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Just heard an idea as to a cause of my symptoms, but need some insight


My physiotherapist suggested the reason only Ventolin relieves my breathing and tightness is because I breath wrong with my mouth. She thinks because I have a dodgy breathing pattern I get the air trapping and hyperinflation we saw on the chest x-ray and lung function tests leading to chest muscle tension. The tension radiates up my back and neck making my nose feel 'blocked.' The Ventolin relaxes my chest and I can breath deeper using my nose. This may be why I often wake up ok in the morning before I start thinking about my breathing, although I do tend to gasp in my sleep a lot which is still unexplained. It may also explain why I do better in the warmth.

We don't know if asthma is behind the air trapping but apparantly anxiety and overbreathing can cause air trapping too. Right? This is where I need some insight please! First I've heard of this all but I don't want to get my hopes up if my physio is wrong-! I am a very tall and skinny young male so I don't know if the air trapping we discovered is just a red herring or not.

13 Replies


I've always found it worthwhile to check out every idea - even if it leads to a dead-end as you will also always find one that is correct for you. I haven't heard of this one but I hope that it will lead to better health for you. Check out the Buteyko Method of breathing as this sounds a little familiar. Wishing you the best!

Hi GreatGateway, air-trapping is term I also have not previously heard but it turns out to be a great keyword for searches (in my case, Bing). I found several blogs and medical journal papers about the phenomenon. Too much to take in to give a clear summary of (for example: one 2007 study shows the efficacy of inhaled corticosteroids one air-trapping in mild to moderate asthma. Elsewhere air-trapping is looked at where it is a symptom of severe asthma and mixed conclusions are drawn.)

I always find breathing out harder than breathing in when my asthma's up but I don't know if that's the same thing.

The benchmark exhalation is 70%, lower exhalation indicates air trapping - well, so I thought I read but I can't find where now to check!

Thanks for your post, it has given food for thought, I hope you find clarity, it is certainly right to look at the symptom from various perspectives.

Here are some resources I found:

The first is an interesting asthma blog called 'Breathinstephen'


The other two are a med study and a press release.



Cheers, Ollie.

I ought to add in regard to breathing: Patrick McKeown is a writer on asthma and breathing techniques, he follows the Buteyko methodology, that to a certain extent is gaining credibility in medical circles (I found an NHS leaflet mentioning his techniques a while back).

The main idea is that nose breathing is good because it better regulates the balance of carbon dioxide and oxygen than mouth breathing. Physiological responses to an imbalance are thought to include constriction of the airways and a blocked nose.

in reply to O-T-

Sorry Tugun, hadn't noticed you'd already suggested Buteyko!

in reply to O-T-

Do you think anxiety breathing is what gives rise to the "asthma" I've been feeling and why only Ventolin helps?

In previous posts I mentionned how I never cough, wheeze or drop in peak flow, how preventers have never helped, how I experience contradictory symptoms like bradycardia instead of tachycardia and how Ventolin doesn't always work perfectly.

in reply to GreatGateway

I'm afraid this takes me out of my province somewhat. It is certainly true that anxiety is implicated in asthma and too many non-asthmatics blather about it as a cause but even so, anxiety probably precedes breathing issues in many instances, though I feel at most it could trigger asthma symptoms in an asthmatic, not cause the disease. Breathing problems are highly likely to sow the seeds of anxious and depressive tendencies rather than the reverse. But then one finds vicious circles of sorts.

I haven't an opinion on the cause of asthma but I suspect house dust mites may be the worst offender: apparently more women than men have asthma but as children the gender spread is about equal. One would then wonder statistically who spends the most time indoors and in what kinds of environment? Children typically have more similar lifestyles than adults.

Dysfunctional breathing is the keyword - it has been mentioned before on this forum and someone posted a link to an NHS leaflet about it (I think that was the one that also mentioned Buteyko).


I've always been a mouth breather and purse breathing which is now old hat but trying to change that habbit isn't easy as you can imagine. Now with a physiotherapist it's shallow breathing to achieve no wheeze just through my nose I be manage 2 minutes before I'm gasping for a deep breath. When I'm in A&E I get told off for shallow breathing and say deep breaths which contradicts what I'm being told. I find that no 2 professionals are in agreement. Good luck

I don't think asthma is caused by incorrect breathing - if anything, the latter is a symptom of the former. I was recently diagnosed with late onset asthma and fixed small airways obstruction. The CT scan shows air trapping in the small airways which don't collapse properly on exhalation; in small airways disease this a structural defect, whereas in asthma it is caused by the immune system incorrectly stimulating the small airways to remain open. Ventolin helps by reversing this effect.

There is a lot of talk about people breathing "incorrectly", and I am a bit suspicious of breathing exercises which seem unnatural. When you are asleep your breathing is controlled by the autonomic nervous system, which is perfectly capable of breathing "normally". Problem is, when you are awake, you can override the automatic system, particularly when you are under stress. This seems to cause people to "chest breathe" rather than the "normal" diaphragmatic breathing which occurs at night. There is a Yoga exercise I saw recently which suggests breathing out for twice as long as you breath in, presumably in an attempt to remove the "trapped" air in the small airways - although the logic seems sound, whether it actually works in practice is debatable, but it can't do any harm I suppose.

Main thing is to treat the asthma in a way which works for YOU.

Expert Reviewed

How to Diagnose Lung Hyperinflation

Lung hyperinflation is the chronic and excessive inflation or expansion of the lungs. It can result from excess carbon dioxide being trapped in the lung or a lack of lung elasticity due to pulmonary illness. Additionally, any obstruction within the bronchial tubes or alveoli, the channels that transport air into the lung tissue, can cause hyperinflated lungs. To diagnose lung hyperinflation, be aware of its causes and symptoms, and seek a professional diagnosis.

Part One of Three:

Recognizing the Symptoms


Pay attention to changes in breathing. Does taking a breath feel difficult or painful? Do you feel that, when breathing, you are not getting enough oxygen? These sensations are not a guarantee of lung hyperinflation. They are, however, warning signs when experienced with other symptoms.[1]


Be wary of a chronic cough. Coughing is a common side-effect of certain pulmonary illnesses as well as smoking. Lung hyperinflation leads to a chronic, wheezing cough that interrupts normal daily functions.

If you have hyper-inflated lungs, you may have difficulty walking up hills and succumb to coughing easily. If you have a chronic cough that does not go away for two weeks, you should see a doctor for a diagnosis.[2]

Listen for a whistling sound when air is drawn into the lung. This can indicate reduced elasticity of the lung, a symptom of lung hyperinflation.[3]


Watch for other changes in the body. Other changes in the body, when combined with the above symptoms, may point to lung hyperinflation. Watch for the following symptoms: [4]

Frequent bouts of sicknesses like bronchitis

Weight loss

Waking up at night

Swollen ankles



Part Two of Three:

Getting a Medical Diagnosis


Let a doctor assess your medical history and conduct a physical examination. Your doctor will make an initial assessment of your condition by gathering information about your past and present health history. Significant factors that can indicate lung hyperinflation are:

A family history of lung conditions, like lung cancer, asthma, and chronic obstructive pulmonary disease

Present habits, like vigorous exercise or smoking

Living environment, such as living in a polluted city or with a smoker

Active medical conditions like asthma or mental health conditions like chronic anxiety[5]


Get chest x-rays. A chest x-ray generates an image of the lungs, air passages, the heart, blood vessels, and the bones of your chest and spine. A chest x-ray can be used to gauge whether lungs are hyperinflated.

An x-ray can show fluid and air around the lungs, signifying an underlying problem like COPD or cancer. This can be the cause of lung hyperinflation and the sooner you get the disease diagnosed the better.[6]

Lung hyperinflation is present when the x-ray shows the front of the fifth or sixth rib meeting the middle of your diaphragm. More than six front ribs touching your diaphragm is consistent with hyperinflation.[7]


Get a computer tomography (CT) scan. CT scans are an imaging method that uses x-rays to produce a three-dimensional representation of the body.The pictures generated by the machine illustrate the scope of lung damage and hyperinflation.

A CT scan can show an increase in lung size and may even show air trapped in one or both lungs. Trapped air usually appears as black on an x-ray screen.

A special dye is sometimes used in CT scans to highlight the areas x-rayed. This is usually given by mouth, by enema, or by injection but is fairly rare for a CT scan focusing on the chest. During the scan, you'll have to wear a hospital gown and remove any items, like jewelry and eyeglasses, that may interfere with the scan.[8]

During a CT scan, you'll lie on a motorized table and your body will be inserted into a donut-shaped machine. A technologist will communicate with you from another room. He or she may ask you to hold your breath at certain points during the scan. The procedure is painless and usually takes around 30 minutes.[9]


Have pulmonary function tests done. Pulmonary function tests are tests that measure breathing capacity and overall pulmonary function.[10]To confirm a diagnosis of lung hyperinflation, two numerical values are assessed during a pulmonary function test.

FEV1 (Forced Expiratory Volume in 1 second): This is the amount of air that can be blown out of your lungs in the first 1 second.

FVC (Forced Vital Capacity): This reflect the total amount of air that you can exhale.

The normal results of FEV1/FVC ratio should be more than 70 percent. Less than this percentage indicates lung hyperinflation, since a patient with this condition cannot blow air out as fast as a healthy person does.

During the test, a doctor will use medical instruments to measure your breath. While usually painless, you may experience some shortness of breath as it involves forced, rapid breathing. Do not smoke four to six hours before the test and do not eat a heavy meal beforehand.[11]


Part Three of Three:

Assessing Your Risk


Understand the effect of chronic obstructive pulmonary disease (COPD). COPD is present when there is an obstruction in your lungs that disrupts airflow. COPD is usually treated by monitoring and controlling symptoms through a combination of medical assistance and lifestyle changes. Hyperinflation of the lungs is frequently caused by COPD. If you've previously been diagnosed with COPD, this could increase your risk for lung hyperinflation.[12]

To treat COPD, your doctor will recommend a combination of lifestyle changes and prescription medications. If you are a smoker, it's important you quit. Making symptoms of COPD worse by neglecting medication or continuing to smoke can increase your risk of lung hyperinflation.[13]


Be aware of the effect of asthma. Asthma is caused by inflammation of the airways. Depending on the severity of an asthma attack, swelling can disrupt air flow to the lungs. Over time, this can result in lung hyperinflation. Treatment of asthma usually involves building an action plan with your doctor about medication, lifestyle changes, and how to manage asthma attacks when they occur. Talk to your doctor about better managing your asthma as to avoid lung hyperinflation.[14]


Learn the effect of cystic fibrosis. Cystic fibrosis is a chronic disease that may affect several organs and systems in your body. It is an inherited disorder of the exocrine gland, characterized by an abnormal production of mucus that tends to be much thicker and stickier than usual, which can plug your airways. As with anything that blocks airways, cystic fibrosis can lead to lung hyperinflation. If you have cystic fibrosis, you are at an increased risk of lung hyperinflation

I wonder if coughs are guaranteed with this? I never cough or wheeze. :p


Sounds finicky..I have a respiratory physiotherapist who teaches me how to use my diaphragm, to increase my lung capacity. Exercises are traditional and have helped me well. That is the question, do you feel it is helping you?

in reply to Hidden

To be honest not much, but then again I discovered last night that even Ventolin isn't always ideal. When I took it last night I felt relief from my chest tightness, but my bradycardia, non-automatic breathing breathing and random gasps for air with SPO2 drops continued (no change in peak flow)

in reply to GreatGateway

there are other bronchodilators did you try atrovent or spiriva, there are long-lasting. I would go back to your GP or specialist

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