improve

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



substantially as well. All people who mouth breathe have a higher level of gum disease and teeth cavity.

The final recommendation is not to eat for a number of hours before going to bed. Eating a meal or drinking a protein drink such as milk or hot choclate etc will result in increasing breathing. You will then have the double factor of increased breathing due to lying in a horizontal position and the increased breathing due to eating or drinking. It would be a guarantee of a poor nights sleep.

Exercise to stop Coughing attack

Coughing is one of the symptoms of asthma and some people are more prone to bouts of coughing than others. The problem is not with a once off cough, but an episode of coughs which are difficult to stop. Coughing attacks can occur at any time but tend to be more frequent at night time or early morning. It is important to reduce coughing as frequent coughing puts an overstrain on the heart.

Coughing is a reflex used to move mucus or other substance from the airways. Excess mucus is caused by overbreathing which will trigger the cough. Before the cough, the person takes a deep breath and coughs resulting in a forced expiration. This forced expiration causes a loss of carbon dioxide which will create more mucus. This additional mucus will result in another cough. Now the cycle is in progress. The person will take another deep breath and will cough with a forced expiration. This loss of carbon dioxide from the forced expiration will create more mucus which will cause another cough and so on.

The main point of this exercises is to break the coughing attack or cycle by doing the following.

Try not to cough at all. Try to suppress your cough. This will feel ticklish but after a while the urge will reduce. Swallowing will help reduce this feeling.

Do not force mucus. Mucus is the bodys defence against a loss of carbon dioxide. Forcing mucus to come up without addressing breathing will lead to the creation of more mucus. Instead reduce your breathing and the mucus will come up naturally. It can then be swallowed to dissolve harmlessly in the acid of the stomach.

Cough only through your nose. Note that it is the forced expiration of air out through the mouth that perpetuates the coughing cycle. Coughing through the nose reduces the volume of air expired thus leading to a substantial reduction in the amount of carbon dioxide lost.

After coughing do a 1 to 3 second breath hold so that carbon dioxide levels can be slightly replenished. 1 to 3 second breath hold is very comfortable and so will not disrupt breathing patterns.

Try to relax all muscles and perform breathing exercises as outlined above. The main point to remember with coughing is that the deep breathing and forced exhalation will only perpetuate the cycle. Being conscious of this will reduce the attack.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Blowing Nose

Oftentimes children may have a slight cold which will contribute to their asthma symptoms. They will use a hankerchief very often to blow and clean their runny nose. Every time we blow our nose, we lose carbon dioxide. Too much blowing of nose will result in too much a loss of carbon dioxide. This will lead to an increase in the production of mucus. The child will then blow their nose to clear mucus. Blowing of nose will result in a further loss of carbon dioxide which will create more mucus. Like coughing the blowing of the nose can cause a vicious cycle of mucus and nose clearing.

Follow the same rules with regard to coughing.

Try not to blow nose and do so only when necessary Blow nose gently. Blowing of the nose forcibly will result in a greater loss of carbon dixoide and can result in sinus and ear problems. After blowing nose do 3 second control pause Reduce breathing. For a child- do sets of steps


Like coughing and blowing of the nose, the same rules apply to sneezing.

Try not to sneeze and do so only when necessary. Place your finger under your nose

when you feel the urge. Oftentimes this will be enough to prevent the oncoming sneeze. Sneeze gently if you can. Sneezing forcibly will result in a greater loss of carbon dixoide

and can result in sinus and ear problems. After sneezing do 3 second control pause


Speaking for long period of time leads to asthma symptoms. Research has indicated that talking for a period of time leads to a substantial reduction of carbon dioxide. People working in professions where talking is necessary need to pay particular attention to the link between talking and carbon dioxide loss. The following points are important to pay attention to when talking.

Do not breathe in through your mouth prior to talking. Initially this will be a little difficult as it is necessary to pay attention to what you are going to say while also observing your breathing. However, it is very important to reduce your mouth breathing and so the effort will be worthwhile. Practice talking in front of a mirror saying the alphabet etc.

Shorten your sentences. Long winded sentences result in a large exhalation of carbon Dioxide. Instead shorten your sentences and put mental pauses mid sentence

Take small breaths through the nose mid sentence.

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Listen to other peoples bad breathing. Listen to other people on the phone and taking huge

This alone can be enough to maintain a low carbon

sharp inhalations prior to talking. dioxide.

a low carbon sharp inhalations prior to talking. dioxide. Fig 11: Holding of the breath and

Fig 11: Holding of the breath and reduced breathing after coughing, sneezing and blowing nose. Note the large

exhalations which cause a loss of carbon dioxide. Breath holding and shallow breathing reverses this.

Breathing Exercises

Some medical persons involved with helping people with asthma will recommend breathing exercises such as blowing air as hard as you can through a straw to move marbles or blowing up balloons etc. Other exercises involve taking very deep breaths in through the nose and out through the mouth. Please do not follow this advice.

If we forcibly blow all our air out in an exhalation, we take a deep inhalation of air prior to doing exercise or after we have completed it. Blowing air may be from doing breathing exercises, speaking, coughing, blowing nose, cooling down our food prior to eating or any other reason. We know that blowing air from the body causes too much carbon dioxide to be carried out with each breath. This loss of carbon dioxide will cause spasm of smooth muscle, increased mucus and eventual asthma attack.

Physiotherapists have been trained to help people forcibly remove mucus with coughing exercises or tapping of the back etc. Gentle tapping with reduced breathing would be okay. However coughing exercises will only make asthma worse. Please note that the placebo group in the trials at The Mater Hospital in Brisbane were taught by traditional physiotherapy. They showed no improvement while the Buteyko group showed very significant progress.

To help remove mucus, do not do any coughing or blowing exercises. Mucus is the bodies defence to prevent the further loss of carbon dioxide. By forcibly removing the mucus, we increase our breathing which increases the loss of carbon dioxide which will create more mucus. Instead perform shallow breathing exercises as above and drink a glass of warm water with a half teaspoon of sea salt dissolved in it. The mucus will then loosen up and will be brushed upwards to the pharnx by cilia which are fine hairs lining our airways. The mucus can then be harmlessly swallowed. By reducing our breathing, the body has no need to create additional mucus as part of its defence mechanism. Mucus already created will be removed naturally.

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Breathing Muscles

The diaphragm, intercostal and accessory are the three main groups of muscles used for breathing. Diaphragm breathing is the most effective in reducing hyperventilation. The diaphragm is a strong, thin, flat sheet of muscle which separates the chest from the gut. It is tailor made and shaped like the dome of an umbrella. When breathing in, the Medulla Oblongata located in the brain sends a message to the diaphragm which then flattens down creating a negative pressure in the thorax. This causes the lungs to draw in air to equalise this negative pressure. The downward movement of the diaphragm on the abdominal contents causes the stomach to expand a little as we breathe in.

To find out if you are breathing with your diaphragm. Hold one hand across your breastbone and the other hand on your tummy. At rest there should be no upper chest movement and only very small movement of the tummy. The tummy will expand as you breathe in and contract as you breathe out.

If you breathe primarily with your upper chest, then it is necessary to practice breathing abdominal.

chest, then it is necessary to practice breathing abdominal. Fig 12: This bell jar experiment illustrates

Fig 12: This bell jar experiment illustrates the central role which the diaphragm performs during breathing. To breathe in nerons within the brain stimulate the diaphragm to contract (move downwards 1 cm to 10 cm) which enlarges the chest cavity or thorax. This causes a negative pressure as in the first diagram resulting in inhalation until the pressure in the alveoli within the lungs equals atmospheric pressure. At the end of inspiration, the nerves to the diaphragm ceases firing and so this muscle relaxes. This “compresses” the air within the alveoli which causes an exhalation. It is the movement of the diaphragm from the relaxed position to the contracted position which causes the tummy to move out and from the contracted position to the relaxed position which causes the tummy to move in.

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Strategy for abdominal breathing

Sit up straight and adopt correct posture

Lengthen the distance from your sternum (chest bone) to your navel

Have both feet flat on the floor

Relax shoulder and upper chest- very important

Lips together and jaw relaxed, breathe in gently through your nose

Place one hand on your chest and one hand on your tummy

Suppress or reduce the amount of movement of your chest with your hand

Instead feel with your other hand your tummy move out with each inhalation and feel your tummy move in on each exhalation

Imagine a loose elastic band around your waist stretching as you inhale and contracting as you exhale

When breathing out- let air exhale naturally- do not force air out- the elastic recoil of your diaphragm and lower chest will help to breathe air out effortlessly and quietly

Do not wear very tight fitting belts or clothes which will restrict abdominal breathing. Your posture influences whether you breathe abdominally or upper chest. If you are slouched- you will tend to breathe deeper using your upper chest. If you sit up straight, you will breathe less deeply and will use your diaphragm more. Focus on your stomach expanding with each inhalation and contracting with each exhalation. These movements are noticeable but slight. It is only if you are breathing a large volume of air that you will have considerable movement, this would not be good.

At first nose/abdominal breathing will feel strange if you have been predominantly chest breathing

You may feel an air hunger as abdominal breathing reduces hyperventilation, this is a good sign of progress.

Practice doing this for ten minutes each day along with your exercises until you have reduced upper chest breathing considerably

Remember- Breathe in - tummy out Breathe out - tummy in

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



IMPORTANT- Cleansing Reactions

Overbreathing causes various physiolological changes to the body. It is important to know that reduction of breathing may lead to various cleansing reactions and symptoms. The symptoms you may experience are fever, headache, diarrhoea, coloured urine, nausea, sweating, vomiting, increase temperature, excess mucus from nasal cavity and airpipes, excessive tiredness with increased yawning, mild depression, general flu like symptoms or feeling off colour for a couple of days.

Some people may experience a recurrence of symptoms in reverse corresponding to reaching levels of 4, 4.5, 5.5 and 6.5% of CO2 content in alveolar air or control pause of 10, 20, 40 and 60 seconds respectively.

When you experience a headache or other cleansing reaction, continue to reduce your breathing as this will shorten the lenght of time of your symptoms. Know that the symptoms are due to your overbreathing and that the control pause will increase after the symptoms have passed. It is okay to take a headache tablet to reduce symptoms.

When you experience cleansing reactions, increase your water intake.

People who have been on a large course of steroids may experiencing smelling of the tablets/medicine through the skin. Again, this will pass, concentrate on doing shallow

Not all people experience cleansing reactions and for most people it is a slight headache.

So do not be alarmed when you do feel off colour. Know that this is our body readjusting to a healthier way of life and that the symptoms will go in a short time.

On a positive note, all people will experience signs of health improvement including fewer asthma symptoms, increased calmness and concentration, better sleep and more energy.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Length of time to practice breathing exercises;

Mild Asthma

Never had any critical life threatening attacks or hospitalised Never used oral steroids such as prednisone Experience symptoms less than three or four times a week Can gain relief from a single puff of an inhaler Practice half an hour twice per day for two months at least

Moderate Asthma

Mild continuous asthma Regularly use bronchodilator with usually a steroid preventive inhaler

Practice half an hour twice to three times per day for three months at least

Severe Asthma

Multiple types of medication- reliever and preventer Need frequent hospital visits

Practice half an hour three times per day for three to twelve months.

Practice time may seem to be a burden but it is very necessary as you are reversing a lifetime of bad breathing. This cannot happen overnight. This time is the most rewarding investment you can do to improve your quality of life. Initially I found the exercises to be time consuming- however the rewards have far outweighed the time involved many fold.

Goal of Breath retraining

The primary goal of breath retraining is to reduce the volume of air to more correct levels. Increased observation of breathing and practice of exercises as above is necessary to achieve this. After a number of months application of breathing exercises and with an increase of control pause to forty seconds, the amount of time set aside to do exercises can be decreased.

By then, reduced breathing will have become your way of life as you will be incorporating reduced breathing in your every day activities. Your breathing will be reduced during your speaking, eating, walking, sleeping, reading, cycling and whatever activity you are doing. Anytime you then notice your breathing increasing, you will know to reduce it. This will become an unconscious activity.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor




Medication for the control of asthma is very necessary. The following information regarding medication is based on regular questions I have received from concerned users. The first point I would like to make is that it is very important to know and understand the difference between different types of medication. Medication can be divided into two main groups namely reliever medication (bronchodilator) and preventer (steroid).

Reliever medication is further divided into short acting and long acting. Short acting reliever inhalers are to be taken only when needed. Commonly prescribed short acting reliever medications are Ventolin, Salamol, and Bricanyl. Long acting reliever inhalers such as Oxis and Serevent are to be taken at regular times. Reliever medication come in grey, green or Blue inhalers.

Preventer medication is predominantly steroid based and must be taken all the time according to doctors instructions. Preventer medication is in red, brown or orange inhalers. Commonly used preventer medications are Flixotide, Becotide and Pulmicort.

Short-acting bronchodilators (reliever)

Should be used on an "as needed" basis to overcome attacks Take one puff only each time. Buteyko recommends to take one puff and wait for the medication to take effect. This happens within five minutes. If you still need to take another puff, then do so. There is no point in taking two puffs of reliever medication when you only need one. Steroids are different, use steroids according to prescription. Until recently a standard recommendation was to use two puffs four times a day. But “asthmatics do rather less well than when they took their bronchodilator only when they needed it”. Professor Brostoff Asthma the complete guide Over use of short acting reliever inhalers leads to scarring of the airways and irreversible damage.


They do not cure asthma- they don’t address the cause

They cause hyperventilation. They force airways open and cause overbreathing. They are also adrenaline based which causes hyperventilation.

Long-acting bronchodilators (reliever)

Keep airways open for several hours Taken once every 12 hours and are prescribed for use on a regular basis, two puffs at a time Should NEVER be used for emergencies. Some people have died taking long-acting relievers for symptomatic relief

People who undertake Buteyko Breathing are advised to replace their long acting inhaler with a short acting one such as ventolin.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Side effects of Bronchodilators Hyperventilation Tremor in muscles (often felt as a shaking of the hands) Restlessness Dizziness Headaches Palpitations Gastrointestinal upset

“Research shows that short acting beta 2 relievers used regularly, make the airways more sensitive to allergens and exercise” Professor Jonathan Brostoff- Asthma The Complete Guide

“Short acting beta agonist Professor Jonathan Brostoff - Asthma the Complete Guide

Steroids (preventer) Most effective anti-inflammatory drugs Inhaled steroids usually brown canisters Do not give immediate relief True worth only emerges with continuos use Reduce inflammation Do not cure the underlying disease Take daily whether asthma symptoms occur or not Common mistake is to stop taking preventer when have fewer symptoms

Asthma slowly worsens again, the need for relievers increases and this can result in a serious, uncontrolled asthma attack.

Never stop your preventive medication without consulting your doctor

Steroids are very necessary in the control of asthma. Although steroid inhalers do have side effect, they are far safer in treating asthma than an over reliance on reliever inhaler. It is known that countries which have adopted a policy of steroid use for the treatment of asthma have a lower death rate than those which have not. Use of reliever medication has been described as putting paint on rust. Symptoms are suppressed while the underlying condition gets progressively worse. This results in greater difficulty maintaining control and risk of serious attack. On Asthma Care website, there is an article entitled Are Asthma Drugs the Cure that Kills? This is located by clicking the link media articles.

All patients to Asthma Care will experience a substantial reduction of symptoms within a short time after commencing breath retraining. The need for short acting medication will therefore greatly decrease. When you or your child has not needed their reliever medication for five weeks, make a visit to your doctor to have an examination. When your doctor is happy with your progress, your steroid dosage will be reduced a little.

After this time with a small reduction of steroid, you may have slight asthma symptoms. Continue to practice your breathing exercises and when you do not need your reliever medication again for a period of four weeks, visit your doctor to have your steroid intake reduced a little for the second time. Only reduce your steroid intake in conjunction with your doctor as insufficient preventer medication could result in a serious uncontrolled attack.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Steroids Dose

Adults Children Over 5

A Low dose

A Moderate dose

A high dose

Children less than 5 Years of age

A Low dose

A Moderate dose

A high dose

Asthma facts

100-400 mcg per day 500-800 mcg per day more than 800 mcg

less 200 mcg per day 250-400 mcg per day more 500 mcg per day

Study conducted by the ISAAC concluded in 1998 that Ireland has the forth highest prevalence of asthma in the world with 274,000 people (half of which are under sixteen years of age) after United Kingdom, New Zealand and Australia. “For asthma symptoms, the highest 12 month prevalence were from centres in the UK, Australia, New Zealand and Republic of Ireland. The lowest prevalence were from centres in several Eastern European Countries, Indonesia, Greece, Taiwan, Uzbekistan, India and Ethiopia. 463,801 children in total were studied in centres from 56 countries. Published in The Lancet Volume 351 Issue 9111 25 April 1998- World wide variation in prevalence of symptoms of asthma.

70% of people have persistent asthma for which preventative medication is necessary.

Boys have asthma more commonly than girls

About half the children with mild asthma will improve and "grow out of" the condition through their teenage years

Adult or "late onset" asthma occurs, more frequently in women than in men

Rate of asthma among children in Ireland









Death Rate from Asthma in Ireland - This is due to poor awareness and control of condition. Over reliance on reliever medication.

1980- 69 males 65 females 1990- 95 males 64 females 1998- 51 males 54 females 2000- 40 males 44 females

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Research Results

Two trials have been conducted on Buteyko Breathing Therapy and Asthma in the western world. Throughout the development of Buteyko Breathing Method, several trials were conducted in Russia which substantiated the therapy lead to its incorporation in Russian medical doctrine. Medical textbooks in Russia contain information regarding Professor Buteyko’s discovery.

The first trial of the Western world was conducted in 1995 at the Mater Hospital in Brisbane, Australia. This was overseen by some of Australia's medical asthma experts. Taken from an initial 170 people, 39 asthmatics were selected as they met criteria regarding asthma diagnosis. These were divided into two groups. One group was taught normal physiotherapy and conventional management of asthma. This is called the placebo group.

The second group was taught Buteyko Breathing therapy. The trial was blind meaning that neither group knew which therapy they were being taught. There was no mention of the word Buteyko during Buteyko Breathing sessions.

Average intake of air per person between attack 15 litres of air per minute- three times the norm

Buteyko Breathing Group results

After 6 weeks

Results after eight months

Reliever medication

Placebo group had increased average use by 9%

Inhaled Steroid Buteyko decreased average use by 49%

Symptom Scores Buteyko group - 71% improvement Placebo group - 14% improvement

The volume of air inhaled was reduced from an average of fifteen litres to an average of nine litres per minute for the Buteyko group. Those who reduced their inhaled volume of air the most also reduced their medication the most (under medical supervision of Professor Charles Mitchell). This proves the direct correlation of over breathing and asthma symptoms.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Following the trial, all persons who were part of the placebo group were then trained in Buteyko Breathing Therapy. On average this group also showed the same improvement as the first Buteyko group involved with the trial.

Second Trial in Western World

This trial was researched by Jill McGowan as part of her PhD. with The University of Strathclyde. This involved 600 patients and was conducted from April 2001 until April 2002. These results are preliminary, are subject to scientific scrutiny and are due to be published in a scientific journal.

Reliever Medication


Buteyko Group - decreased by 98%, 6 months and remained same at 12 months

Placebo and Control groups - no significant change

Preventer Medication


Buteyko Group - decreased by 92%, 6 months and remained same at 12 months

Placebo and Control groups - no significant change

Quality of Life


Buteyko Group - increased by 100%, 6 months and remained same at 12 months Placebo and Control groups - no significant change

Will Asthma Care Work for Everybody?

No it will not.

The reason is because not all people have enough discipline to follow through and practice their breathing exercises. The results from all trials show that the people who reduce their breathing volume the most reduce their need for medication the most. Reduction of breathing volume is by regular practice of breathing exercises, increased observation of breathing at all times and relaxation of the respiratory muscles to create a little air shortage at all times.

If you are doing all the above and are not achieveing results then increase the amount of time you are spending on practice exercises. If this does not achieve results for you, then call Asthma Care at 091 756229 or send us an email to info@asthmacare.ie. We will then arrange a follow up session for you so that results can be achieved.

If you are a severe asthmatic, then you need to spend as much time as possible being aware of your breathing and doing exercises. If you have emphysema, then you need to spend even more time than a person with asthma doing these exercises. If you are bed ridden, then it is good to spend all day observing breathing. We will work with all persons until they can apply method correctly and have results.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Diet and Asthma.

Asthma Care program is 90% about retraining of breathing with 10% observation of diet. The recommendations regarding diet are very helpful for better breathing, better control pause, less asthma symptoms and better health.

Guidelines with regard to diet are as follows:

Only eat when you feel hungry. When you feel hungry, your body is telling you that it is time to eat. If you do not feel hungry, then you do not need to eat. If you eat when you are not hungry, your body uses energy in order to process a food that it does not need. This increases your breathing and is not good for your health.

Limit high protein foods such as dairy foods, meat, fish, eggs High protein foods increase our rate and volume of breathing thus causing mucus production. Children with constantly blocked or runny noses often clear when they stop drinking cows milk. Many allergies and breathing problems can be directly related to dairy consumption.

Studies indicate that proteins in cows Milk, eggs, peanuts, soy and wheat are the most common food allergies. Milk is the most harmful of these foods and some studies indicate that children who are not fed milk before the age of two have less allergies. It is interesting to note that the world wide rate of asthma is highest in Anglo-Saxon countries of UK, Australia, New Zealand, Ireland, USA and Canada. These are also the countries with the highest per capita consumption of milk in the world.

Japanese who consume hardly any milk because of their genetic inability to digest lactose after infancy have an asthma prevalence of 1/20 of ours.

Milk is not the only food to provide calcium. Good sources of calcium include kelp, turnip greens, rhubarb, broccoli, lambs kidney, tofu, tinned salmon with bones, baked beans, fortified oatmeal and other cereals, all leafy green vegetables and kale.

Fresh food is best. The longer the time a food is harvested before it is eaten, the more nutrition it loses. Some foods are harvested twelve months before they are consumed. The amount of nutrition in these foods is substantially lower than if the food was consumed straight after harvesting. For this reason, I would regard all breakfast cereals as stale foods.

Limit refined foods- e.g. white bread, jams, chocolate etc. or most foods that are mass advertised. Dr Price’s research of the Gaelic people living on the Hebrides in the 1930s noted that when the traditional people changed from a diet of small sea foods and oatmeal to the modernised diet of “angel food cake, white bread and many white flour commodities, marmalade, canned vegetables, sweetened fruit juices, jams, and confections”, first generation children became mouth breathers and peoples’ immunity from diseases of civisliation reduced dramatically.

The traditional diets were found to provide at least four times the minimum requirement of nutrients. The modern diet did not meet the minimum requirement. For example, here is a quote taken from Dr Price’s book Nutrition and Physical Degeneration

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



“Modern white flour has had approximately four fifths of the phosphorous and nearly all of the vitamins removed by processing, in order to produce a flour that can be shipped without becoming infested with insect life. Tests showed that White bread was unable to sustain insect life, while half a slice of whole rye bread was totally consumed by bugs.”

Limit sugar

Limit Junk food

Don’t smoke

Limit foods that promote inflammation Red meat encourage the mast cells to release leukotrienes, which are even more potent than histamine. (leukotrienes, histamine are inflammatory chemicals)

Limit Coffee and conventional tea. Coffee sharply increases breathing.

Coffee and tea will temporarily help you to breathe because it stimulates the adrenals in an

extreme situation. However in the long run, it will only succeed in further exhausting you. Caffeine tends to open up the airways and will have this effect on most asthmatics. The amounts needed to have any noticeable effect are a large number of coffees, but this will produce some unpleasant side effects.

Cooked food produces more ventilation than raw food

Don’t eat a heavy meal last thing before going to bed- will deep breathe during the night and will not have a good nights sleep

Spice up your meals- garlic, ginger, curry etc.

Sea Salt in cooking is good. A half a teaspoon of sea salt in warm water is a known anti histamine. It also helps reduce palpitations and helps break up mucus trapped in airways. You should get relief from symptoms after fifteen minutes.

Eat five servings vegetables a day. Eat fruit but not too much citrus or bananas. Citrus is

Drink water- mucus tends to be thicker when you are dehydrated.

Observe which foods make your asthma symptoms worse. All foods increase our breathing,

Is there any foods you crave for instance chocolate or crisps? If so it is likely that you an intolerance to these foods and consume then due to the bodys release of endorphins to avoid pain.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Foods to limit in quantity are:

Dairy and products containing dairy ingredients Milk, Yoghurt, Cheese, Ice cream, cream soups, Chocolate.

High protein Beef, pork, chicken, fish, eggs

Stimulants Coffee, strong teas, alcohol, cocoa, soft fizzy drinks, drinking chocolate.

Antigens Citrus fruits, raspberries, strawberries, wheat, nuts.

Vitamin supplementation

Vitamin and mineral supplementation is recommended because hypervetilation causes the body to excrete some minerals such as magnesium, calcium and potassium in order to maintain PH. It is therefore necessary to replenish these, as the loss of magnesium leads to further hyperventilation.

Nowadays, the soil from which are food is harvested is overused and does not have time to replenish vital minerals which we need. Pesticides, chemicals are all added in an effort to increase production. We have to accept that the quality of our food is not as high as it was for our ancestors. It is because of this reason that I supplement my diet.


The best form of magnesium to purchase is liquid magnesium. It is more expensive and a little difficult to find but is better absorbed by the body. Magnesium in chalk form is more commonly found in any health store and is beneficial to take. People who have difficulty breathing will find that magnesium is helpful within a couple of days of starting to take this vitamin. Most people with asthma are deficient in magnesium. (in fact I have spoken with a Kinesiologist in the UK who told me that over the thousands of asthmatics he tested, they were all deficient in magnesium.) Speak with an authority at the health store prior to purchasing magnesium.

Magnesium is a natural bronchodilator (opens the airways)

Some hospitals in USA prescribe intravenous magnesium to complement with other medicine in the event of an attack.

Magnesium helps stabilise

Some studies conclude hyperventilation stops with magnesium supplement

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Sources of magnesium include whole grains, nuts, avocado, beans and dark leafy vegetables. Supplement magnesium according to recommended daily amounts as stated by manufacturers. Vitamin B5 or Pantothenic acid

When B5 is deficient the adrenal glands become weak and compromised

Allergies are often a sign of B5 deficiency

Involved in the production of cortisone and other hormones produced by the adrenal

Good sources of B5 are liver, kidney, whole grain products, peanuts, eggs and watermelon


Your body is 70% water

Eat high water content food- fruit and vegetables

Water transports the nutrients

Dehydration- histamine increase greatly (histamine is an inflammatory cell)

Drink warm water regularly

Alcohol or caffeine- are diuretics- promote loss of water- dehydration

You need to replenish the water you lose each day by drinking pure water. You lose water through sweat and in the excretion of bodily waste.

With asthma the need for water increases as laboured breathing contributes to dehydration. We breathe an average of 18,000 times per day. We all know that if we breathe for one or two breaths directly onto a dry window, there will be a residue of moisture left on the window. This is a loss of moisture from the body. Imagine the amount of moisture that we lose in a 24 hour period.

Drink eight glasses of pure water not coca cola or any other soft drink throughout the day. Drinking alcohol, coffee, tea, coca cola and other caffeine drinks promote water loss and dehydration. These drinks are known as diuretics.

If you are very active and play a lot of sports, then your need for water increases.

At first sign of symptoms, drink warm water with a half a teaspoon of sea salt in combination with breathing exercises to greatly reduce an attack.

High water consumption may cut cancer risk by essentially washing carcinogenic substances out of the body before they have a chance to come into contact with vulnerable tissue. It is worth noting that the healthiest and as a result longest living people in the world live on a high water content diet.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor



Allergy During Asthma Care workshop, very little time is devoted to allergies as this information can be got from any self help manual on asthma or from The Asthma Society of Ireland (tel. 01 878 8511). The main point is that over breathing results in the immune system working under par. When the control pause increases to forty and beyond, allergens will become far less of a problem. Buteyko recognised asthma as having one cause namely over breathing. Allergies are triggers to asthma attack, they are not the cause. Until your control pause reaches forty, take usual measures for the avoidance of allergies because until then allergens will continue to trigger your attack. Reduced breathing will reduce affects from allergies and triggers.

When you come in contact with an irritant or allergen for example a cloud of dust along the street. Breathe out and hold your breath, take 10-15 steps without breathing. Try to hold your breath until you pass the allergen. If there is a lot of allergen and it is not possible to hold your breath, then breathe very shallowly.

The purpose of this is to raise your defence system and also to inhale far fewer allergic particles. This should be done any time you observe pollutants. E.g. hold your breath when someone sprays deodorant, when a bus passes on the street etc. etc.

As dust mites are very common allergens, steps to take are listed briefly. House Dust Mites

Use anti mite covers on mattresses and put tape on seams to reduce dust mite escaping.

Wash bedclothes regularly at a temperature of 60 degree or higher

Do not sleep in lower half of a bunk bed

Soft toys harbour a lot of dust mites. Freeze toys for an hour each week prior to washing.

Remove pot plants and fish tanks as they are sources of humidity

Do not dry clothes on radiators

When dusting use a damp cloth to prevent dust from rising

If you are allergic to dust, do not work in a dusty environment. Always wear a dust mask.

Use a dyson vacuum cleaner or one that retains air

Have wooden floors in bedrooms and not carpet

Curtains with light material instead of heavy curtains.

Dust mites, moulds, pollen and Cat dander are microscopic airborne particles. They are very difficult to avoid all the time. Instead take whatever measures you can to reduce your exposure to them and concentrate on increasing your control pause to forty. When your control pause reaches forty, you will have no further questions on allergens.

Temperature Extremes. Temperature extremes of both hot and cold increase breathing. The sport with the greatest risk for people with asthma is cross country skiing. During cold winter days, it is advisable to wear head gear. If entering cold water, enter very gradually. People who straight into jump into cold water take a deep breath due to a reflex action. In this situation, it is best to immerse gradually and so prevent the deep breath. When entering from indoors to outdoors or from one temperature to another e.g. shower to cold room- breathe shallow. Do not pant. Do not stay in rooms which are to hot and try not to over dress.

Copyright 2002 by Patrick McKeown Do not reduce medication without approval from medical doctor