Novel Respiratory Therapy for the Improvement of Post COVID Condition Symptoms: A Case Series.

INTRODUCTION: Speech-language pathologists are seeing a growing number of patients whose voice and upper airway symptoms are complicated by dyspnea, cognitive difficulties, anxiety, extreme fatigue, and other debilitating post COVID symptoms. These patients are often less responsive to traditional speech-language pathology treatments and there is emerging literature that suggests dysfunctional breathing (DB) might contribute to dyspnea and other symptoms in this patient population. Treatment of DB through breathing retraining has been shown to improve breathing and successfully reduce symptoms similar to those seen in patients with long COVID. There is some preliminary evidence that breathing retraining is helpful for patients with post COVID condition symptoms. However, breathing retraining protocols tend to be heterogeneous and are often not systematic or well described. METHODS: This case series reports on an Integrative Breathing Therapy (IBT) protocol used in patients diagnosed with post COVID condition symptoms attending an otolaryngology clinic who presented with signs and symptoms of DB. A systematic evaluation of the biomechanical, biochemical, and psychophysiological dimensions of DB based on principles of IBT was performed on each patient to enable targeted patient-centered care. Patients were then provided with intensive breathing retraining that aimed to comprehensively improve breathing functionality in all these three dimensions of breathing. Treatment involved 6-12 sessions of weekly 1-hour group telehealth sessions combined with 2-4 individual sessions. RESULTS: All participants showed improvements in the parameters of DB measured and also reported a reduction in symptoms and improved daily function. CONCLUSIONS: These findings suggest that patients with long COVID who present with signs and symptoms of DB might respond positively to comprehensive and intensive breathing retraining that addresses biochemical, biomechanical, and psychophysiological dimensions of breathing. More research is required to further refine this protocol and confirm its effectiveness through a controlled trial.

Effects of a nasal breathing protocol on physical fitness and pulmonary function in young basketball players.

BACKGROUND: Respiratory muscle training has been shown to provide positive effects for both health and performance purposes. The aim of this study was to evaluate the effects of a six-week period of nasal breathing on pulmonary function and cardio-respiratory fitness in young basketball players. METHODS: Thirty-four, male, basketball players were enrolled and assigned either to experimental group (EG) or to control group (CG). All participants were tested for Yo-Yo Intermittent Recovery level 1 (Yo-Yo IR1), Shuttle Sprint Test (SST), Forced Vitality Capacity (FVC), Forced Expiratory Volume in one second (FEV1) and Peak Expiratory Flow (PEF). EG group followed reduced breathing frequency training program focused on intermittent running exercises while performing nasal breathing. RESULTS: The main findings were significant interactions in Yo-Yo IR1 test, FVC, FEV1 and PEF (P<0.05) in favor of EG compared to CG. Conversely, no significant changes were detected between EG and CG in the SST total time. CONCLUSIONS: Young basketball players may benefit from nasal breathing protocol during their regular training practice leading remarkable improvements in both physical fitness and pulmonary function.

Breathing retraining in sleep apnoea: a review of approaches and potential mechanisms.

PURPOSE: Anatomically based treatments for obstructive sleep apnoea (OSA) may not completely resolve OSA. This has led to interest in exploring ways of addressing physiological risk factors. This review examines the literature for research reporting on the effects of various types of breathing training and breathing activities on sleep apnoea. It also reviews and discusses proposed therapeutic mechanisms. METHODS: A search of electronic databases was performed using the search terms related to various breathing therapies or to activities requiring high levels of breath control such as singing and the playing of musical instruments and sleep apnoea. RESULTS: A total of 14 suitable studies were reviewed. A diverse variety of breathing retraining approaches are reported to improve sleep apnoea, e.g., Buteyko method, inspiratory resistance training, and diaphragmatic breathing. There is also a reduced incidence of sleep apnoea with intensive and regular participation in activities that require high levels of breath control, e.g., singing and playing wind instruments. Improvements in sleep-disordered breathing are thought to be related to improvements in (1) muscle tone of the upper airway; (2) respiratory muscle strength; (3) neuroplasticity of breathing control; (4) oxygen levels; (5) hyperventilation/dysfunctional breathing; and (6) autonomic nervous system, metabolic, and inflammatory status. CONCLUSION: Breathing retraining and regular practice of breath control activities such as singing and playing wind instruments are potentially helpful for sleep apnoea, particularly for individuals with minimal anatomical deficit and daytime breathing dysfunction. Research is needed to elucidate mechanisms, to inform patient selection, and to refine clinical protocols.

Breathing training for dysfunctional breathing in asthma: taking a multidimensional approach.

Various breathing training programmes may be helpful for adults with asthma. The main therapeutic aim for many of these programmes is the correction of dysfunctional breathing. Dysfunctional breathing can be viewed practically as a multidimensional entity with the three key dimensions being biochemical, biomechanical and psychophysiological. The objectives of this review are to explore how each of these dimensions might impact on asthma sufferers, to review how various breathing therapy protocols target these dimensions and to determine if there is evidence suggesting how breathing therapy protocols might be optimised. Databases and reference lists of articles were searched for peer-reviewed English language studies that discussed asthma or dysfunctional breathing and various breathing therapies. Biochemical, biomechanical and psychophysiological aspects of dysfunctional breathing can all potentially impact on asthma symptoms and breathing control. There is significant variation in breathing training protocols and the extent to which they evaluate and improve function in these three dimensions. The various dimensions of dysfunctional breathing may be of greater or lesser importance in different cases and the effectiveness of breathing training protocols is likely to be improved when all three dimensions are considered. Outcomes for breathing training for dysfunctional breathing in asthma may be most successful when the three key dimensions of dysfunctional breathing are evaluated at the start of treatment and monitored during treatment. This allows breathing training protocols to be adjusted as appropriate to ensure that treatment is sufficiently comprehensive and intensive to produce measurable improvements where necessary.

A case of remission from pre-diabetes following intermittent hypoxic training.

A female patient (49 years of age) with obesity (body mass index: 35.3kg/m(2)) and diagnosed with pre-diabetes presented to the clinic of one of the authors (RC) with recent weight gain (approximately 10kg) over the preceding 12 months, despite several unsuccessful attempts at weight loss. She reported being short of breath performing light activities and feeling fatigued the majority of the time. Treatment consisted of a run in period of five weeks following the Commonwealth Scientific and Industrial Research Organisation (CSIRO) diet, followed by four weeks of the CSIRO diet plus intermittent hypoxic training (IHT) using the GO2(®) altitude training device. Anthropometric measures, bloods and questionnaires were completed before treatment (week 0), end of diet phase (week 5), and end of diet plus IHT phase (week 9). At the end of week five, the patient had lost some weight and had an improvement in glycaemic control. However, there was a clinically greater improvement in weight loss and glycaemic control from week five to nine following the IHT, resulting in remission from pre-diabetes. This case study shows that incorporation of IHT has benefits existing beyond a standard dietary approach, helping to achieve remission from pre-diabetes back to a normal fasting glucose state.

Relationship between dysfunctional breathing patterns and ability to achieve target heart rate variability with features of "coherence" during biofeedback.

BACKGROUND: Heart rate variability (HRV) biofeedback is a self-regulation strategy used to improve conditions including asthma, stress, hypertension, and chronic obstructive pulmonary disease. Respiratory muscle function affects hemodynamic influences on respiratory sinus arrhythmia (RSA), and HRV and HRV-biofeedback protocols often include slow abdominal breathing to achieve physiologically optimal patterns of HRV with power spectral distribution concentrated around the 0.1-Hz frequency and large amplitude. It is likely that optimal balanced breathing patterns and ability to entrain heart rhythms to breathing reflect physiological efficiency and resilience and that individuals with dysfunctional breathing patterns may have difficulty voluntarily modulating HRV and RSA. The relationship between breathing movement patterns and HRV, however, has not been investigated. This study examines how individuals' habitual breathing patterns correspond with their ability to optimize HRV and RSA. METHOD: Breathing pattern was assessed using the Manual Assessment of Respiratory Motion (MARM) and the Hi Lo manual palpation techniques in 83 people with possible dysfunctional breathing before they attempted HRV biofeedback. Mean respiratory rate was also assessed. Subsequently, participants applied a brief 5-minute biofeedback protocol, involving breathing and positive emotional focus, to achieve HRV patterns proposed to reflect physiological "coherence" and entrainment of heart rhythm oscillations to other oscillating body systems. RESULTS: Thoracic-dominant breathing was associated with decreased coherence of HRV (r = -.463, P = .0001). Individuals with paradoxical breathing had the lowest HRV coherence (t(8) = 10.7, P = .001), and the negative relationship between coherence of HRV and extent of thoracic breathing was strongest in this group (r = -.768, P = .03). CONCLUSION: Dysfunctional breathing patterns are associated with decreased ability to achieve HRV patterns that reflect cardiorespiratory efficiency and autonomic nervous system balance. This suggests that dysfunctional breathing patterns are not only biomechanically inefficient but also reflect decreased physiological resilience. Breathing assessment using simple manual techniques such as the MARM and Hi Lo may be useful in HRV biofeedback to identify if poor responders require more emphasis on correction of dysfunctional breathing.

Medically unexplained dyspnea: partly moderated by dysfunctional (thoracic dominant) breathing pattern.

BACKGROUND: Dysfunctional breathing (DB) may contribute to disproportionate dyspnea and other medically unexplained symptoms. The extent of dysfunctional breathing is often evaluated using the Nijmegen Questionnaire (NQ) or by the presence of abnormal breathing patterns. The NQ was originally devised to evaluate one form of dysfunctional breathing - hyperventilation syndrome. However, the symptoms identified by the NQ are not primarily due to hypocapnia and may be due to other causes including breathing pattern dysfunction. OBJECTIVES: The relationships between breathing pattern abnormalities and the various categories of NQ symptoms including respiratory or dyspnea symptoms have not been investigated. This study investigates these relationships. METHOD: 62 patients with medically unexplained complaints, that seemed to be associated with tension and breathing dysfunction, were referred, or self-referred, for breathing and relaxation therapy. Dysfunctional breathing symptoms and breathing patterns were assessed at the beginning and end of treatments using the NQ for assessment of DB symptoms, and the Manual Assessment of Respiratory Motion (MARM) to quantify the extent of thoracic dominant breathing. Subscales for the NQ were created in 4 categories, tension, central neurovascular, peripheral neurovascular and dyspnea. Relationships between the NQ (sum scores and subscales) and the MARM were explored. RESULTS: Mean NQ scores were elevated and mean MARM values for thoracic breathing were also elevated. There was a small correlation pre-treatment between MARM and NQ (r=0.26, p<0.05), but classification of subjects as normal/abnormal on both measurements agreed in 74% (p < 0.001) of patients. From the sub scores of NQ only the respiratory or 'dyspnea' items correlated with the MARM values. Dyspnea was only elevated for subjects with abnormal MARM. After treatment, both MARM and NQ returned to normal values (p< 0.0001). Changes in NQ were largest for subjects with abnormal MARM pre-treatment. There was a large interaction between the change in the NQ sub score dyspnea and initial MARM values. (p<0.001).

Relationships between measures of dysfunctional breathing in a population with concerns about their breathing.

BACKGROUND: Dysfunctional breathing (DB) is implicated in physical and psychological health, however evaluation is hampered by lack of rigorous definition and clearly defined measures. Screening tools for DB include biochemical measures such as end-tidal CO(2), biomechanical measures such assessments of breathing pattern, breathing symptom questionnaires and tests of breathing function such as breath holding time. AIM: This study investigates whether screening tools for dysfunctional breathing measure distinct or associated aspects of breathing functionality. METHOD: 84 self-referred or practitioner-referred individuals with concerns about their breathing were assessed using screening tools proposed to identify DB. Correlations between these measures were determined. RESULTS: Significant correlations where found within categories of measures however correlations between variables in different categories were generally not significant. No measures were found to correlate with carbon dioxide levels. CONCLUSION: DB cannot be simply defined. For practical purposes DB is probably best characterised as a multi-dimensional construct with at least 3 dimensions, biochemical, biomechanical and breathing related symptoms. Comprehensive evaluation of breathing dysfunction should include measures of breathing symptoms, breathing pattern, resting CO(2) and also include functional measures such a breath holding time and response of breathing to physical and psychological challenges including stress testing with CO(2) monitoring.

Evaluation of breathing pattern: comparison of a Manual Assessment of Respiratory Motion (MARM) and respiratory induction plethysmography.

Altered breathing pattern is an aspect of dysfunctional breathing but few standardised techniques exist to evaluate it. This study investigates a technique for evaluating and quantifying breathing pattern, called the Manual Assessment of Respiratory Motion (MARM) and compares it to measures performed with Respiratory Induction Plethysmography (RIP). About 12 subjects altered their breathing and posture while 2 examiners assessed their breathing using the MARM. Simultaneous measurements with RIP were taken. Inter-examiner agreement and agreement between MARM and RIP were assessed. The ability of the measurement methods to differentiate between diverse breathing and postural patterns was compared. High levels of agreement between examiners were found with the MARM for measures of the upper rib cage relative to lower rib cage/abdomen motion during breathing but not for measures of volume. The measures of upper rib cage dominance during breathing correlated with similar measures obtained from RIP. Both RIP and MARM measures methods were able to differentiate between abdominal and thoracic breathing patterns, but only MARM was able to differentiate between breathing changes occurring as result of slumped versus erect sitting posture. This study suggests that the MARM is a reliable clinical tool for assessing breathing pattern.

Investigating the claims of Konstantin Buteyko, M.D., Ph.D.: the relationship of breath holding time to end tidal CO2 and other proposed measures of dysfunctional breathing.

OBJECTIVES: Konstantin Buteyko, M.D., Ph.D., claimed that breath holding time (BHT) can be used to detect chronic hyperventilation and that BHT predicts alveolar CO(2) (Pa(CO(2))) according to his patented mathematical formula. The Buteyko Breathing Technique (BBT) is believed to correct chronic hyperventilation as evidenced by increased BHT. In this study, we test Buteyko's claims and explore the relationship between BHT and end-tidal carbon dioxide (ETCO(2)) as well as measures of dysfunctional breathing (DB) including the Nijmegen questionnaire, the Self Evaluation of Breathing Questionnaire, and thoracic dominant breathing pattern. SUBJECTS: Eighty-three (83) adults healthy or suspected of having dysfunctional breathing, 29 with abnormal spirometry readings, 54 with normal spirometry. OUTCOME MEASURES: BHT, performed according to BBT protocols, was measured along with ETCO(2) and other measures of DB including the Nijmegen questionnaire, and manual assessment of respiratory motion, a palpatory technique for measuring thoraco-abdominal balance during breathing. Correlations between measures of DB were made in the whole sample and also in subgroups with normal or abnormal spirometry. DB measures were compared in normal and abnormal spirometry groups. RESULTS: The results revealed a negative correlation between BHT and ETCO(2) (r= -0.241, p<0.05), directly opposite to Buteyko's claims. BHT was significantly shorter in people with abnormal spirometry (FEV(1) or FVC<15% below predicted), with no difference in ETCO(2) levels between the abnormal and normal spirometry groups. In the abnormal spirometry group, lower BHT was found to correlate with a thoracic dominant breathing pattern. (r= -0.408, p<0.028). CONCLUSIONS: Although BHT does not predict resting ETCO(2), it does correlate with breathing pattern in subjects with abnormal spirometry. It is proposed that altered breathing pattern could contribute to breathing symptoms such as dyspnea and that breathing therapies such as BBT might influence symptoms by improving the efficiency of the biomechanics of breathing.