holistic approach to asthma, sinusitis and reflux

Over the last three years I have developed, in order:

September 07 I was diagnosed with reflux which is being treated with Omeprazole

April 08 I had a FESS to clear my sinuses which the doctor said were in a dire state

Ultimately September 08 I was diagnosed with late onset asthma after a lung cancer scare and we have now progressed to Seretide & Montelukast.

My feeling is that I am continually degenerating and my breathing is now worse than it was 12 months ago, however I swim 1800m a week and go to the gym twice a week as well and I can't even get a 'poor' Balke rating, about 27.5 is my norm.

The current state of affairs is that no one seems too bothered about the reflux, I see an ENT man for my sinuses and a chest man for my asthma

I suppose there are two questions here:

1. Is this normal course of events with late onset asthma, i.e. the degenerative effect or do I have something else?

2. Is there anyone in the medical profession that takes a holistic view of the three symptoms, which from my research appear to be connected in some way and is there anyway I can get this looked at from a holistic point of view?

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sorry to hear your having such trouble, and i can't answer the question, but can offer you some comfort in that you are not alone. I was diagnosed with asthma last year, just before you, but even though I have symptoms (cough and occasion shortness of breath), my own doing though, too much exercise, the doc really wasn't too concerned, anyhow I now have montelukast as well as seretide, so same as you, but I do strangely agree with you in that it feels like im worse than I was.

The alternative therapy route is a bit hit and miss, some things work for some people. Yoga, acupuncture, massage, sinus rinse all worth a go, but no guarantees.

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Holistic approach

Hi Iggins.

I am a life long asthma sufferer who gained massive relief from all symptoms 6 years ago. I was on seretide at the time but am now a very rare user of medication (ventolin). The only difference i have made is to my breathing.

Sorry to hear about your traumatic health issues in the last 3 years. I am not familiar with the reflux but the other two issues are definitely linked to your breathing. I would guess that you are a mouth-breather or if a nasal breather then not consistently or perhaps you sniff, cough or sigh regularly or snore during or have a dry mouth after sleeping.

There is a ENT specialist based in Limerick Hospital who has changed his method of dealing with patients in the last few years. He sends them first to learn the buteyko breathing method and has found that many of his patients then do not require a FESS. Was this for nasal polyps? Could you breathe in any amount through your nose prior to your operation? If fully obstructed then surgery was the only option. I have polyps but they stay under control with nasal breathing (so far and i believe permanently).

Sorry to hear that your asthma and general feeling is that your health is getting worse. I believe that buteyko breathing can halt or reverse the degenerative effects in many asthmatics as well as helping the overall health and fitness of everyone else. It is IMO optimal breathing and was rediscovered by a russian respiratory physician in the 1950's though its how we are designed to breathe (like all mammals) through evolution. This is largely forgotten through the high incidence of mouth breathing (also effects your teeth) in Western developed countries through societal effects (that are now creeping into other countries too as they ape our poor lifestyle habits).

Ask your doctor about this, personally i would not let him put you off without very good reason. I would recommend learning from a trainer, as it is far quicker.

It may ultimately allow you to go back diving - i love scuba diving though its the only activity (and i am very active) i do where i breathe through my mouth! (seeing as i havent any gills!).

WoodySom - i think this would also be of great benefit to you from your posts (not having met you of course this is impossible to say online- but you ""sound"" or what you ""write"" leads me to believe you would also see major improvements in your activity levels and feel the benefit of your exercise rather than a large dip afterwards. When you cough you should keep your mouth closed. Also you should revert to exercise at asthma friendly maintaining nasal breathing levels and see your symptoms and dip go away. Your shortness of breath would improve by using some basic good asthma husbandry techniques.

Buteyko should be added to your list of remedies alongside yoga etc. It is approved (with qualifications) by the British Thoracic Society as (i think) a useful adjunct or something along those lines. It is hit and miss depending on the ability of the patient to do the exercises (which are progressive depending on the severity of the patient's condition) and to practice them. The only alternative aspect of it is "" it's an alternative life with vastly reduced symptoms and enhanced quality of life"".

Good luck Iggins from a Padi Diver (whenever i get the chance (warm waters, holidays, someone to mind the kids and the availability of a buddy!)

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...This is largely forgotten through the high incidence of mouth breathing (also effects your teeth) in Western developed countries through societal effects (that are now creeping into other countries too as they ape our poor lifestyle habits). ..."" [Buteyko'd...]

Have you any good evidence to back up this claim, Buteyko'd? I know fans of buteyko hypothesise that mouth breathing and hyperventilation are the cause of asthma and similar diseases but there are alternative hypotheses about the rise in prevalence of asthma, underpinned by quite a bit of research, prinicipally the hygiene hypothesis. And also, how do you explain the presence of asthma-like disease in other mammals, such as horses who do not habitually mouth-breathe? My daughter rides regularly and one of the ponies at the farm suffers from 'equine heaves', an asthma-like disease which is caused by sensitisation to mould spores in hay or straw. It is dealt with in this particular case by keeping the animal away from hay, not using straw as bedding etc. The pony is perfectly fine as long as she is not exposed to hay or straw, which make her cough and 'heave' when trying to exhale.

Iggins, I'm very sorry to hear about your asthma and I hope things improve. It might be worth seeing if a referral to a clinic where they deal with difficult and/or complicated asthma is possible. Also, have you tried the Asthma UK nurse helpline? I have encouraged a couple of people to contact them and they have been very helpful. With regard to buteyko, there is some encouraging evidence that it is of benefit to some asthmatics and I would by no means discourage you from exploring it. The current medical consensus (as per BTS/SIGN guideline) is that it can help with symptom control and reduce bronchodilator medication usage but does not address underlying inflammation or improve lung function. Proper medical supervision is essential and I would personally be wary of any therapist who uses the ""asthma-free naturally"" marketing approach.

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re:Buteyko'd post to me, if I tried to run by breathing through my nose only, then it would be so slow as to become just a fast paced walk, and I'm better than that. I don't dispute the fact that it may work, but it's not what will work for my fitness levels, and so medical intervention is the way forward, as far as i can tell. I'm trying montelukast, if that doesn't work, then plenty more drugs to try, but I have-to and want to find a solution to the problem, and maintain my activity levels or even increase them.

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one step back and three million forward

Reply to Woody-som,

You may need to go backwards in order to move further forwards. Your legs are capable of running faster, further etc but not in tandem with your lungs. If you have a race or target in mind then by all means continue. If you wish to exercise without this huge dip (because you are pushing your lungs too far and hyperventilating at a rate in excess of your exercise level) it would pay you great dividends to learn to breathe optimally when running (this would also result in feeling better after running and carrying through into the rest of your life/day).

Without this optimisation, I would fear that you will continue to experience the same results with extra medication.

Given your level of fitness, you would progress from your fast walk pace very quickly. Your lungs are telling you that they are only able to deal with that level of exercise at the moment even though you are actually far fitter in every other way.

You would be able to exercise far more often (depending on available free time-even several times a day and every day without the dip). The speed will quickly increase as you reverse a lifetime (guessing you’ve run for a number of years) habit of mouth breathing. It’s a short time, 6 to 8 weeks if you give it your full attention, at which stage you would be able to do what you aspire to…run further and far faster at increased levels of activity and more regularly (dip will be gone) without causing symptoms or needing your ventolin boost during, after or before you exercise (the last one being the last to go)(

Good habits are to:

Do breath holds (on the out breath) while nasal breathing in the lead up to the run

warm up for ten minutes beforehand and start off slowly (if racing be fully warmed up beforehand)

keep up nasal breathing for at least 10 minutes after exercise,

do not sprint finish even though you’re very likely to love to do this and

slow down to a pace that you can maintain nasal breathing at all times and walk or stop if necessary.

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mouth breathing hypothesis

Reply to ClaireOB,

I suppose my mention of the mouth breathing hypothesis is explained by my personal success with buteyko (having tried all sorts of medication and some alternative therapies i found that Buteyko's complementary technique an immediate success) . I do think there is a lot of merit in many of the other hypotheses (it is very complex) including the hygiene one but not when examined in total isolation. Without an analysis of how we breathe and the effects of mouth breathing (rather than the causes which are many) in tandem with research into these hypotheses then we will continue to fall short in the studies and trials. i feel that various hypotheses on their own do provide an broad explanation for the variety and complexity of asthma.

I am aware that the way of breathing (through your mouth versus through your nose) seems to be overlooked in many of the hypotheses and IMO is surely at the source of the problem but this I believe is considered as perhaps too simple an explanation. I know that my own allergic type responses have diminished hugely and i have an acute sense of smell now rather than none (nose previously always blocked) although i was sensitive to the effect of smell generating things (as i understand it through inhaling alot of trigger elements e.g. pollen from lillies).

I understand that the heaves or COAD is very similar to asthma and is as a result of breathing in the spores in the straw/hay. The best results to deal with this are to limit exposure through the dousing of the hay with water (so the spores are not inhaled) or through elimination. Horses with heaves tend to upper thorax breathe rather than abdominal breathe (i asked a vet) and there can be a heave line develop on the body of the poor horse. This is similar to humans except in these cases humans start mouth breathing very early on and also can well express their symptoms to their doctor unlike the horse! Horses almost without exception breathe at all times through their nose. All animals do (mammals at least- fishes etc do not). I believe that this is significant, is ignored as implausible (somehow we are higher order through our fantastic brain) and huge parallels should be drawn with the animal kingdom.

Nasal breathing (and at the right volume and rate- it is well possible to over breathe even as a nasal breather) largely protects us from the effects that triggers cause to our breathing. This protects us from our underlying condition or weakness (same as the horse) which is likely to be genetically inherited (but which may have been dormant in previous generations due to a variety of reasons (type of work, amount of exercise, diet, standard of health, housing, etc etc).

This is where i understand that nasal breathing protects me from my underlying condition - i am still asthmatic, i still have the very same sensitivity but i protect this from causing me any symptoms by continuing to nasal breathe (very much automatic now) and good asthma husbandry means this allows me to participate in things i want to do even when i have a chest cold. That is a big change from my previous state of housebound and limited quality of life when I had a chest cold.

I dont believe that buteyko is suggested to improve lung function, it may do over a long term period (i am sure mine is higher that it was) but it maintains lung function with a higher quality of life and reduced medication. I do believe that inhaling far less irritants or trigger particles into your lungs MUST improve irritation and by consequence underlying inflammation. With your nose expelling particles in 15 minutes as opposed to particles remaining lodged for 60-120 days through deep lodgement in the lungs when mouth breathed in should surely contribute to a reduction in inflammation just perhaps not immediately (lag phase perhaps due to 60-120 days needing to be cleared first).

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I'm not sure it's correct to suggest that nasal breathing has been overlooked as a primary cause of the increase in prevalence of asthma in industrialised countries. One could argue equally that there is something - or maybe several things - about our westernised lifestyles that promotes inflammation and obstruction in the airways of predisposed people and that this in turn causes the mouth breathing and hyperventilation which worsen the symptoms of diseases like asthma. There also seems to be agreement that breathing retraining (including Buteyko, Papworth and other methods) can benefit asthma in terms of symptom reduction and reduced rescue medication use - e.g. see here where two Australian government-funded medical researchers discuss and demonstrate breathing retraining techniques including buteyko - asthmacrc.org.au/breathing_... . So I don't think the argument that breathing techniques are being overlooked holds much water any more.

What concerns me is that many (by no means all) proponents of Buteyko promote it by use of anecdotes promising complete or near freedom from the need to use asthma medications but fail to point out that the present consensus in medicine, based on the available research, is considerably more restrained in its view of the benefits of the technique. I have seen websites state that it is suitable for all asthmatics, even severe, but no mention of the fact that hypoventilation can be a marker of disease severity in asthma, so proposing that such people practice what is in effect voluntary hypoventilation might not be a good idea at all. In short, I am not 'agin' the technique but worry that its benefits are being overstated and that there is too much reliance on anecdote on the part of people who promote it. My preference would be for it to be taught by people with a wider medical and respiratory training rather than by lay enthusiasts and done only in close collaboration with one's doctor or asthma nurse. As pointed out before, asthma can be deadly and must be taken seriously.

Also, I'm not sure that all mammals have evolved to nose-breathe all the time, having observed all the local dogs trotting about in the current fine weather, mouths open and tongues hanging out!

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breathing techniques and their benefits. Excellent link Claire.

Reply to ClaireO'B

Whatever the cause of our mouth breathing and hyperventilation, it is something we can take conscious control of (initially) before it becomes our NEW subconscious way of breathing. This does not need to be a medical intervention. A series of different exercises work although they can be time-consuming unless incorporated into daily routines. Breathing techniques will continue to be overlooked until they become common practice. The insistence and ridicule by both GPs and consultants that are regularly commented on by other posters are symptomatic of this ignorance (lack of knowledge) as well as ignorance (plain rudeness to ridicule anyone). This is probably on an assumption that they know more- which in relation to buteyko and its benefits they plainly do not. But I do know that this is slowly changing so I can see your point. I just believe that it should be faster- that’s all.

That link you sent through was excellent and I would recommend it to anyone to watch. They seem to hold back on saying that the buteyko breathing technique doesnt address the underlying inflammation. I believe this will be proven in time- it makes sense to me that reducing the amount of triggers inhaled will reduce the irritation which will address the inflammation over a medium or long period.

I agree that with some more severe asthmatics that the benefits are probably overstated as they may have moved beyond this help. Reduced and very easy exercises to encourage nasal breathing (to gain the benefit from filtration) may help in a small way.

As pointed out on the mayo clinics page mayoclinic.com/health/asthm... and I re-quote “While breathing exercises for asthma are gaining recognition and popularity in the United States, few experts are trained to provide instruction. If you decide to try breathing exercises, you may have to rely on instructional videos or books.” This hold true for the UK and Ireland too although I would suggest that it is easier to learn from a practitioner, many of whom are ex-asthmatics so understand a lot about it. Nature abhors a vacuum. Until there is wider expert training available, then the people who wish to gain the benefits from this and other techniques are left with little choice. This should be done in consultation with the prescribing doctor as you mention (I agree fully though many are also unfamiliar with the technique other than basic knowledge).

I agree that SOME proponents of Buteyko may exceed their brief. There may be an element of ”anti-establishment” protest in this and that is regrettable.

You are quite correct to say that dogs (and most if not all mammals (e.g. lions if you watch nature programmes)) breathe through their mouth for cooling purposes (in warm or hot weather) and after strenuous exercise. They naturally revert immediately to nasal breathing when cooled off or when the extreme heat period is over. No healthy animal breathes consistently through its mouth other than during exercise and heat or a combination of both.

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Buteyko'd, the video was interesting but I think you're slightly glossing over the fact that it was based on the 2006 Thorax paper, of which Professor Christine Jenkins from the Woolcock Institute was co-author and project leader. It concluded:

""...Breathing techniques may be useful in the management of patients with *mild* asthma symptoms who use reliever frequently, but **at present there is no evidence to favour shallow nasal breathing over non-specific upper-body exercises.**"" [my asterisks]

thorax.bmj.com/cgi/content/...

So it's not quite the specific endorsement of Buteyko you appear to imply. My 'take home' from this video was that Professor Jenkins was of the opinion that these techniques would be most beneficial to those with *mild* asthma symptoms who use (?overuse) rescue medication frequently. In the presentation she does emphasise that breathing exercises do not address the lung inflammation inherent in asthma and that medication is still required, especially with more severe asthma. This is what she has said in an interview:

""...“The research study was designed to measure the effect of two very different exercise regimes on a person’s asthma symptoms, lung function, use of medication and quality of life”.

“However it found no evidence to favour one breathing technique over the other. Instead, both groups of exercises were associated with a dramatic reduction in reliever use. Using either type of exercise was effective in markedly reducing the use of reliever medication. A reduction in inhaled corticosteroid (ICS) dose was also achieved, probably resulting from trial participation and clinical care in the study.

According to Professor Jenkins the results of regularly undertaking the exercises could be particularly beneficial to the management of patients with mild asthma symptoms, who use a reliever frequently”...""

physorg.com/news131186341.h tml

I would be very, very careful about suggesting that those with more severe asthma should undertake these techniques without close medical supervision, given that hypoventilation can be a marker of disease severity and can result in an increased blood level of carbon dioxide. Certainly, two people with severe asthma I know have been specifically warned about this by their consultants, who explained why trying to increase their CO2 levels might not be the most wonderful idea but, as I said before, I have yet to see a buteyko website mention this aspect.

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Buteyko and severe asthma

I'd agree with Claire on this.

I have raised the Buteyko method with my GP and my chest consultant. Neither discounted it, but did see it as a useful tool for the right people. In respect of my chest man his view was that it could and does help with milder forms of asthma, but in my case he didn't think it would help as mine is more about hyperventilation and this born out by Pof. Jenkins' paper.

As a result of a conversation with one of the asthma nurses on the hotline (extremely helpful and knowledgeable) I have asked to be referred to the Royal Brompton, however my GP has decied before that, we double the seretide to four times a day from two, I go for phsyiotherapy (also suggested by the asthma nurse) and we carry out a full spiro reversability test in month. From there we can then decide on the4 next steps -

I do get the impression that the treatment of asthma is more akin to pinning a tail on a donkey than a science!!!

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Please be careful

I have spoken to my resp nurse and she says that Buteko should not be used or tried by people with brittle, difficult or severe asthma it could cause a life threatening attack.

If you look in the front on the buteko books that you can buy it also tells you in the warning parts only to try with doctors guidance, some one trained in it, or in some one with mild asthma!

Please be careful. I am glad i checked it out before trying it!

[omahjoa]

Hi I was eventually diagnosed with churg strauss. It took years. Started with severe sinus. Had three oops. Huge polyps. Then asthma. Coughing constantly. In 2016 I was finally diagnosed. All the medication has given me reflux but this is controlled by omaprazol. Can't do without it. My life has been on hold as so exhausted and I'll. Starting mepo on Tuesday. Will keep you updated. Hope you get some answers xx