Breathlessness is a significant issue for a lot of people in the community. We all breathe naturally, without thinking most of the time. But, what happens when we experience shortness of breath?
One in seven Australians (over 1.45million), have a condition called COPD (Chronic Obstructive Pulmonary Disease). Which, as the name sounds means people with COPD have a lot of difficulty with breathlessness.
In addition, let’s not forget about the 2 million people in Australia who also suffer from Asthma. Asthma is another condition in which breathing is temporarily compromised and they experience shortness of breath.
The simple act of breathing can be quite complicated and delicate. For some people in the population the simple act of breathing can be quite distressing at times and can lead to a life or death situation.
Breathlessness can stop people from doing normal every day activities like; hanging the clothes out on the line, taking the dog for a walk or even tying their own shoelace. Breathlessness is a serious problem in the community. If you know someone who complains of breathlessness, make sure you share this article with them.
How do we breathe?
Our respiratory system is a network of muscles and tissue. You’ve probably heard of the lungs and diaphragm, they are part of the breathing process. But there are many more things to consider.
When you breathe in the diaphragm contracts and moves downward. At the same time intercostal muscles (muscles around the ribs) also contract this pulls your rib cage outward. This increases the available space in the chest cavity to allow your lungs to expand.
As you suck the air down in an in breath it travels down through the windpipe, down into the bronchial tubes and reaches the alveoli.
The alveoli are very small air sacks, which contain capillaries. Capillaries allow the oxygen to diffuse through the walls into the blood stream. At the same time carbon dioxide diffuses from the blood stream to the capillaries.
When you breathe out, the diaphragm and intercostal relaxes the chest cavity narrows. Due to the smaller chest cavity space air is then forced out of the bronchioles and lungs.
When we are resting breathing is effortless. Breathing muscles become more involved during exercise or if a person has lung disease like COPD.
Breathing muscles of the chest and abdomen are muscles they can be trained so you can breathe better. You can do this by doing regular exercise, as well as using specific breathing equipment to improve muscle strength of the pulmonary system.
Why do I get breathless?
Breathlessness can happen for a variety of reasons, most commonly people feel breathless because of lack of fitness. You may feel breathless when climbing stairs, walking down the street or tying your shoelace. All of these activities increase the amount of muscle mass we activate. Muscle activation uses oxygen and so you breathe more to increase oxygen in the blood stream.
If you get breathless from doing simple tasks and haven’t been diagnosed with a lung condition it’s a good indication to start exercising, because the problem will only get worse. With disuse comes a decrease function, this means your ability to do this may decrease further and further. If this is you simply start of by doing simple activities to get moving again like walking up and down the hall way of you home for 5 minute block, or try gardening or arm exercises if you have trouble walking.
Similarly, when you purposely exercise like running, swimming or lifting weights you will increase you’re breathing rate. If you are exercising at a particularly high intensity like sprinting for example, you will feel the extreme end of breathlessness. This type of breathlessness is transient and something you should embrace. It challenges the respiratory system and keeps your heart and lungs fit and healthy.
COPD & Asthma
Breathlessness is a problem when it starts to impact your quality of life such as those people with COPD or Asthma. Both of these conditions restrict the amount of airflow that can get into the lungs and can be very debilitating.
If you do have COPD or severe Asthma you might find simple tasks like moving around the home leaves you wheezing or gasping for breath. Medications can be prescribed by your doctor to reduce this, but you may also want consider easy exercise and breathing training to improve this situation.
Exercise is one of the most potent things we can do for the body it not only helps you breathe better but trains your body to be more resilient and proves mental health. Often anxiety and depression arise when breathlessness is a constant problem. The distress of not being able to breath properly causes anxiety, along with stress as well as depression from not being able to do the things you want to do every day.
Why am I breathless and tired?
You may be breathless for a number of the previously mentioned reasons, tiredness could equally be related to feeling stressed or over exercised. In the context of a pulmonary disease like asthma or COPD, tiredness is a symptom of not being able to get enough air in.
We need to breathe for energy production. The process of metabolism uses oxygen to create ATP energy. The energy your muscles use to move. Other organs like the brain and heart also use ATP to function properly. This is called the aerobic energy system, which is typically associated with low level and prolonged movement. For example hanging clothing on the line, walking and putting dishes away.
The body also has an anaerobic system in which is produces energy. This occurs at very short, high intensity duration activity for example lifting a heavy box, sprinting or lifting weights. It causes lactic acid production in the body and is short lived.
You are tired because when you have less oxygen passing through in the system, you also have less carbon dioxide escaping the body. To improve tiredness, you need to reduce breathlessness.
Take note that there are many other medical conditions that also cause breathlessness and tiredness. These include; Heart failure, heart rhythm disorders, Anemia, lung cancer, vitamin B12 deficiency, sleep apnea, obesity and whooping cough. Visit your doctor for a proper diagnosis of your condition.
How do I reduce breathlessness?
There are many ways you can reduce breathlessness. Primarily you should visit your doctor for an appropriate diagnosis, testing and medication therapy of the condition causing breathlessness.
If you suffer from COPD then pulmonary rehabilitation is the first measure to improve breathlessness and teach breathing technique. Pulmonary rehabilitation centers are usually run in conjunction with local hospitals. A referral can be obtained by visiting doctor.
Secondary and adjunct treatment to the above you can also try inspiratory muscle training. I am now offering this in my exercise physiology clinics in Sydney. This involves using a resistive device to breathe in and out of.
Initially you will be tested how strongly you can breathe in. This is very different to a normal spirometry test. From here we set a resistance on the device for you to train on.
To use the device you need to sit or stand with good posture. Don’t round the shoulders. You create a mouth seal on the device and breathe out till you have run out of breath. Then you start your breathing training with a quick short breath in. As you breathe in quickly let your belly expand to breathe in, simultaneously relaxing your shoulders and chest.
As the devices have mouth to device contact, we do sell the devices for individual use. You can purchase the device on our website or in person. To improve your breathing, like any other form of exercise, you need to practice daily.
This type of inspiratory muscle training will improve your maximum inspiratory pressure (MIP), that is the maximum force generating capacity of the inspiratory muscles. It will also improve inspiratory peak flow, how fast you can get air into your lungs. This type of training will improve exercise endurance and improve your quality of life.
At the moment this is the only adjunct treatment to standard care that you can do at home and it is effective. A daily breathing exercise program may only take 5-10min daily, but it’s worth it if you are feeling short of breath all the time.
How to improve COPD and breathlessness?
There is no cure for COPD however there are things you can do to breathe easier. These are;
- Quit smoking (Visit the Quitnow website)
- Start exercising
- Attend pulmonary rehabilitation (See your Doctor for a referral)
- Start resistive breathing training* (Come and see us for an appointment)
- Get appropriate medications and remember to take those medications
- Learn to manage anxiety and stress
COPD and exercise
Exercise is a great treatment for almost all conditions and this also holds true for COPD. The benefits are that it can increase mobility, reduce chronic disease risk like heart disease and diabetes, whilst improving quality of life. Typically with breathlessness it causes the person to reduce their natural movement patterns causing them to be more and more sedentary over time.
This not only exacerbates breathlessness from lack of fitness, it also induces muscle wastage. Which, impacts on the ability of an individual to perform simple tasks around the home. A person with COPD may benefit from implementing a simple exercise program that includes the following:
- Timed hall way walking lasting 5 min bouts, with long 2-3 minutes rests in between.
Strength training such as;
- Sit to stands (squats)
- Wall push ups
- Leg extensions using ankle weights
- Shoulder presses using hand weights
- Arm curls (bicep curls) using hand weights
All of the above can be done within the home and intensity modified according the current ability and progressed over time. If you need help doing this contact us in Sydney for exercise physiology and breathing training programming.
What is resistive breathing training for COPD?
Resistive breathing training can reduce breathlessness (dyspnea) and teach diaphragmatic breathing. Training includes breathing through a breathing training device 30 times a day under a pre-determined pressure. With testing completed every 2 weeks to measure improvements in pulmonary function and breathing capacity.
Ultimately it’s breathing through a device that creates pressure. This pressure trains the muscles of the pulmonary system to get stronger, so your breathing becomes easier.
COPD patients typically already have strong inspiratory muscles due to the constant resistance placed on your breath. Inspiratory muscle training, trains you just above your normal capacity, improving strength further. This is useful so that your normal day-to-day activities feel easier and you are less breathless. It does not cure COPD, it makes your breathing muscles fitter and stronger.
It has been shown to improve;
- Diaphragm thickness and strength
- Diaphragm contraction speed
- Training tidal volume
- Shortness of breath
Ultimately this means you should be able to do more of the things you love like gardening, walking, and shopping, with reduced breathlessness.
What is resistive breathing training for Asthma?
For Asthma the same device is used as for the treatment of COPD, however using differing breathing paces. For Asthma inspiratory muscle training involves long slow controlled breaths under resistance using the same device.
Making inspiratory muscles stronger enables asthmatics to gain better control over their symptoms by lowering perception of breathlessness. This training is only suitable for stable asthmatic symptoms, who are well managed on medications or otherwise. It is also only suitable for those who are well aware of their asthma symptoms. If you have a low perception of breathlessness or have sudden onset of asthma symptoms that catch you off guard, then this is not the training for you.
What’s the next step?
Contact us if you need help designing and exercise program to improve your physical health and breathing. Life’s too short to be breathless.