Runny Nose (Rhinitis) Linked To Adult-Onset Asthma

The September 2008 issue of The Lancet Medical journal reported a study that showed a link between rhinitis (runny nose in med-speak) and adult-onset asthma. A summary of the journal article is here. What they found by studying various populations in Europe was that adults who suffer from runny noses have an increased risk of getting asthma. The authors of the study concluded, "Rhinitis, even in the absence of atopy, is a powerful predictor of adult-onset asthma." Atopy is a sensitivity to some type of allergen.

This an interesting and not unexpected finding. The Buteyko Breathing method (learn about the Buteyko Breathing method and Professor Konstantin Buteyko) is based on the theory that asthma is caused by overbreathing, or chronic hyperventilation. The theory goes that many people hyperventilate on an ongoing basis (reports have quoted between 5 and 10% of the population show varying signs of hyperventilation). People who are predisposed to getting asthma i.e. they have hypersensitive airways, will in turn respond to this ongoing hyperventilation by developing asthma symptoms. There is a known link between hyperventilation and bronchoconstriction (airway narrowing) - several studies have demonstrated that hyperventilation induces bronchospasm. There have also been studies that show that people with asthma over-breathe. A normal tidal volume (volume of air breathed in one minute) is 3-5 liters per minute. Asthmatics have been shown to breathe anywhere from 10-19 liters of air per minute, and this is not even when they are having an asthma "attack". During an acute asthma episode the volume of air breathed increases even further.

So, there is fairly good evidence to show that asthmatics over-breathe and over-breathing causes airway narrowing. But what on earth does this have to do with runny noses you might ask? Professor Buteyko argued that the airways swell during asthma in order to reduce further carbon dioxide loss (carbon dioxide is blown off when we breathe and over-breathing leads to too much carbon dioxide loss). He described it as a protective mechanism. This theory can be expanded to the nose. Many of us are mouth breathers and mouth breathing encourages hyperventilation as more air can be gulped down by the mouth than through the nose. If you breathe through your mouth, one of the ways your body might respond to the over-breathing this induces is to cause swelling and mucus formation in the nose in order to prevent the loss of more carbon dioxide - your nose blocks so that you cannot lose more carbon dioxide. Unfortunately this also makes it harder to breathe through your nose and so a vicious circle can be set up.

These theories of Buteyko are backed up by some fairly strong studies, but the studies only show a link between reduced breathing and reduced asthma symptoms. They cannot show the mechanism by which this has occurred. So the mechanism I have written about above, courtesy of Professor Buteyko, remains a theory. But it's as good a theory as anything else I have read.

So, rather than wait until your runny nose induces asthma (and obviously this will not occur in everyone), why not fix the runny nose? How? By learning to breathe through your nose and reduce your breathing volume. You probably won't be aware that you are over-breathing and you may not even realise you are a mouth breather, but getting this checked out is easy. Reversing the problem requires a commitment on your part to breathe differently, but it is not difficult, it just requires some focus and time commitment. Learn some new good habits to replace the less healthy ones. Better than asthma drugs, right? Cheaper too. People who already have asthma can reverse it through the same mechanisms. In fact anyone who finds it difficult to breathe through their nose can benefit from learning some strategies for nose clearing, nose breathing and reduced volume breathing. Over-breathing is very common in our society and you may even now be suffering from the symptoms of chronic hyperventilation.

So, where can you go for help? Contact me at Breathingwise Inc (Breathingwise serves Los Angeles and Orange County and nearby areas) or find a Buteyko practitioner in your area.

Legal Disclaimer: Unfortunately, because of the litigious world in which we live, I must remind you that this blog expresses my opinion only. Although my opinion is based on the most up to date, published research I can find, it has still been interpreted by me and remains an opinion, not fact. It takes a very long time for scientific theory to be classified as fact. Theories are 'proven' and 'disproven' for years before consensus is reached. So really, consider everything you read, here or anywhere else, as a theory and as information that may or may not apply to and/or assist you. I suggest you use any information you get here to start a discussion with a knowledgeable, compassionate health professional as to how it relates to your situation. I am not liable for any injury that you suffer supposedly as a result of anything you read here.

Hyperventilation Syndrome Treatment Is Breathing Easy

If you suffer from hyperventilation syndrome you are probably familiar with the symptoms; difficulty breathing; being unable to take a deep breath; sighing and yawning a lot; tingling in hands; pins and needles around the mouth; among other unpleasant and annoying sensations. However you may have found finding appropriate treatment for hyperventilation syndrome a frustrating exercise. Treatment for overbreathing is all about learning to breathe easy!

See my earlier blog posts to learn more about chronic hyperventilation or overbreathing, what it is, what causes it, how to find a breathing disorders specialist and so on.

The aim of treatment is to restore chronically low levels of carbon dioxide and to prevent them getting low during times of stress. This may mean a complete overhaul of your breathing pattern. I have mentioned in earlier postings that many people who hyperventilate breathe using their upper chest muscles instead of their diaphragm. This is very inefficient and ultimately becomes tiring and painful as the rib cage is a heavy thing for small muscles of the chest to be hauling up and down several thousand times a day. You owe it to yourself to learn not to do it! So that's one thing - learn how to breathe with the diaphragm. And for all of you A-type personalities, this includes during those times when you're screaming at your stock broker or traffic has made you late for the meeting. We are not talking about Zen meditation sessions where you lie back and practice diaphragmatic breathing for 20 minutes, we mean learning how to do this 24/7.

Next is learning how to keep your mouth shut. Albert Einstein said "If A equals success, then the formula is: A=X+Y+Z. X is work. Y is play. Z is keep your mouth shut." Now, he may or may not have been only referring to knowing when not to offer your opinion, but I like to think that Einstein, being the smart guy he was, also knew a thing or two about breathing. If you are a habitual mouth breather, and many of you are, then you are probably gulping down too much air. So, another aim of hyperventilation syndrome treatment is learning how to breathe through the nose. Once again, we mean day and night, 24/7, all the time, with possible exceptions for heavy exercise! Your nose cleans, filters, warms and humidifies the air. It even removes some bacteria. Your mouth is just a big wide wind tunnel. Which would you rather have going into your lungs - nose air or mouth air?

Treatment for overbreathing also involves learning how to breathe less. Quiet breathing. Breathing you can't hear and can barely see. Low volume, low rate. Breathing that is just enough for your body's metabolic requirements. Sounds easy, but if you were doing this already then you wouldn't have hyperventilation symptoms. Learning to reduce the volume of ventilation is not an easy thing to do as it involves putting up with some air hunger for awhile. You will need to set aside some practice sessions whereby you perform breathing exercises that induce air hunger. The exercises are not onerous but they do require a committment.

But hey, you want to feel better, right? None of this is difficult, it just requires some motivation and perseverence. A good breathing disorders specialist will help guide you and you will more than likely come out the other end, in just a few weeks, symptom free and less swept up by the stressful events in your life. For more information go to www.breathingwise.com.


Legal Disclaimer: Unfortunately, because of the litigious world in which we live, I must remind you that this blog expresses my opinion only. Although my opinion is based on the most up to date, published research I can find, it has still been interpreted by me and remains an opinion, not fact. It takes a very long time for scientific theory to be classified as fact. Theories are usually 'proven' and 'disproven' for years before consensus is reached. So really, consider everything you read, here or anywhere else, as a theory and as information that may or may not apply to and/or assist you. I suggest you use any information you get here to start a discussion with a knowledgeable, compassionate health professional as to how it relates to your situation. I am not liable for any injury that you suffer supposedly as a result of anything you read here.

Chronic Hyperventilation Treatment Is A Rare and Wonderful Thing

Chronic Hyperventilation treatment really is a rare and wonderful thing. It is rare because there are few practitioners that know how to treat this breathing disorder and wonderful because treatment when you can get it is life altering.

The symptoms of chronic hyperventilation are unpleasant but not usually life threatening by themselves. However the uncomfortable sensations of dizziness, inability to take a deep breath, pins and needles and chest pain (among others) do tend to worsen over time. Eventually you start to feel desperate because no one can tell you what is wrong with you and no one can offer you much help or advice. You might have been told you are simply suffering from anxiety or panic disorder (not that there's anything simple about either of those things) or that the problem is something that will probably just go away. Unlikely!

So, if you are one of the lucky(?) ones who has somehow figured out that overbreathing might be what ails you, then help is at hand if you know where to look for it.

The first thing to do is go online and look for practitioners in your area who specialize in breathing disorders. Most Buteyko breathing practitioners will have knowledge and experience with chronic hyperventilation treatment and they are listed on the web. Physiotherapists can also help, but check that they have a specialist interest in breathing disorders. Physiotherapists and physical therapists specialize in a variety of areas and not all will be versed in this area. Some chiropractors and massage therapists can also help but once again, check if they have expertise in managing overbreathing and other breathing disorders. Chronic hyperventilation treatment is no laughing matter so as with most things, you want to make sure you find someone who knows what they are talking about. You might even ask a practitioner if they'll give you your money back if you're not satisfied after an initial consultation. Most will, as they will want to be confident themselves that they can help you or they will not want to charge you.

What can you expect from chronic hyperventilation treatment? It will vary. In my clinic I go through a very thorough assessment process so that I can be confident that it is pure chronic hyperventilation and not some other cause for your distress. This involves some extensive questioning and the completion of an internationally validated assessment tool called the Nijmegen Questionnaire. I will also want to know what investigations you have had and what other disorders have been ruled out. There is no single diagnostic process for chronic hyperventilation syndrome, it is more a matter of assessing all the information and ruling other things out.

Then comes a physical assessment of your breathing rate and pattern: How do you breathe? How fast do you breathe? What is your heart rate? What is your carbon dioxide level (I have a capnometer that measures this)? Is your breathing pattern an upper chest pattern? Do you use your diaphragm when you breathe at rest? Is your breathing rate regular or irregular? Do you sigh and/or yawn a lot (i.e. am I boring you? Just kidding, this is actually an important diagnostic indicator).

There are a variety of things a practitioner should look at in order to properly assess what your problem is and how it can best be approached in terms of chronic hyperventilation treatment. A thorough assessment and explanation is something you should certainly expect and feel confident about. If this does not occur, politely excuse yourself and do not return! I am sure by the time you have been told that overbreathing or chronic hyperventilation syndrome might be what is troubling you then you are in no mood to waste your time or money with ineffective treatment. This doesn't mean however that the practitioner can do the work for you. No sirree Bob. In order to treat the overbreathing you are going to have to commit to doing a few things yourself!

Next blog post I will talk more about what you might expect with chronic hyperventilation treatment.

Legal Disclaimer: Unfortunately, because of the litigious world in which we live, I must remind you that this blog expresses my opinion only. Although my opinion is based on the most up to date, published research I can find, it has still been interpreted by me and remains an opinion, not fact. It takes a very long time for scientific theory to be classified as fact. Theories are usually 'proven' and 'disproven' for years before consensus is reached. So really, consider everything you read, here or anywhere else, as a theory and as information that may or may not apply to and/or assist you. I suggest you use any information you get here to start a discussion with a knowledgeable, compassionate health professional as to how it relates to your situation. I am not liable for any injury that you suffer supposedly as a result of anything you read here.

Why is carbon dioxide so important?

It's ironic, really. Scientists tell us the planet is generating too much carbon dioxide (CO2) and here's me telling you many of us are retaining too little of it in our bodies. Perhaps there's some sort of "trade" deal big breathers can do with big industry!

If you read my last two blog posts you will have discovered that many people (at least 10% of the general population and probably almost everyone who has been diagnosed with asthma), overbreathe to some extent and suffer unpleasant symptoms as a consequence. Breathing more than the body needs for its metabolic requirements blows off too much carbon dioxide. Usually this overbreathing is not noticeable to an untrained observer and it is therefore often referred to as hidden hyperventilation. An overbreather is not sitting in a chair with heaving bosom or panting like a dog in summer, but he or she is likely to be heavy sighing or yawning a lot. So why does it matter if we breathe a little more than is necessary?

Ultimately this means your body keeps less of the CO2 it needs. CO2 is a waste gas i.e. it is an end product of metabolism, but it is a very important waste gas and it affects the functioning of all our bodily processes. "Carbon dioxide is the chief hormone of the entire body, it is the only one that is produced by every tissue and that probably acts on every organ." This quote is by Dr. Yandell Henderson from the Cyclopedia of Medicine, 1940, and it holds true today.

Our brain instructs us to breathe based on the levels of carbon dioxide in the blood and alveoli. If you hold your breath and swim underwater, eventually you feel a strong urge to breathe. It seems as though this is because you are short of oxygen. In reality it is the build up of carbon dioxide that triggers the respiratory center in your brain to say "Breathe, for goodness sake!" Your blood level of oxygen has to become very low (think asphyxia) before this will stimulate your respiratory drive. So if the level of carbon dioxide goes below what the brain's respiratory center perceives as normal, it will tell you to breathe less (i.e. stop blowing off more CO2). Conversely, if you hold your breath and let CO2 build up (there are other things that will also cause a build up of CO2 but we won't go into them here), then this also registers with the respiratory center and it tells you to breathe more. The respiratory center acts like a thermostat. Many of us have been quietly overbreathing (or perhaps noisily overbreathing in the case of asthma) for so long that the respiratory center has readjusted its thermostat to consider a lower level of CO2 as normal. It now feels normal for us to be pumping air in and out of the lungs at an increased rate and we maintain this low level of CO2. I talked about this in my last blog post.

Because CO2 is such an important gas, a lack of it is not without consequences. It is carbon dioxide that tells hemoglobin to release oxygen to the tissues. If you have a low level of CO2, hemoglobin will hang onto its oxygen molecules (this is called the Bohr effect) and your cells and tissues, including the brain, will suffer from a lack of vital oxygen.

CO2 is carried in the body as carbonic acid. If we lose it (breathe too much out), we have relatively less acid and the body's pH rises (becomes more alkaline). This causes some acute biochemical changes and is the reason why people who overbreathe often report pins and needles in their arms and around the mouth, muscle twitching and generalized weakness and muscle fatigue.

Just in case you hadn't heard enough, CO2 is also a very powerful dilator, or relaxer, of blood vessels and other smooth muscle e.g. breathing tubes. So once again, if you have low CO2 your body will respond by constricting these vessels. This will affect blood flow to the brain and heart, and air flow in and out of the lungs. You might experience chest pain and palpitations, faintness or dizziness (remember the blood is already not releasing as much oxygen and you're also not delivering as much blood as the vessels are squeezed), visual disturbances and auras, as well as air hunger and perhaps wheezing.

A lack of CO2 also stimulates cells in the lungs to produce more mucus. This may be a defence mechanism the body mounts in order to stop the further loss of CO2, but if you have asthma and are suffering from narrow airways, then an increase in mucus production is not helpful.

So this is why breathing too much does not in fact provide you with a lot of nice extra oxygen. Indeed it has the opposite effect and a handful of other unpleasant side effects as well. These hyperventilatory effects mimic other disorders (heart disease, migraine, for example). So it is often the case that people are sent from doctor to doctor, only to have these other possible causes ruled out, and are then labelled "anxious". Because of course anxiety does cause overbreathing, just as overbreathing can make us anxious! This is an unhelpful diagnosis for what is essentially a "diet" deficient in CO2 and there is something you can do about it beyond taking anti-anxiety medication. Breathe less!

I say that like it is a simple matter, but in fact it is not easy to reverse an ongoing habit, especially one related to your breathing, and you will need help. More about what you can do next time.

Legal Disclaimer: Unfortunately, because of the litigious world in which we live, I must remind you that this blog expresses my opinion only. Although my opinion is based on the most up to date, published research I can find, it has still been interpreted by me and remains an opinion, not fact. It takes a very long time for scientific theory to be classified as fact. Theories are 'proven' and 'disproven' for years before consensus is reached. So really, consider everything you read, here or anywhere else, as a theory and as information that may or may not apply to and/or assist you. I suggest you use any information you get here to start a discussion with a knowledgeable, compassionate health professional as to how it relates to your situation. I am not liable for any injury that you suffer supposedly as a result of anything you read here.

Why Do I Overbreathe?

Last time I talked about chronic Hyperventilation Syndrome and its symptoms. Why do people become chronic over-breathers? It's a good question. The answer is, no one really knows for sure, but there are some good theories.

Firstly, like anything, there is probably some nature as well as some nurture involved. Our genes dictate, to some extent, whether or not we will develop certain health problems. For example, there is a large study underway by the COPD Research Registry called the COPD Gene study. It aims to determine why some smokers (about 10-20%) develop chronic lung disease and others do not. The theory is that the answer lies in nature and the genes we are encoded with.

For chronic Hyperventilation Syndrome, it is likely that some people, given certain triggers or life events, will have a tendency to over-breathe (perhaps others will get skin rashes, or stomach ulcers, or maybe they are all linked in some way - we do not really know).

With Hyperventilation Syndrome there seems to be a tendency to breathe with the upper chest rather than the diaphragm. Many people find diaphragmatic breathing difficult, even though it is the most energy-efficient means of quiet breathing. So, we have a genetic predisposition to overbreathe, and a tendency to not engage the diaphragm effectively.

Then there is usually some sort of stressor, or trigger, that sets off the symptoms. Hyperventilation Syndrome tends not to turn up overnight, like an unwelcome visitor, and stay forever. Usually the "visitor" sends warning signs to indicate they might be planning a visit, then they show up for a few days, until eventually they've moved in permanently and you don't know how it happened! In other words the symptoms start by being intermittent and only vaguely annoying and gradually get worse until they become quite frequent.

It is thought that stress, or an unresolved or ongoing distressing situation, may be a trigger in many people. We have always had stress in our lives, but with our modern existence becoming increasingly sedentary, this stress has a different impact.

We used to worry about finding enough food to eat and fending off predators or other groups competing for the same resources. This was certainly stressful, but it also involved physical activity. So with the stress came the 'fight or flight' response and an increase in breathing. But then we went off to fight the good fight and metabolically we needed the extra breathing in order to perform the tasks ahead of us.

Today, unfortunately, a lot of our stress comes from being in traffic, or while we're at work on the computer, or otherwise sitting around worrying about all the things we have to worry about. We have so many labor-saving devices, the increase in breathing that comes naturally with stress and worry is not matched with an increase in output. It's a little like getting all dressed up for the date that doesn't show.

Now, imagine months or even years of this. One thing after another. Eventually, the brain thinks "Now hang on, this body that I'm in charge of keeps breathing at this crazy level and blowing off all this carbon dioxide. I'm going to re-set the carbon dioxide 'thermostat' to a new lowered level. Let's make this the new 'normal' and keep instructing the lungs to breathe at this rate in order to maintain this new level. This body seems to like it, after all, or it wouldn't be doing it so much!". Bingo, we have symptoms that are with us a lot and we don't feel so good. This of course means more stress, as it's highly likely no one can tell you why you don't feel so good. Is it heart disease? Is it cancer? Oh dear, this is stressful. And on we breathe..........

And that, in a nutshell, is one of the main theories behind why some people (and it's a very conservatively estimated 10% of us) learn to over-breathe all the time and why others do not -although I would suggest that if any of us worked hard at it for long enough we could all achieve it.

Next time I think I'll answer the question "So what if I have low carbon dioxide and I breathe more than the next person?". Surely that means more oxygen, right? Maybe it's a good thing? Aaaaaah.... no! Remember, you can go to http://www.breathingwise.com/ for more information.

Legal Disclaimer: Unfortunately, because of the litigious world in which we live, I must remind you that this blog expresses my opinion only. Although my opinion is based on the most up to date, published research I can find, it has still been interpreted by me and remains an opinion, not fact. It takes a very long time for scientific theory to be classified as fact. Theories are 'proven' and 'disproven' for years before consensus is reached. So really, consider everything you read, here or anywhere else, as a theory and as information that may or may not apply to and/or assist you. I suggest you use any information you get here to start a discussion with a knowledgeable, compassionate health professional as to how it relates to your situation. I am not liable for any injury that you suffer supposedly as a result of anything you read here.

Hyperventilation Symptoms

Most people would recognize an acute hyperventilation attack when they witnessed or suffered one, but many of us overbreathe all the time without even knowing it. Hyperventilation symptoms in a person who has a chronic, or ongoing, pattern of overbreathing differ somewhat from an acute hyperventilation episode.

What is the difference between acute and chronic hyperventilation? In an acute attack the sufferer is usually breathing very rapidly and is in an obvious anxious or panicked state - the sympathetic nervous system is operating under 'fight or flight ' conditions. Conversely, with chronic hyperventilation the sufferer does not look like they are breathing hard or fast, at least to an untrained eye. Commonly they will yawn or heavy sigh a lot and it is these deep breaths, with only a slightly elevated breathing rate, that can maintain someone in a state of chronic hyperventilation.

What does it mean to hyperventilate, or overbreathe, all the time? When we breathe more than the body needs (to meet its metabolic requirements at any particular time), we blow off too much carbon dioxide. This alters the body's pH or acid-alkaline balance. Carbon dioxide is acid so by reducing the levels in the body, it becomes more alkaline. When this occurs because of an increased breathing rate or depth, it is called respiratory alkalosis. This sets up a biochemical imbalance that produces some disturbing symptoms.

Hyperventilation Symptoms:
NB: Many of the symptoms of acute and chronic hyperventilation are the same, it is the lack of obvious overbreathing or distress with chronic hyperventilation that often has doctors searching erroneously for other diagnoses.

• Dizziness, confusion, unexplained fatigue, weakness ( these are common presentations because low CO2 reduces blood flow to the brain).
• Tingling or numbness, especially around the mouth or in the hands, due to nerve hypersensitivity from the biochemical imbalance.
• Chest pain - your chest may feel sore. The chest pain may feel like angina but in this case it is usually relieved by exercise and not relieved by nitroglycerin.
• Frequent yawning and sighing as mentioned above.
• Air 'hunger' and feeling like you cannot take a deep breath or 'get your breath'.
• Poor exercise tolerance. You may get breathless much more easily and your legs ache and feel weak upon exercise - this is because your body is retaining lactic acid in order to counter the prevailing alkaline environment.
• You may have an upset or sore stomach probably due to swallowing air.
• Phobic reactions to certain places or events that have brought on symptoms in the past are common. This can lead to frequent panic episodes with more acute hyperventilatory type symptoms.

All of these hyperventilation symptoms are typical in people who routinely overbreathe. So, why is chronic Hyperventilation Syndrome so seldom diagnosed and talked about? Especially since medical studies have estimated that up to 10% of the otherwise healthy population suffer from chronic hyperventilation to some degree. People with asthma and COPD are also prone to overbreathing. That's a lot of people wandering around out there, breathing more than they need to be. Many of them are also wondering why they feel so bad as their doctors have found nothing wrong or told them they are suffering 'anxiety'.

Certainly the symptoms of Hyerperventilation Syndrome alone are enough to make one anxious, but in most cases the overbreathing precedes the panic and worry. Dr Claude Lum, a British chest physician who wrote extensively about chronic hyperventilation said that one of the diagnostic clues to this disorder was 'fat folder syndrome' - anyone with a fat case file and no obvious organic disease but symptoms that include some of those listed above, should be considered a prime candidate for a diagnosis of chronic Hyperventilation Syndrome.

If this is you, I suggest you contact your doctor to talk about this. You can also visit www.breathingwise.com for more information. Chronic hyperventilation is not usually life threatening, but it is unpleasant and you can be helped. Treatment is relatively straightforward and involves learning to breathe in a different way and manage your stress levels so that your breathing doesn't take over when life starts to get a little rugged...or someone cuts you off in traffic....or your colleague sends you a nasty email.... but more about that next time! There is a lot more to learn about hyperventilation syndrome and I'll cover it in my next few blog posts.

Legal Disclaimer: Unfortunately, because of the litigious world in which we live, I must remind you that this blog expresses my opinion only. Although my opinion is based on the most up to date, published research I can find, it has still been interpreted by me and remains an opinion, not fact. It takes a very long time for scientific theory to be classified as fact. Theories are 'proven' and 'disproven' for years before consensus is reached. So really, consider everything you read, here or anywhere else, as a theory and as information that may or may not apply to and/or assist you. I suggest you use any information you get here to start a discussion with a knowledgeable, compassionate health professional as to how it relates to your situation. I am not liable for any injury that you suffer supposedly as a result of anything you read here.