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COPD

Chronic obstructive pulmonary disease (COPD) and the Buteyko Method

Chronic obstructive pulmonary disease (COPD) is an umbrella term for a number of breathing related conditions including emphysema and chronic bronchitis.

While COPD involves irreversible damage to the lower airways and small airsacs, most people with the condition (approx. 60% to 70%) demonstrate some degree of reversible narrowing of the airways. (1-4) The difficulty in breathing which results from reversible airway narrowing is not caused by destruction of the lung tissue. Instead, it is due to reversible factors including a combination of inflammation, increased mucus or constriction of smooth muscle in the airways.

Airways with a good degree of reversible obstruction can be helped with medication and other proven modalities such as the Buteyko Method.

Traditionally, the Buteyko Method has been applied for asthma which is a breathing condition involving reversible obstruction of the airways. Over the past twenty years, hundreds of thousands of people with asthma have successfully applied the Buteyko method, and to date 12 clinical trials show positive improvements to quality of life, reduction of asthma symptoms such as coughing and wheezing as well as a reduction in the need for asthma medication.

For the past fifteen years, Buteyko Clinic International has applied the Buteyko Method for persons with COPD. As the Buteyko Method works on reversible airway obstruction, those persons with a greater tendency for reversible airway obstruction will show greater improvements. A rule of thumb to determine the degree of airway reversibility is whether medication helps to make your breathing easier. If you experience significant relief after taking a reliever (rescue) or preventer medication, then Buteyko is very likely to help you as well. If on the other hand, you experience little relief from taking asthma or COPD medication, (steroid or rescue) then the likelihood of Buteyko helping significantly lessens.

The Buteyko Method involves switching from mouth to nose breathing on a permanent basis, along with practising breathing exercises which are specifically designed to bring breathing volume to calmer and more normal levels. As breathing becomes more efficient, the feeling of breathlessness during rest and physical exercise reduces. Furthermore, symptoms such as coughing, wheezing and chest tightness will also reduce.

Central to the Buteyko Method is a measurement of breath hold time called the Control Pause. Research has shown a relationship between breath hold time (Control Pause Measurement) and the severity of COPD. In a study of 35 patients, breath hold time was significantly lower in persons with COPD, and correlated positively with spirometr measurements including FVC and FEV1.

The goal of the Buteyko Method is to improve breathing patterns, as indicated by achieving a higher breath hold time (control pause). Every five seconds improvement to the control pause, results in an alleviation of breathing difficulty and improved control of COPD.

How to improve the control pause

How to achieve a higher control pause

Breathing through the nose is vitally important for persons with COPD, as this helps improve gas exchange. Due to gravity, the greatest concentration of blood flow is in the lower lobes of the lungs. However, if one breathes through an open mouth- it is the upper parts of the lungs which receive greater ventilation. In order to help redistribute air to the lower lobes of the lungs and to bring the blood from the lower lobes to the upper nose, nasal breathing is very important. Known as ventilation perfusion, having a greater distribution of blood throughout the lungs is important for reducing the risk of chest infections, as well as improving arterial oxygen uptake and gas exchange.

In addition to ventilation perfusion, breathing slowly through the nose harnesses a higher concentration of the gas nitric oxide which performs a number of functions in the lungs including opening of the airways (bronchodilation), and sterilisation of incoming air.

Good breathing patterns during rest involve breathing through the nose, driven by the diaphragm, effortless and gently paused on the exhale. Practising the Buteyko Method for COPD, assists with breathing becoming calmer and lighter to enable easier breathing and improved gas exchange in the lungs.

Furthermore, slowing down breathing helps to improve blood circulation and activate the body’s relaxation response, practices which are good for overall health.

Patrick McKeowns Tedx Talk provides a good introduction to the Buteyko Method for better breathing and health.

References:

  1. American Thoracic Society/European Respiratory Society Task Force: Standards for the diagnosis and management of patients with COPD. Version 1.2. New York:American Thoracic Society, 2004. PDF available for download at https://www.thoracic.org/copd-guidelines/resources/copddoc.pdf (accessed March 20, 2009).
  2. Siafakas NM, Vermeire P, Pride NB, et al.: for the European Respiratory Society Task Force: Optimal assessment and management of chronic obstructive pulmonary disease (COPD). Eur Respir J 1995;8:1398-1420.
  3. The COPD Guidelines Group of the Standards of Care Committee of the BTS. BTS guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997;52(suppl 5):S1-S28.
  4. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011. Available from: goldcopd.org. Accessed online July 12, 2012.
  5. Viecili RB, Silva DR, Sanches PRS, Müller AF, da Silva DP, et al.(2012) Real-Time Measurement of Maximal Voluntary Breath-Holding Time in Patients with Obstructive Ventilatory Defects and Normal Controls. J Pulmon Resp Med 2:127
  6. Alejandro Sánchez Crespo, Jenny Hallberg, Jon O Lundberg, Sten G E Lindahl, Hans Jacobsson, Eddie Weitzberg, Sven Nyrén. NASAL NITRIC OXIDE AND REGULATION OF HUMAN PULMONARY BLOOD FLOW IN THE UPRIGHT POSITION. J Appl Physiol (1985) 2010 Jan 29;108(1):181-8. Epub 2009 Oct 29.