Bronchospasm: Definition, Symptoms, Causes, and Treatment

Bronchospasm (definition) is defined as constriction of bronchi and bronchioles. It can generally happen due to 3 factors:
- a spasm in the smooth muscles of bronchi and bronchioles
- an inflammation of the airways
- excessive production of sputum (mucus) due to an allergic reaction or possible irritation caused by mechanical friction of air (due to shear stress), overcooling or drying of airways (i.e., during exercise induced asthma).

Bronchospasm is a normal physiological reaction to alveolar hyperventilation (Badier et al, 1998; Clarke et al, 1982; Jamison et al, 1987; O'Cain et al, 1979; Sterling, 1968), as you can see from the titles of these articles (see below). Do people with bronchitis, asthma, and other conditions suffer from alveolar hypocapnia (CO2 deficiency in airways)? What is known about minute ventilation in people with bronchospasm?

Minute ventilation rates (chronic diseases)

Condition	Minute ventilation	Number of people	All references or click below for abstracts
Normal breathing	6 l/min	-	Medical textbooks
Healthy Subjects	6-7 l/min	>400	Results of 14 studies
COPD	14 (±2) l/min	12	Palange et al, 2001
COPD	12 (±2) l/min	10	Sinderby et al, 2001
COPD	14 l/min	3	Stulbarg et al, 2001
Asthma	13 (±2) l/min	16	Chalupa et al, 2004
Asthma	15 l/min	8	Johnson et al, 1995
Asthma	14 (±6) l/min	39	Bowler et al, 1998
Asthma	13 (±4) l/min	17	Kassabian et al, 1982
Asthma	12 l/min	101	McFadden & Lyons, 1968
Cystic fibrosis	15 L/min	15	Fauroux et al, 2006
Cystic fibrosis	10 L/min	11	Browning et al, 1990
Cystic fibrosis*	10 L/min	10	Ward et al, 1999
CF and diabetes*	10 L/min	7	Ward et al, 1999
Cystic fibrosis	16 L/min	7	Dodd et al, 2006
Cystic fibrosis	18 L/min	9	McKone et al, 2005
Cystic fibrosis*	13 (±2) l/min	10	Bell et al, 1996
Cystic fibrosis	11-14 l/min	6	Tepper et al, 1983

Bronchospasm can be induced by many chemicals that can cause either bronchoconstriction or bronchodilation, but CO2 plays the key role due to two factors: its vasodilatory potency (see links with medical studies below) and additional negative effects caused by alveolar hypocapnia (lack of CO2), as the Table above proves. 

What else influences bronchospasm?

Chronic hyperventilation (breathing more air than the medical norm) also leads to cell hypoxia and immunosuppression regardless of ventilation-perfusion ratio and arterial CO2 levels (it can get too high for many lung pathologies). As a result of alveolar hyperventilation, there are additional effects, such as frequent respiratory infections, excessive production of sputum (mucus) and chronic inflammation. Allergic triggers (dust, pollen, and many others) cause additional problems due to the hypersensitive immune system caused by systemic body hypoxia. All these factors narrow airways and worsen their conductivity, triggering bronchospasm.

Symptoms of bronchospasm

Bronchospasm symptoms include difficulty breathing, wheezing, coughing, and dyspnea (shortness of breath). Increased respiratory ventilation drastically amplifies the effects of bronchospasm.

Causes and mechanism of bronchospasm

Bronchospasm mechanism follows from the above Table, which shows that these groups of people are heavy breathers. They all have low CO2 levels in their lungs. As a result of low alveolar CO2, they also have low body-oxygen levels due to effects of alveolar hypocapnia, which either destroys lungs (causing arterial hypercapnia and hypoxemia as for people with COPD) or causes arterial hypocapnia with reduced oxygen transport, as an additional factor that is present during bronchospasm.

Bronchospasm, therefore, due to its effects on oxygen transport, leads to low oxygen levels in tissues and favors chronic inflammation (see links below). As a result, people with lung conditions (asthma, bronchitis, bronchiestasis, bronchiolitis, cystic fibrosis, tuberculosis, sarcoidosis, and many others), experience chronic bronchospasm in the smooth muscles of airways due to chronic alveolar hypocapnia. This YouTube video explains the cause of bronchospasm.

Surgery of the throat or anesthesia can also be among some rare bronchospasm causes.

Treatment of bronchospasm

Bronchospasm can be successfully treated, as over 180 Russian medical doctors, found. The effective way to deal with bronchoconstriction is the Buteyko breathing medical therapy that is approved by the Russian Ministry of Health. It has been applied on more than 200,000 people with health problems (such as asthma, bronchiestasis, bronchiolitis, bronchitis, COPD, and many others) that involve bronchospasm.

Bronchospasm cure (clinical remission), according to these Russian medical doctors, has simple criteria. The patient needs to achieve more than 20 seconds for the body-oxygen test in order to prevent symptoms of bronchospasm at rest. Healing of airways is possible when automatic breathing parameters are nearly normal (more than 40 seconds for the body-oxygen levels 24/7). Physical exercise with nose breathing is a very beneficial lifestyle factor that assists breathing retraining and gradual increase in body oxygen stores. Nose breathing at exercise prevents exercise-induced asthma and bronchospasm.

Bronchospasm symptoms can be effectively eliminated with breathing exercises that involve those breathing devices that trap exhaled CO2 (such as the Amazing DIY breathing device, Frolov breathing device, and Samozdrav). These devices help to increase body-oxygen levels and reduce bronchospasm in a matter of minutes. However, up to 2-4 weeks are often necessary in order to significantly change automatic or basal breathing patterns. Any bronchospasm treatment must also address lifestyle changes (prevention of supine sleep, prevention of mouth breathing, and so forth). The best lifestyle program can be found in the Buteyko technique. Oxygen Remedy online webinars is likely the easiest way to achieve clinical remission in relation to bronchospasm.

Reference pages: Breathing norms and medical facts:
- Breathing norms: Parameters, graph, and description of the normal breathing pattern
- 6 breathing myths: Myths and superstitions about breathing and body oxygenation (prevalence: over 90%)
- Hyperventilation: Definitions of hyperventilation: their advantages and weak points
- Hyperventilation syndrome: Western scientific evidence about prevalence of chronic hyperventilation in patients with chronic conditions (37 medical studies)
- Normal minute ventilation: Small and slow breathing at rest is enjoyed by healthy subjects (14 studies)
- Hyperventilation prevalence: Present in over 90% of normal people (24 medical studies)
- HV and hypoxia: How and why deep breathing reduces oxygenation of cells and tissues of all vital organs
- Body-oxygen test (CP test) : How to measure your own breathing and body oxygenation (two in one) using a simple DIY test
- Body oxygen in healthy: Results for the body-oxygen test for healthy people (27 medical studies)
- Body oxygen in sick : Results for the body-oxygen test for sick people (14 medical studies)
- Buteyko Table of Health Zones: Clinical description and ranges for breathing zones: from the critically ill (severely sick) up to super healthy people with maximum possible body oxygenation
- Morning hyperventilation: Why people feel worse and critically ill people are most likely to die during early morning hours

References: pages about CO2 effect:
- 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: How alveolar CO2 influences oxygen transport
- Oxygen transport: O2 transport is controlled by vasoconstriction-vasodilation and the Bohr effects, both of which rely on CO2
- Free radical generation: Reactive oxygen species are produced within cells due to anaerobic cell respiration caused by cell hypoxia
- Inflammatory response: Chronic inflammation in fueled by the hypoxia-inducible factor 1, while normal breathing reduces and eliminates inflammation
- Nerve stabilization: People remain calm due to calmative or sedative effects of carbon dioxide in neurons or nerve cells
- Muscle relaxation: Relaxation of muscle cells is normal at high CO2, while hypocapnia causes muscular tension, poor posture and, sometimes, aggression and violence
- Bronchodilation: Dilation of airways (bronchi and bronchioles) is caused by carbon dioxide, and their constriction by hypocapnia (low CO2)
- Blood pH: Regulation of blood pH due to breathing and regulation of other bodily fluids
- CO2: lung damage: Elevated carbon dioxide prevents lung injury and promotes healing of lung tissues
- CO2: Topical carbon dioxide can heal skin and tissues
- Synthesis of glutamine in the brain, CO2 fixation, and other chemical reactions
- Deep breathing myth: Ignorant and naive people promote the idea that deep breathing and breathing more air at rest is beneficial for health
- Breathing control: How is our breathing regulated? Why hypocapnia makes breathing uneven, irregular and erratic.

References

Badier M, Beaumont D, Orehek J, Attenuation of hyperventilation-induced bronchospasm by terfenadine: a new antihistamine, J Allergy Clin Immunol. 1988 Feb;81(2):437-40.

Clarke PS, Jarrett RG, Hall GJ, The protective effect of ipratropium bromide aerosol against bronchospasm induced by hyperventilation and the inhalation of allergen, methacholine and histamine, Ann Allergy. 1982 Mar;48(3):180-3.

Jamison JP, Glover PJ, Wallace WF, Comparison of the effects of inhaled ipratropium bromide and salbutamol on the bronchoconstrictor response to hypocapnic hyperventilation in normal subjects, Thorax. 1987 Oct; 42(10): 809-14.
....This suggests that bronchoconstriction in response to hypocapnic hyperventilation in normal subjects is not mediated via a cholinergic reflex.

O'Cain CF, Hensley MJ, McFadden ER Jr, Ingram RH Jr, Pattern and mechanism of airway response to hypocapnia in normal subjects, J Appl Physiol. 1979 Jul;47(1):8-12.
We examined the bronchoconstriction produced by airway hypocapnia in normal subjects... Pretreatment with a beta-sympathomimetic agent blocked the response, whereas atropine pretreatment did not, suggesting that hypocapnia affects airway smooth muscle directly, not via cholinergic efferents.

Reynolds AM, McEvoy RD, Tachykinins mediate hypocapnia-induced bronchoconstriction in guinea pigs, J Appl Physiol. 1989 Dec;67(6):2454-60.
... We conclude that, in the guinea pig lung, HIBC [hypocapnia-induced bronchoconstriction] is mediated by TKs [tachykinins] that are released after the activation of bronchial axonal reflexes.

Sterling GM, The mechanism of bronchoconstriction due to hypocapnia in man, Clinical Science 1968 Apr; 34(2): p. 277-285.

Straub NC, Section V, The Respiratory System, in Physiology, edited by. Berne RM & Levy MN, 4th edition, Mosby, St. Louis, 1998.

* Upper left illustration by Victor Lunn-Rockliffe

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