Breathing Exercises for COPD: Increase Alveolar CO2 and Cell O2

Breathing exercises for COPD are vital since acute COPD exacerbations are always accompanied by increased lungs ventilation: breathing becomes faster and usually deeper. Studies also show that COPD patients have heavy breathing at rest before acute exacerbations, when they are in stable conditions.

Table. Hyperventilation in COPD

Condition	Minute ventilation	Number of people	Prevalence of CHVS	All references or click below for abstracts
Normal breathing	6 l/min	-	0 %	Medical textbooks
Healthy Subjects	6-7 l/min	>400	0 %	Results of 14 studies
COPD	14 (±2) l/min	12	100%	Palange et al, 2001
COPD	12 (±2) l/min	10	100%	Sinderby et al, 2001
COPD	14 l/min	3	100%	Stulbarg et al, 2001

Man with acute COPD exacerbation It is clear then that increased ventilation reduces alveolar CO2, while CO2 is a powerful bronchodilator. As a result, overbreathing further reduces CO2 levels in airways, causes bronchospasm, increased friction of air moving in constricted airways, extra mucus production (that further worsens air movement), increased hypoxemia, and reduced oxygen levels in cells. Furthermore, studies have found injurious effects of alveolar hypocapnia (low CO2 in the lungs): see links below. Therefore, it is not a surprise that severity of acute COPD exacerbations can be greatly reduced if the patient slows down their breathing and accumulates CO2 in airways in order to expand them. It is called Buteyko reduced breathing exercise and it can be found in the Section "Learn here".

MDs smiling Another option of breathing exercises for COPD is to increase alveolar CO2 using a breathing device. This clinical trial evaluated the effects of breathing exercises with the Frolov breathing device on acute exacerbation of COPD in hospitalized patients (after the exacerbation) with a moderate degree of the disease. (Over 500 medical doctors endorse and apply the Frolov breathing device in Russia.)

Breathing exercises for COPD patients (from 10 up to 30 min per day maximum) were continued after their discharge from the hospital. The therapy was used in addition to standard medication. Final measurements (lung function tests) were done after 90 days of breathing exercises. Here is a partial translation of this medical study.

Can breathing exercises for COPD normalize lung function test results?

After testing hundreds of people with COPD, Russian Buteyko MDs suggested that COPD patients require more than 20 seconds for the body oxygen test in order to prevent acute COPD exacerbations and improve their fitness and symptoms. However, if people with COPD get more than 40 seconds they can achieve clinical remission with normal lung function results. They need to slow down their heavy breathing back to the medical norm. This requires breathing exercises and lifestyle changes (see "Learn" Section). Here is a study about the effects of breathing exercises only.

Clinical Investigation of Frolov Breathing Device (TDI-01) in Complex Therapy

of Patients with Chronic Obstructive Pulmonary Disease

Scientific Research Institute of Physiology, Siberian Division, Russian Academy of Medical Sciences
Sergey Georgievich Krivoschekov, MD, PhD, Professor, Manager of the Laboratory of Functional Reserves of the Human Organism
Irina Vladimirovna Savitskaya, MD, Chief Physician of the Clinic of the Institute of Physiology

(Siberian Division, Russian Academy of Medical Sciences)
Olga Vladimirovna Gilinskaya, MD, Pulmonary Physician

This controlled randomized study was conducted from March 10, 1998 to May 15, 2000. The objectives of the research were:
- to investigate the influence of the individual device TDI-01 (Frolov breathing device) exercises on the respiratory system of patients with COPD
- to compare efficiency and safety of this therapy for this group of patients
- to investigate the possibility of reduction (elimination) of medication as a result of the Frolov breathing exercises therapy
- to investigate criteria of efficiency and safety of the method.

Experimental group

Woman coughing The experimental group had 40 hospitalized patients with COPD of moderate severity, 55-60 years old, with COPD duration from 5 to 8 years. (This was a group of typical COPD patients.)

The initial duration of breathing exercises was 10 minutes with 1 additional minute increase after each 2 days. On the 42nd day, the duration of the breathing exercises was 30 min and then it remained unchanged until the end of the study (day 90). Initial duration of the breathing cycle was 4-7 seconds and after the patients achieved 30 s, it was suggested to keep it unchanged.

All patients were discharged from the hospital on the 18th day. Their medication reduction (day 18) was 20%. Additional investigations were conducted on days 42, 60 and 90. By day 90, the medication dose was about 40% from the initial dose (a 60% reduction). The results of lung function and other tests are provided below (see the Table).

Control group

The control group had 42 patients with COPD of moderate severity, 55-60 years old, duration of the disease was from 4.7 to 9.2 years.

These patients did not practice breathing exercises and were also discharged from the hospital on the 18th day. Reduction in medication: 10% at the time of their discharge from the hospital and 30-40% at days 60 and 90.

Conclusions
The respiratory system 1. During investigation of the Frolov breathing device therapy (TDI-01) on patients with COPD (stable state, moderate severity), there were no complications or side effects which could be dangerous for health. Clinical observations showed the safety of its application. This can be explained by that fact that this method is drug-free and is based on activation of physiological processes.

2. Breathing exercises with the TDI-01 have a positive effect on the lung function test in COPD and this effect increases with the duration of the therapy and duration of the breathing cycle.

3. The most informative parameters of effectiveness and control during application of the TDI-01 for patients with COPD are: FEV1 (forced expiratory volume in 1 second); RV (residual volume); EVC (expiratory vital capacity); FEV\FVC, end tidal O2, and end-tidal CO2.

4. The TDI-01 therapy for patients with COPD (stable state, moderate severity) is effective and this has been confirmed by better lung function tests and reduction in medication for patients of the experimental group in comparison with patients of the control group who had only medication therapy.

5. The positive effect of the TDI-01 lung function test results in patients with COPD could be explained by positive air pressure during exhalations and improved bronchial conductivity.

6. One of the positive effects of the TDI-01 is a favorable positive effect of systematic breathing exercises, and this improves the respiratory function at rest and during exercise.

Lungs alveoli 7. During systematic application of the TDI-01, there is an improvement in ventilation-perfusion parameters, optimization of gas exchange, long-term adaptation to systematic training in conditions of alveolar hypoxia / hypercapnia. This simultaneously helps the anti-infective host defense, increased resistance of the organism, and stable improvements in the health of patients with reduction in medication.

8. Application of the TDI-01 for patients with COPD is economically effective and can be used in hospitals, clinics, and rehabilitation centers.

9. Effective application of the TDI-01 for treatment of patients with moderate severity of COPD shows its effectiveness for patients with light severity of COPD.

Dynamics of Lung Function Parameters in Patients with
COPD (Control and Experimental Groups)

Parameter	Group	Initial	Day 22	Day 42	Day 60	Day 90
VC
	Control	62,1±1,8	62,8±1,9	63,9±2,2	64,8±2,4	65,4±3,7
	Experimental	61,3±1,6	61,3±1,2	65,8 ±1,2	67,1±1,4	67,9±1,3
FEV1	Control	61,6±2,4	63,0±3,	64,2±2,9	65,5±4,2	66,2±6,1
FEV1	Experimental	62,1 ±2,1	64,6 ±1,8	66,9±1,6	67,2±1,7	67,7±2,3
PEF	Control	46,9±5,9	51,1±5,5	55,2±6,0	57,3±6,2	60,9±7,5
PEF	Experimental	47,5±5,4	53,9±5,3	58,2±5,8	60,1±5,2	63,4±5,1
RV	Control	132,2±5,7	128,1±4,3	125,5±5,3	122,2±5,8	119,0±6,4
RV	Experimental	130,9±5,1	122,8±4,6	117,5±3,2	115,8±3,5	113,2±3,8
TLC	Control	107,3±7,4	106,5±7,2	105,3±6,8	104,9±7,2	104,2±8,1
TLC	Experimental	106,9±7,8	105,1±6,9	104,9±5,8	104,7±6,1	104,3±6,9
FRC	Control	103,4±3,8	102,8±3,5	102,1±3,7	102,5±3,9	102,9±4,8
FRC	Experimental	102,9±3,6	102,6±3,1	102,9±2,8	101,5±3,3	101,7±3,4
FEV/FVC,%	Control	53,4±3,6	58,2±4,8	60,2±4,5	58,1±3,4	58,8±5,2
FEV/FVC,%	Experimental	55,2±3,6	57,4±4,2	58,4±6,4	64,8±5,6	64,7±4,4

Table abbreviations: VC (vital capacity); FEV1 (forced expiratory volume in 1 second); PEF (Peak Expiratory Flow); RV (residual volume); TLC (total lung capacity); FRC (Functional residual capacity); FEV/FVC ratio ,%

/ Translated by Artour Rakhimov, February 2011

Observation. It is possible to notice that if the control group had a certain improvement in some lung function parameter (VC, FEV, and so on), the improvement in the experimental group was about 2 times larger.

Other pages of this site explain details of Buteyko breathing exercises (see "Learn" Section) that are to be used as breathing exercises for COPD.

Reference Web Pages: Breathing norms, Medical Graphs and Tables about Breathing Rates (Minute Ventilation) and Body Oxygen in Healthy, Normal and Sick People
Breathing norms Parameters, graph, and description of the normal breathing pattern
6 breathing myths 6 myths about breathing and body oxygenation (prevalence: over 90%)
Hyperventilation Definitions of hyperventilation: their advantages and weak points
Hyperventilation Syndrome in the Sick. Table 1. Western scientific evidence about prevalence of CHV (chronic hyperventilation) in patients with various chronic conditions (34 medical studies)
Normal Minute Ventilation in Healthy Subjects: Easy and Light Breathing (14 Studies)
Hyperventilation Prevalence Present in Over 90% of Normal People (24 medical publications)
HV and hypoxia How and why deep breathing reduces oxygenation of cells and tissues of all vital organs
Body oxygen test How to measure your own breathing and body oxygenation (a simple DIY test)
Body oxygen in healthy Table 4. CP (body oxygen level) in healthy people (27 medical studies)
Body oxygen in sick Table 5. CP (body oxygen level) in sick people (14 medical studies)
Buteyko Table of Health Zones with clinical description of most common zones
Morning HV Morning hyperventilation effect or how and why critically ill people are most likely to die during early morning hours

References: CO2 Effects Web Pages
Vasodilation: CO2 expands arteries and arterioles facilitating perfusion (or blood supply) to all vital organs
The Bohr effect How and why oxygen is released by red blood cells in tissues
Cell Oxygen Levels and oxygen transport are controlled by alveolar CO2 and breathing
Oxygen Transport depends on breathing and these two effects (Vasoconstriction-Vasodilation and the Bohr effect) are parts of two diagrams that summarize influences of hypocapnia (low CO2 content in the blood and cells) on circulation and O2 delivery
Free Radical Generation takes place due to anaerobic cell respiration caused by cell hypoxia. Hence, antioxidant defenses of the human body are also regulated by CO2 and breathing
Inflammatory Response is controlled by breathing since hypoxia leads to or intensifies chronic inflammation through over-expression of the hypoxia-inducible factor 1, while normal breathing reduces these processes
Nerve stabilization takes place due to calmative or sedative effects of carbon dioxide in neurons or nerve cells
Muscle relaxation or relaxation of muscle cells is normal at high CO2, while hypocapnia causes muscular tension, poor posture and, sometimes, aggression and violence
Brochodilation - dilation of airways (bronchi and bronchioles) by carbon dioxide, and their constriction due to hypocapnia
CO2: Best Natural Cough Suppressant and "home remedy" since it calms urge-to-cough nerve receptors located in the tracheobronchial tree and larynx
Blood pH regulation and regulation of other bodily fluids
CO2: Lung Damage Healer: Elevated carbon dioxide prevents injury and promotes healing of lung tissues
CO2: Skin and Tissue Healer
Synthesis of Glutamine in the Brain, CO2 fixation, and other chemical reactions
CO2 myth "CO2 is a toxic waste gas" myth
Breathing control How is our breathing regulated? Why hypocapnia makes breathing uneven and erratic?

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