Asthma has been very much in the news with the launch of  Puff, the dragon mascot for WA Asthma Foundation campaign ‘Manage My Asthma’ funded by Telethon.

With an improvement in the weather bringing an enthusiasm for getting active together with air- borne triggers such as pollen it seems as good a time as any to talk about:

EXERCISE INDUCED ASTHMA

Exercise is one of the most common triggers for asthma.

Many highly successful athletes have asthma which means if it is well managed it should not prevent you reaching your goal!

Asthma is basically over – reacting, twitchy airways when exposed to triggers such as cold, smoke, pollen etc.

Before the air reaches our lungs it has to travel through approx. 2,400 km's of progressively smaller tubes. Once we are past the first split into the right and left lung these tubes are lined with bands of muscle.

During an asthma episode or flare – up, this muscle tightens around the airways causing them to narrow. This is the tight chest feeling or sometimes noisy wheeze.

Narrowing of the airways can happen in a few ways

1.       The bands of muscle around our airways  spasm, therefore narrowing the tube

2.      The wall of the airway can swell, become thicker and allow less room for air flow.

3.      The lining of the airways can produce mucus.

ASTHMA MEDICATION

1.      If you take medication make sure you understand what you are taking and why.

2.      Relievers – commonly Ventolin – blue puffer – relaxes the muscles around the airways and can be used 5 mins prior to exercise.

3.      If you are taking your Ventolin more than 2-3 times a week OUTSIDE OF EXERCISE your asthma is not well managed. This could mean there is some swelling of the wall of the airways which may need another type of medication. See your GP.

4.      Preventers – these are to help with reducing narrowing due to swelling in the walls of the airways. Commonly a red/brown colour device

5.      Spacers – these are chambers that the puffer fits into. It helps to suspend the medication in the air which means it reaches right into your lungs. If you have puffers and are not using a spacer even with a good technique, you will be swallowing a significant amount. It is no good in your belly!

BREATHING MATTERS

The crux of asthma management is making sure the way you are breathing is not bringing it on...

1.      Mouth breathing – allows vast quantities of dry, unfiltered air straight to your airways. This can trigger spasm of the muscles around your airways – breathe through your nose 100% outside of exercise and during if you can.

2.      Nasal breathing warms, humidifies and filters air – warm up slowly at nose breathing pace before your training sessions.

3.      Post-exercise, come straight back to nasal breathing as many any people experience episodes of asthma after stopping exercise due to continuing to breathe huge amounts of air.

4.      Strengthening your muscles of breathing will make them more efficient – this means less breathing effort and shortness of breath. Inspiratory Muscle Training using a POWERBreathe is available in our Athlete’s Programme at Evolved Physiotherapy and Performance

Lastly, narrowing of the airways by muscle spasm can happen without a diagnosis of asthma, simply by poor breathing habits.

Following the London Olympics a team of physios have been looking at those athletes diagnosed with what was thought to be asthma but now realised to be dysfunctional breathing bringing on similar symptoms.

 So learn how to breathe!

1.      Get into a habit of breathing through your nose at all times. Shut your mouth till you are moving during training or have started your race!

2.      Practice long slow exhale, through your nose – this calms the nervous system and prevents over breathing  ( this is so important with asthma as the most common cause for a flare up is emotional stress – think pre-race!)

3.      Use your diaphragm (belly breathing) rather than upper chest muscles – relax your shoulders.

At Evolved Physiotherapy and Performance, we have a unique service using computer-based assessment software that can

1.      Analyse the chemical component of your breathing i.e. carbon dioxide levels

2.      Assess your respiratory muscle strength and work out a training programme

3.      Offer specific breathing retraining programmes for athletes in any sport

I am also an Asthma Educator with the WA Asthma Foundation and can discuss asthma triggers, explain medications and how to take them and liaise with your GP where necessary.

Let’s hear it for the nose, arguably one of the most ridiculed, surgically altered, digitally explored but underused parts of our anatomy.

I will be explaining why the mouth just doesn’t cut it where breathing (vigorous exercise aside) is concerned and how it can be detrimental to our physical and mental health and even our growth and posture.

Everything about the nose is highly specialised for the delivery of air into our lungs not unlike the mechanism of an air conditioner.

Here’s how the air-conditioner works

1. Warming - If you are a nose bleeder you will know we have a rich blood supply close to the surface helping warm the air.
   
2. Humidifying – Dry inhaled air is moistened by mucus lining the nose. Lungs like warm moist air, especially twitchy, irritable airways ( think asthma)
   
3. Millions of hairs or cilia which filter unwanted irritants in the air line the nasal passages
   
4. Bacteria fighting chemicals and white blood cells do their stuff, including a gas called nitric oxide which kills bacteria and helps with dilating our airways and blood vessels
   
5. The shape of the turbinates ( shelf- like bones)  provides the optimum speed of air flow for all this to take place.
   
6. The resistance we feel breathing out through the nose provides back pressure into our lungs keeping them open and helping with oxygen transfer
   
7. Smell! – Historically those of us with a good sense of smell had a natural selection advantage. Detecting danger, assessing safe foods and even choosing a mate! The nasovaramine organ sitting just in the septum (middle of the nose) is said to detect pheromones. Women chose partners partly on the basis of their smell ( PARTLY, I repeat!)  And the oral contraceptive interferes with this. Now there’s a research project waiting to happen.

THE MOUTH – WHY TAKING THE BYPASS IS NOT ALWAYS THE RIGHT CHOICE

The mouth is very nicely designed for eating, drinking, formation of words, smiling etc.

We use our mouths to breathe under stress where the nose is not providing enough volume and speed. Laughing, crying, vigorous exercise i.e. a handy short term option.

Breathing through the mouth is like travelling straight through on a city bypass. The faster easier
option, path of least resistance.

But if you do this, you will miss all the attractions and benefits offered in the city (nose) as we have already found out.

 Myth -  Mouth = more air = more oxygen   

1. Wrong – At rest, larger mouth breaths will huff out too much carbon dioxide from our bodies. Low carbon dioxide actually leads to less oxygen being delivered to everywhere we need it. Our brain is one area very greedy for oxygen. Brain fog, lack of concentration, difficulty focusing are all symptoms of breathing too much.
   
   
2. Low carbon dioxide also causes smooth muscles to contract – smooth muscle lines all our tubes – gut, airways ( particularly relevant with asthma), and circulatory system.  So our breathing, our digestion and our blood supply to all areas of our body are affected.
   
   
3. Do you remember going to your dentist, having fillings done, being told you will probably need braces when you are a teenager? Now your dentist is much more likely to tell you how being a mouth breather will lead to dry, inflamed gums, plaque, narrow jaw, overcrowded teeth, narrowed airway etc. etc. Nose breathing from birth is essential for normal healthy growth of the jaw. We have 22 bones in our skull, all of which are influenced by the forces of muscles such as our lips and tongue.
   
   

These muscles do not do their job if we mouth breathe. The tongue stays low in the mouth instead of widening the upper jaw, the lower jaw hangs down and back narrowing our upper airway and the roof of our mouth becomes a high arch narrowing our airway above, i.e. our nasal passages. 

Lastly breathing through our mouth affects our head posture. We tend to use muscles in our neck/shoulder/chest area to breathe instead of our main muscle the diaphragm.These upper chest muscles send signals to the brain saying ‘help! Action! We’re in trouble.

Anxiety or busy brain and mouth breathing go hand in hand.

Making the switch can be hard.

Often the resistance we feel when changing from mouth to nose makes us feel we are not getting enough air.

This is a very common reason for many adults and children persisting with mouth breathing, even following surgery to clear the airways (tonsils, adenoids, sinuses).

Guidance and reassurance that you are getting enough oxygen, as well as using the correct breathing muscles is part of breathing re- training.

The health benefits in changing breathing habits go beyond the scope of this blog but hopefully this will be enough to convince you to try!

Summer time in Australia can be particularly problematic for people with asthma. Wood smoke from hazard reduction burns and bush fires contain harmful gases. These include carbon monoxide, nitrogen oxide, carbon dioxide and a range of organic compounds, any of which could irritate sensitive airways and trigger asthma. 

Children, the elderly, and people with asthma and other breathing problems are usually the first to feel the effects of smoke and particle pollution so they need to take extra care during summer.

What can I do to minimise my exposure?  Hazard reduction burns to reduce the threat of bushfires occur in most Australian states and territories in late winter or spring. These are usually publicised through local newspapers and radio and there is often a timetable on the rural fire service (or similar organisation) website for each state.

Tips for staying safe and well  During bushfire season you should:

• Visit your doctor to update your Asthma Action Plan prior to the burn-off/bushfire season.
• When there is smoke from fires in the area, unless you are advised to evacuate you should stay indoors, close all windows and doors and block all air vents and use a filtered air conditioner to circulate air.
• Avoid doing physical activity outdoors when there is smoke around.
• Continue using your preventer medication as prescribed on your written Asthma Action Plan and ensure you have plenty of reliever medication with you at all times.
• Keep an extra reliever puffer with your most precious papers or photographs or evacuation kit to ensure it goes with you if you need to leave suddenly. Do not keep an inhaler in your car as extreme heat may make your medication ineffective. Some medication canisters can also explode under intense heat conditions in cars.

What should I do if I am exposed to bushfire smoke? If you do have to go outside when there is bushfire smoke:

• Stay low to the ground, and wear a face mask or thick cloth that firmly covers your nose and mouth to prevent breathing in a large amount of smoke.
• If you are exposed to smoke and your reliever medication isn’t controlling your asthma symptoms, start asthma first aid and get medical help as soon as you can.

Note: Even after a fire has passed, you still need to be careful as large fires may smother an area with smoke haze for days. After the fire, wear a face mask or cloth, and wet down any dry, dusty areas before doing any cleaning up.

Wheezing, coughing, chest tightness or shortness of breath can occur for several days after smoke is inhaled, so people with asthma and other lung conditions need to very carefully monitor and manage their asthma and seek medical attention if increased symptoms persist.  

Bushfire volunteers, emergency personnel and media representatives  Because of their long and intensive exposure to fire, heat and smoke, many volunteers working in bushfire affected regions have an increased risk of asthma attacks. If you have asthma, make sure other volunteers around you know you have asthma in case you need help. Make sure you take plenty of breaks to get away from smoke and rest indoors wherever possible.

Note: Be especially careful to make sure you have reliever medication with you at all times.

For more information contact your Asthma Foundation on 1800 645 130