How to measure your Control Pause (CP);

• Take a small, silent breath in and a small, silent breath out.
• Hold your nose with your fingers to prevent air from entering your lungs.
• Count how many seconds until you feel the first signs of air hunger.
• At the first sign of air hunger, you will also feel the first involuntary movements of your breathing muscles. Your tummy may jerk. The area around your neck may contract.
• Your inhalation at the end of the breath should be calm.
• Release your nose and breathe in through it.

The following are important points to be aware of before we start:

• The breath is taken after gently exhaling.
• The breath is held until the first movements of the breathing muscles. It is not a measure of the maximum length of time that you can hold your breath.
• Your CP only measures your breath hold time. It is not an exercise to correct your breathing.

Remember that taking your control pause (CP) entails holding your breath only until the first involuntary movements of your breathing muscles. If you had to take a big breath at the end of the breath hold, then you held your breath for too long.

What does the Control Pause (CP) mean?

If your CP is less than 10 seconds then:

Asthma symptoms are severe. Breathlessness, wheezing and/or coughing will be frequently present throughout the day and at night. Relative breathing volume as determined by such a low breath hold is very big.

If your CP is less than 20 seconds then:

• Symptoms such as coughing, wheezing, breathlessness, exercise-induced asthma, colds, chest infections and fatigue are present. The lower your breath hold, the greater your symptoms.

If your CP is between 20 and 40 seconds then:

• Main symptoms will have gone, but you may develop symptoms if exposed to a trigger. The affect of a trigger is proportionate to your CP. As an asthmatic you will feel quite well and your breathing will be a lot calmer. In addition, you should not have any nighttime episodes or exercise-induced asthma and your colds and chest infections will have decreased significantly.

If your CP is greater than 40 seconds then:

• No asthma symptoms are present. You will feel very well with good energy, clarity and breathing. To ensure a permanent physiological change, it is necessary to attain a morning CP of 40 seconds for 6 months.

The lower your breath hold, the greater your breathing volume and the greater your asthma symptoms. For example, a very severe asthmatic will have an CP of less than 10 seconds. Their breathing will be very noticeable both at rest and while participating in physical exercise. An asthmatic with a morning CP of 40 seconds will have no symptoms. Their breathing will be unnoticeable during rest. Physical exercise will produce a lot less ventilation and they should not experience exercise-induced asthma at all.

Essential rules to make progress:

• You will feel better each time your CP increases by 5 seconds.
• If your CP does not change, you will not feel better.
• Your CP should increase by 3 – 4 seconds each week.
• The most accurate CP is taken first thing after waking. You cannot influence your breathing during sleep. As a result, this CP is the most accurate as it is based on your breathing volume as set by the respiratory centre.
• Your CP as taken throughout the day will provide feedback of your asthma at that time.
• Your goal is to have morning CP of 40 seconds for 6 months.

Three steps to increasing your CP:

STEP 1

Stop Big Breathing: a. Close Your Mouth
b. Stop Sighing – swallow
c. Apply gentle calm breathing
d. Never hear your breathing during rest

STEP 2

Practice reduced breathing

STEP 3

Take physical exercise with correct breathing.

(Physical exercise is necessary to increase the CP from 20 to 40 seconds.)

Control Pause as a determinant of carbon dioxide tolerance (Peer reviewed medical papers investigating breath hold time)

As far back as 1975, researchers Stanley et al noted that breath holding was a simple test to determine respiratory chemosensitivity and concluded that “the breath hold time/partial pressure of carbon dioxide relationship provides a useful index of respiratory chemosensitivity which is not influenced by airways obstruction.”

Evaluation of breath holding in hypercapnia as a simple clinical test of respiratory chemosensitivity. Stanley,N.N.,Cunningham,E.L., Altose,M.D.,Kelsen,S.G.,Levinson,R.S., and Cherniack,N.S.(1975).Thorax,30,337-343.

In another paper, Nishino acknowledged breath holding as one of the most powerful methods to induce the sensation of breathlessness, and the breath hold test “gives us much information on the onset and endurance of dyspnea (breathlessness).” The paper noted two different breath hold tests as providing useful feedback on breathlessness. The first breath hold test is the length of time until the first urges to breathe. This easy breath hold provides information of how soon first sensations of breathlessness take place, and was noted to be a very useful tool for the evaluation of dyspnea. The second measurement is the total length of breath hold time. This provides feedback of the upper limit of toleration of breathlessness and is influenced by behavioural characteristics such as willpower and determination. As the first test is not influenced by training effect or behavioural characteristics, it can be deduced that it is a more objective measurement.

Respir Physiol Neurobiol. 2009 May 30;167(1):20-5. Epub 2008 Nov 25. Pathophysiology of dyspnea evaluated by breath-holding test: studies of furosemide treatment. Nishino T.

Eighteen patients with varying stages of cystic fibrosis were studied to determine the value of the breath hold time as an index of exercise tolerance. The breath hold times of all patients were measured. Oxygen uptake (Vo2) and carbon dioxide elimination was measured breath by breath as the patients exercised. The researchers found a significant correlation between breath hold time and VO2 (oxygen uptake), concluding “that the voluntary breath-hold time might be a useful index for prediction of the exercise tolerance of CF patients.”

Eur J Appl Physiol. 2005 Oct;95(2-3):172-8. Epub 2005 Jul 9 Relationship between breath-hold time and physical performance in patients with cystic fibrosis.
Barnai M, Laki I, Gyurkovits K, Angyan L, Horvath G.

Results from a study of 13 patients with acute asthma, concluded that the magnitude of breathlessness, breathing frequency and breath hold time correlated with severity of airflow obstruction and secondly breath hold time varies inversely with dyspnea magnitude when it is present at rest.

Rev Invest Clin. 1989 Jul-Sep;41(3):209-13. Rating of breathlessness at rest during acute asthma: correlation with spirometry and usefulness of breath-holding time.
Perez-Padilla R, Cervantes D, Chapela R, Selman M.

In other words the lower the breath hold time, the greater the volume of breathing of asthmatics at rest.

It is the author’s experience that CP is a very useful and accurate tool for determining relative breathing volume both during rest and physical activity. It is simple, safe, involves no sophisticated equipment and can be applied at any time. Overbreathing at rest can be determined by observation and length of CP. The lower the breath hold time, the greater the breathing volume. As breathing during physical exercise will increase proportionately to breathing volume at rest, it follows that breath hold time provides useful diagnostic feedback of breathlessness during exercise.

Easy breath hold versus maximum breath hold

When determining usefulness of breath hold tests, it is necessary to take into consideration subjective influences. In other words, individuals with strong will power can hold their breath for longer than those without. Therefore, breath hold time provides more accurate feedback if subjective influences can be removed.

Holding of the breath until the first involuntary movements of the breathing muscles provides more objective feedback on relative overbreathing.

In a study of 13 normal subjects who performed repeated breath holds, results showed that holding of the breath until the first respiratory sensations does not create a breath hold stress, and so is less influenced by training effect. Authors also noted that holding of the breath until the first breathing sensations is “inversely related to the slope of the hypercapnic ventilatory response curve,” and so provides a very useful diagnostic tool of breathlessness.

Clin Sci (Lond). 1996 Dec;91(6):755-61. Changes in the period of no respiratory sensation and total breath-holding time in successive breath-holding trials.
Nishino T, Sugimori K, Ishikawa T.