by: Peter Kolb BSc(Eng), MSc(Med), CPEng(Biomed) Biomedical Engineer

12 October 1996

Disclaimer:

I declare that I have no interest in or connection with the Buteyko Group, financial or otherwise. I am not a member of any Buteyko Society and the information below is being provided entirely on a voluntary basis. I also have no training as a Buteyko practitioner nor as a medical doctor.

This is not intended to be a DIY manual. While I'm happy to describe what I learned at the Buteyko Clinic for the benefit of those readers who do not have access to a therapist, I will not accept any liability for accidents which might happen to DIY experimenters. You are urged to consult your doctor about anything described in this document which you intend to try.

Peter Kolb

My 15 year old son was a chronic asthmatic up to about 2 years ago. He was on steroids, Intal (Sodium Cromoglycate) and was taking at least 8 puffs of Ventolin a day. He required occasional hospitalisation, and a nebuliser at certain times of the year.

I was sceptical when I heard about Buteyko, but asked the clinic to send me a scientific paper on Buteyko's work. This they did.

I was impressed with the thoroughness and consistency with which Buteyko addressed the fundamental biochemical basis for his theory, all of which looked extremely plausible. So I booked Alex into the course.

The clinic was arranged over one week for a few hours every evening. The Russian presenter had been telling us that the first rule was to breathe through the nose and not the mouth. After a while he quite bluntly picked on Alex for sitting there open mouthed. I interrupted him and told him that Alex had never been able to breathe through his nose and he was being unrealistic. I recalled a few months earlier how Alex had told me: "Dad, just for once I wish I could breathe through my nose like everybody else."

On top of that, I knew that Alex had a different kind of asthma, one that was not caused by hyperventilation. His asthma was caused by allergy. As far as I was concerned the instructor could get the whole of the KGB to jump on him, but he would'nt get a breath of air through his nose.

The Russian clinician quickly rounded up all the youngsters (about half a dozen) in the same condition. They disappeared for about ten minutes and all came back with mouths closed and breathing normally through their noses. He explained that they had done Buteyko breathing exercises and that the nasal passages were part of the respiratory system and responded to the treatment in the same way as the lungs did.

Since that evening Alex has never touched another puff of Ventolin. He gradually weaned himself off the Steroids and has had no more medication and now has no more asthma attacks. He also doesn't need to do any more exercises.

THE BUTEYKO THEORY:

Buteyko theory on asthma is that it is a condition of chronic hyperventilation. This is not the same as plain old "hyperventilation", which is recognised as one of the triggers for an asthma attack. Chronic hyperventilation is a breathing pathology characterised by excessive breathing ALL THE TIME. The term was coined to describe a condition which western medicine does not yet recognise and therefore has no other way of describing. Unfortunately the term is causing a lot of difficulty, so it would probably be better to call the condition one of "over-breathing".

Now your doctor, in all likelihood, won't agree that there is such a condition. Current western medical thinking insists on looking only at the asthma triggers. It took the renegade Professor Buteyko to look beyond the triggers at the biochemistry of the asthma condition to find the actual root cause of asthma. His theory answers questions that your practitioner will in all probability not be able to answer satisfactorily. Questions such as:

PRINCIPLE:

Your lungs play a major role in the regulation of the acidity of your blood by carefully controlling the release of Carbon dioxide. There are many other mechanisms involved as well, but seeing that the lungs actually get rid off the stuff to the outside world, the lungs form a very important part in this process. If you're breathing too much, then you're getting rid of too much carbon dioxide. Then, according to Buteyko, your bronchioles close up to conserve Carbon Dioxide. Smooth muscle, such as is found in the Bronchioles, is known to contract under conditions of low Carbon Dioxide.

Buteyko tells us that with the asthmatic the problem has developed over time and so the long term compensating mechanisms (such as is performed by the kidneys) have already taken over. In other words your system has latched up into an unphysiological state. The bronchioles continue to stay constricted to conserve carbon dioxide. This means that you have a restricted capacity to accommodate moment to moment variations in breathing. A little extra breathing as would be caused by hyperventilating, emotional stress, anxiety, exercise etc. will cause you to blow off even more Carbon dioxide making your bronchioles go into spasm. Allergens that cause swelling of the lung linings will obviously also have this effect.

And when you're having an attack you obviously can't breathe more because you would be blowing off even more Carbon dioxide thereby aggravating an already bad situation.

To make matters worse, low blood Carbon Dioxide results in poor oxygenation of the tissues and you develop a hunger for oxygen. That means you breathe even more and so the cycle maintains itself.

How does swimming help? Well, in the case of swimming you have restricted breathing. Much of the time your head is under water and so you can't breathe as much as you want. Underwater swimming would probably be best of all because you have to hold your breath for longer periods.

Young asthmatics spontaneously revert to normal breathing as they develop. That's how they grow out of it.

So what is the solution?

Our Buteyko therapist taught us to breathe less. We were told that when you're having an attack you should fight the urge to grab more air and breathe less. Try to focus on breathing less and develop a hunger for air. Eventually, with breath holding exercises and a massive effort at stifling your breathing, you should be able to snap out of latch up mode and your body will restore itself and adapt to a normal respiratory pattern, according to Buteyko theory.

Because a number of long term compensation mechanisms have to be restored to normal, the healing process may take some time.

TREATMENT:

You will obtain far more benefit attending a Buteyko clinic rather than trying it on your own. You are urged to avail yourself of a Buteyko clinic if you have one nearby. Unfortunately Buteyko therapy is in its infancy in the west, so you might never have an opportunity to attend one.

There are several reasons why a clinic will give you far greater benefit than a DIY approach.

  1. Buteyko exercises are easy to explain but hard to do. A trained observer will quickly tell you where you're going wrong, giving you immediate feedback.

  2. Chances are you'll toss this page into a cupboard and promise to read it when you have time...... one day. A clinic will help you overcome the major hurdle, viz. getting started.

  3. A wealth of experience has developed over the past decades of teaching people correct breathing. This experience is available to you from your practitioner. He will colour the technique for you with anecdotes, and answer your questions as they arise. Most of us are sceptical to begin with, because the theory contradicts so many of the ideas we have grown up with. A good therapist will be able to provide answers to these concerns for you.

  4. You meet other people at these classes and will find enormous help from the mutual support on offer. The importance of this mutual support cannot be over-stated.

Buteyko Clinics usually give a money back guarantee based on certain mutually agreed criteria. They usually also give you free follow up treatment. This is particularly useful for those who have difficulty with the discipline of performing the exercises. Check first, though, to make sure your practitioner provides these undertakings.

The following is what I recollect being taught at the clinic:

Everything revolves around conserving Carbon Dioxide. This, of course, simply means breath holding and slow, shallow breathing.

  1. ALWAYS BREATHE THROUGH THE NOSE!!!

    Now I can already hear you ask "How can I breathe through a blocked nose?" Well, of course you can't, but you can unblock your nose with Buteyko Exercises. do not use decongestants. Your nose is telling you that you're breathing too much.

    If your nose is chronically blocked through asthma, perform the breath holding and shallow breathing exercises discussed below. You may have to experiment, but it should be possible to open up an asthmatic nose without too much trouble.

  2. Make a conscious effort always to cut down on breathing. Remember, the respiratory centre has to be re-trained and this could take months. Don't concern yourself with any particular breathing pattern. Just focus on breathing less whenever you think of it. Stifle that desire to gasp for air.

  3. Keep on with Steroids and any other asthma preventing medication. Take your steroids when you are free of any impending attack because application of the steroids can actually trigger an attack. Only when you really feel you can (usually after 2 to 3 months), start cutting down very gradually. But always go back to your steroids if necessary. Steroids are beneficial.

    Make sure you adjust the steroid dose IN CONSULTATION WITH YOUR DOCTOR.

    Buoyed by initial dramatic successes, many patients get off their steroids too soon and then have a dramatic relapse in which they find the Buteyko exercises don't work so well any more. At that point it is easy to give up and return to overdosing on Ventolin.

  4. Cut back on Ventolin. Use it as a last resort on an "AS REQUIRED BASIS". You won't need your doctor's permission for that. He'll be happy if you use less. Your Ventolin use will be dramatically cut right from the beginning by doing breath holding exercises.

The following exercises are the basis for the technique.

WARNING: these exercises are not pleasant to do. If they feel pleasant then you are doing them incorrectly.

WARNING: YOU SHOULD CONSULT WITH YOUR DOCTOR TO CHECK THAT YOU ARE FIT TO DO THESE EXERCISES.

While he is unlikely to agree with the principle, he is in a position to judge whether or not you run any risks from doing these exercises.

If you are advised not to perform these exercises then you will have to just focus on breathing less. This alone should help you gradually cut down on your use of Ventolin.

TO WARD OFF AN ONCOMING ATTACK:

Breathe normally and then at the END OF EXPIRATION hold your breath right there for as long as you can stand it. When you eventually recover your breath, do so gradually, using little breaths, without gasping. You must feel starved of air! Relax for a few minutes, just breathing in a shallow fashion, as little as possible, stifling that desire to gasp for air, and then repeat the exercise when you have recovered, perhaps 5 to 10 minutes later. The time between exercises is productively spent practicing the art of breathing less.

You will find that the attack goes away, only to come back a short while later. Then just repeat the exercise as often as the attack returns. Over a few days you will find this will get much easier because the attacks get less severe and less persistent.

If you do not get adequate relief you can always use the Ventolin, but make sure you remain focused on breathing as little as possible.

EXERCISES TO BE PERFORMED SEVERAL TIMES A DAY:

Exactly as above. But when an attack is not imminent, you can probably push yourself a little harder. While you hold your breath to the limit, distract yourself by moving around.

CHECK TO SEE HOW YOU'RE DOING:

Progress can be monitored by what the clinic calls a CONTROL PERIOD. What you do is time yourself while holding your breath for as long as is reasonably comfortable. This period should increase over the weeks as you perform your exercises. Do this in between doing the exercises. (Again, check with your doctor before doing Control Period)

MONITOR YOUR PROGRESS:

Keep a log of your exercises. Keep a record of how often the Buteyko technique has successfully warded off an attack, how much Ventolin you're using and the CONTROL PERIOD. Start your log before you actually start doing the exercises so that you have a baseline to work from. You will find that this log gives you confidence and support when you struggle through those dreadful exercises.

MOUTH TAPING:

Taping the mouth with micropore surgical tape is sometimes necessary to prevent yourself breathing through the mouth at night. You must breathe through your nose, even in your sleep! This usually follows automatically from doing the exercises.

CHILDREN:

The technique is adapted for children by getting them to do physical exercise while holding their breath. They walk normally while holding their breath (after normal expiration) and then monitor to see how many steps they can take. An adult would walk with them to encourage them and check that they're not cheating. The Control Period is similarly adapted. You would record the number of steps they take while they are still reasonably comfortable.

Exercise is not normally recommended while breath-holding because respiration helps pump blood into the atria of the heart. So you should check with your doctor that you don't have any contra-indications. (Remember though, he will probably be unsympathetic to the treatment.)

This is how the youngsters were relieved of chronically blocked noses. They were told to hold their breath at end of normal expiration and then do as many "Squats" as they could. They then relaxed and resumed normal, but stifled shallow breathing. The build up of Carbon Dioxide just opened up the nasal passages. (I did'nt believe it either until my son came to sit next to me with his mouth firmly shut and breathing through his nose for the first time in many years.)

CURE?

The Buteyko clinics are apparently not selling this as a cure, the reason being that they cannot guarantee that a fresh cycle of chronic over breathing won't be triggered at some future event. Personally I think their definition of "cure" is a bit narrow. Buteyko treats the underlying cause of asthma. If the treatment is properly implemented, then both the symptoms and the need for medication disappear. This clearly needs to be differentiated from symptomatic treatment provided by Bronchodilators.

If this is not a cure, then what is? His theory is plausible and his treatment works.

HOW CAN YOU HELP?

There is evidence that the medical profession is reluctant to embrace Buteyko Therapy. The movement spread in Russia because of pressure from patients, in spite of opposition from the medical profession.

You can help by spreading this information. Talk about it with friends and get back to the Asthma support group with your experiences. Help others by supporting them through those difficult times when they're struggling with their exercises.

Peter Kolb, Biomedical Engineer

[email protected]
Telephone: 61-8-9293-5414 (Western Australia)
FAX: 61-8-9293-5407

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