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Asthma Causes, Signs, Symptoms: Coughing, Wheezing, Chest Pain

Asthma and wordsAll available medical evidence suggest that you can have bronchial asthma only if your breathing is too heavy. You cannot have asthma, if you breathe in accordance with medical norms. Therefore, to solve problems with asthma one needs to learn how to breathe correctly.

Symptoms and signs of asthma

Classic asthma symptoms and signs

Girl with asthma coughing* Bronchoconstriction (narrowing of airways: bronchi and bronchioles) - caused by CO2 deficiency
* Inflammation of airways (caused by cell hypoxia produced by hyperventilation, see CO2: Inflammatory Response)
* Increased sensitivity of the immune system to innocent triggers (dust mites, airborne protein from cats and dogs, pollen, and so forth)
* Excessive production of mucus in airways

Early warning signs

Increased mouth breathing, both during days and night sleep
Increased night-time cough
Increased sleeping on one's back
Restless sleep or waking up tired
Worsening allergy symptoms like runny nose
Cough or wheezing with physical activity
Tiredness with activities that you normally could complete easily

Symptoms of mild asthma

Chronic cough, especially at night
Wheezing
Shortness of breath
Increased mucus production, especially in the morning
Chest tightness, pain, or discomfort
Increased difficulty completing your normal activities

Further development of asthma

You can hear yourself wheezing
Experience a cough that just won't go away (day or night)
Have more trouble falling asleep and getting a good nights rest
Increased heart rate (over 80 beats/min)
Have PEFRs (peak expiratory flow rate) well into the yellow zone
Get less relief from your 'quick relief' medications

Signs of a possible emergency (life-threatening asthma attack)

Severe wheezing while breathing both in and out
Breathing very fast
Getting short of breath while or having difficulty talking
A feeling of impending doom or panic
Profuse sweating
Inability to perform PEFR
Color changes in fingertips

Breathing and causes of asthma

How much do asthmatics breathe?

All available medical research suggests that asthmatics are chronic hyperventilators. Let us review these studies since they explain the key cause of asthma. You can click on the graph to see all references and follow the links to read abstracts of all these 5 studies.

Breathing rates (minute ventilation) of asthmatics at rest

Table. Minute ventilation (asthma)

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
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

Note that advanced stages of asthma can lead to lung destruction, ventilation-perfusion mismatch,
and arterial hypercapnia causing further reduction in body oxygen levels.

Chronic hyperventilation causes reduced CO2 levels in alveoli and airways of the lungs. For more details, see causes of asthma.

Can low CO2 levels lead to problems with airways?

CO2 molecule "The mechanism of bronchoconstriction due to hypocapnia in man" (“hypocapnia” means abnormally low CO2 concentrations) was the title of the article published in 1968 by Clinical Science Journal. In this article, Dr. Sterling suggested that CO2 deficiency creates an over-excited state of the cholinergic nerve. Since this nerve is responsible for work of the smooth muscles in bronchi, its excitement leads to constriction of bronchi and smaller air passages (bronchioles). This causes wheezing, coughing, and high heart rate in people with asthma. Mucus production makes these symptoms worse.

Bronchospasm caused by hypocapnia One modern physiology textbook claims, “Agents that tend to dilate human airways include increased PaCO2 (hypoventilation or inspired CO2),” (p. 545; Straub, 1998). This textbook directly asserts that reduced breathing (or hypoventilation) or increased CO2 in the inspired air will dilate airways. Moreover, CO2 is suggested as the most potent natural chemical substance that promotes this "breathing-easy" effect.

Soviet MD and PhD KP Buteyko suggested that asthma is caused by alveolar hyperventilation in the 1950’s (his first medical article about this effect was published in 1964). He observed and discovered the central role of breathing too much in the progress and degree of asthma (Buteyko, 1964). He and his medical colleagues also found that asthmatics can get quick alternative drug-free relief from asthma attack symptoms, if they practiced shallow or reduced breathing.

Dr. Herxheimer independently suggested that hypocapnia or low CO2 was the cause of bronchial asthma in 1946 (Herxheimer, 1946) and 1952 (Herxheimer, 1952) in his articles "Hyperventilation asthma" and "The late bronchial reaction in induced asthma".

Allergies and asthma

How do asthma and asthma attacks develop?

Man with wheezing and asthma Low CO2 values in the bronchi cause chronic constriction of airways (that happens in all people). In addition to this direct effect, chronic hyperventilation makes immune reactions abnormal. The immune system becomes too sensitive in relation to intruders from outside (coming with air or food), but weakens the responses to various pathogens, like viruses and bacteria. (That makes sense since hyperventilation is a defensive reaction and a part of the fight-or-flight response. Hyperventilation then should mean a state of increased alertness and emergency for the whole organism, the immune system included.)

The immune system becomes hypersensitive and seemingly innocent events like breathing cold air or inhaling dust particles can trigger an inflammatory response in asthmatics, excessive production of mucus, a sense of anxiety or panic, more hyperventilation, and further constrictions of airways.

Similar effects take place during physical exercise causing sports induced asthma.

As a result, mucus makes air passages narrower (or even blocks some of them) creating a feeling of suffocation and causing asthma attacks. During an attack, an asthmatic may try to clear the mucus by coughing it out, but that further reduces CO2 concentrations in the lungs and makes air passages narrower. The smart solution to these problems is to do the opposite. How?

This YouTube video (on the right side) provides an overview of problems related to asthma.

Prevention and alternative natural therapy for asthma

Clinical trials of the Buteyko method for asthma

Doctors and their patientsWhat were the main outcomes of randomized controlled trials of the Buteyko breath therapy in western countries? There were 6 trials all together. After 3-6 months of daily breathing exercises, asthmatics required:
- 3-9 times less reliever medication
- about 2 times less steroidal drugs
- significantly improved quality of life
- significantly improved score for asthma symptoms (less cough, wheezing, chest tightness, dyspnea, and other symptoms of asthma).

All these astonishing results in spite of the fact that if we compare pulmonary parameters of the patients in the experimental groups at the end of the trials, they only partially normalized their breathing achieving about 25-30 seconds CP (the body-oxygen test described below).

You can read all abstracts and detailed results of these and other trails: Clinical Trials of the Buteyko Method.

However, there were no changes in lung function results. Why? According to Dr. Buteyko's theory breathing normalization must cure asthma. Did asthmatics change their breathing during these randomized controlled trials? During the most impressive study in Australia (Bowler et al, 1998), in 3 months, consumption of reliever medication was reduced by 96% (or 25 times less) and inhaled steroidal drugs or preventers by about 50%. Respiratory minute volume at rest decreased from initial 14 L/min to 9.6 L/min after 3 months, but the medical norm for breathing is only 6 L/min, while Dr. Buteyko’s standard is 4 L/min at rest for a 70-kg man. Hence, during their best shot, the participated asthmatics got only about a half way towards the standard. Thus, there were a very few asthmatics, if any, who naturally normalized their breath during these trials.

One of the assumptions of the medical doctors, who participated in these asthma trials, was that a Buteyko therapist taught the alternative Buteyko technique, while a controlled group of asthmatics learned the therapy. Indeed, in titles and abstracts of these randomized controlled trials, we can read “trial of the Buteyko method”. How could they study the Buteyko breathing method, if no one learned it?

Young man sleeping, sick, with tissue Of we consider these trials from a practical viewpoint, the patients were mainly limited to practicing breathing exercises (e.g., 1 hour per day). However, breathing retraining requires constant regulation of breathing due to negative effects of lifestyle risk factors. As we already learned it in the past, asthmatics are most likely to die and experience acute episodes and attacks during early morning hours due to the Morning Hyperventilation Effect. What is the point to treat asthma, if most asthmatics sleep on their backs and breathe though the mouth during sleep (hence, dry mouth in the morning)? They will surely produce more irritation of airways, inflammation and mucus during mouth breathing. How could they heal their airways if their irritate them every morning? The typical daily CPs (body-oxygen test results - see below) at the end of these trials, judging by other respiratory parameters, were about 20-30 s. Morning CPs were around 15-22 s. This allows, according to Buteyko Table of Health Zones, reduction in most medication for asthma, but has never been enough to heal airways and normalize lung function results.

Hence, it is not a smart way to teach breathing retraining therapy without:
- nose breathing all the time; mouth taping at night
- avoidance of sleeping on one’s back (it causes higher heart rate and even chest pain)
- wrong coughing techniques and wheezing (ordinary coughing increases production of mucus)
- sufficient physical activity (at least 2 hours every day with nasal breathing only)
- and numerous other lifestyle-related details so that one’s basal breathing pattern is gradually restored back to the medical international standard.

Therefore, when a breathing student normalizes his or her automatic breathing patterns, he or she will have a complete clinical remission (cure) from asthma.

Coughing and acute asthma web pages:
- Stop Acute Asthma Exacerbation in 2-3 min (Breathwork)
- Stop Coughing At Night - A breathing exercise to reduce duration and severity of coughing at night. This exercise helps to fall asleep faster
- Best Cough Treatment Therapy - The ultimate solution to chronic problems with wet or whooping cough, chesty of dry cough, coughing at night, and coughing in children.

How to increase body oxygenation

There are many breathing techniques and methods in order to normalize breathing and increase body-oxygen levels. The Buteyko breathing technique has the most powerful arsenal of lifestyle changing tools, which are described in detail in the Section Learning. The same Section also describes the Buteyko breathing exercises, which are difficult to learn. Furthermore, there are breathing exercises that are more powerful (in comparison with the Buteyko breathing exercises) to increase body oxygenation.

Oxygen remedy is such a program that is based on using the Buteyko lifestyle program and the application of breathing devices (the Amazing DIY breathing device, Frolov device and some others) that trap exhaled air with high CO2 levels for inhalations to boost body-oxygen content. More info about these alternative respiratory techniques can be found here:
* Amazing DIY breathing device
* Frolov breathing device.

Further resources:
- Acute Asthma Exacerbations Clinical Trial - Application of the Frolov breathing device in hospital setting: probably the most successful medical trial in the history of asthma trials
- Clinical effects of the Buteyko breathing technique on asthma and other respiratory disorders - Whatever the breathing technique applied, the final results for over 95% of breathing students depend only on their morning CP achieved.

References

Buteyko KP, An Instruction for VBN Therapy for Bronchial Asthma, Angina Pectoris, High Blood Pressure and Obliterating Endarteritis: Preprint. - Novosibirsk, 1964.

Herxheimer H, Hyperventilation asthma, Lancet 1946, 6385: p. 83-87.

Herxheimer H, The late bronchial reaction in induced asthma, Int Arch Allergy Appl Immunol 1952; 3: p. 323-328.

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

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