Asthma – how it affects breathing

Asthma is a long-term breathing condition that affects the airways. These are the small tubes that transport air in and out of the lungs. It’s these tubes that become inflamed when they come into contact with something that ‘irritates’ them. Consequently, the airways become narrower. And it’s for this reason that people with asthma feel breathless and wheezy. But these symptoms will vary in severity from person to person.

What causes asthma

In the general population, asthma affects approximately 235 million people. And here in the UK, one in every 12 adults is receiving treatment for it.

Asthma tends to run in families, so genetic predisposition is one risk factor. Another factor is environmental. For instance, exposure to particles that may irritate the airways or give rise to an allergic reaction. Such irritants may include tobacco smoke, house dust mites, pet dander, pollen or air pollution.

In addition to genetic predisposition and environmental irritants, there are also other triggers. These can include physical exercise and cold air. So, it’s no surprise to discover that exercise-induced asthma (EIA) is the most common medical issue among winter Olympic athletes. In fact, almost 50% of cross-country skiers in the 2018 Winter Olympics have EIA. But it isn’t only the cross-country skiers who’re suffering. Short-track speed skaters (43%), figure skaters (21%) and ice hockey player (15%) also suffer.

What is EIA

Exercise-induced asthma (EIA) is a condition where exercise itself becomes the trigger for an asthma event. Symptoms will surface only while exercising, or immediately following exercise. And the symptoms feel worst of all after exercise and then start to gradually improve. Treatment for EIA is the same, with long-term medicines that are taken daily. But there is also a natural treatment that is drug-free that can be used alongside medication. And that is Inspiratory Muscle Training (IMT).

Natural asthma treatment without drugs

Data exists from five randomised controlled trials that are unanimously supportive of the use of IMT with POWERbreathe in the management of asthma. In fact, the POWERbreathe Medic is clinically proven by a wealth of research, as well as, the first non-pharmacological treatment for respiratory disease and the only product of its kind on the drug tariff. It is a non-invasive treatment that is drug-free, with no side effects or drug interactions.

POWERbreathe IMT is not suitable for patients with certain conditions so please first consult your specialist respiratory health doctor.

How asthma affects exercise

Breathlessness is a common feature of exercise. Shortness of breath, coughing and wheezing are also symptoms of asthma. So, imagine being an Olympic athlete performing high-intensity training above your lactate threshold. Then imagine being a winter Olympic athlete, with asthma. Breathing moves out of its comfort zone and increases steeply. And with the breathing muscles weakening and tiring, breathing feels harder still. It would be beneficial therefore to improve the state of the inspiratory muscles, mainly the diaphragm and intercostal.

It is possible to exercise specifically the inspiratory muscles with an inspiratory muscle training (IMT) device, such as POWERbreathe IMT. Such a device provides the inspiratory muscles with a resistance to breathe in against. This resistance training makes the inspiratory muscles work harder, improving breathing strength and stamina and reducing breathing fatigue.

What exercise helps asthma

Any form of exercise is good for you and will help keep heart and lungs healthy. In fact, many well-known, world-class athletes have this condition, such as runner Paula Radcliffe and cyclist Laura Trott.

If your symptoms are well managed, and your GP gives the go-ahead, then there’s no reason to limit your choice of exercise.

Practical tips for exercising with asthma

  • Warm-up first, including an inspiratory muscle warm-up with an IMT device
  • Make sure you have your inhaler with you
  • Ensure people around you know that you have asthma
  • If you feel your symptoms coming on during exercise, take your reliever inhaler and wait until symptoms subside

Non-Asthma Related Breathing Problems In Athletes

This BASES Expert Statement looks into exercise respiratory symptoms, such as wheezing, tight chest, difficulty breathing, shortness of breath and coughing which are commonly reported by athletes.

These non-specific symptoms need to be assessed in order to confirm or eliminate the presence of cardio-pulmonary causes.

There is a high prevalence – 70% – of asthma and exercise induced bronchoconstriction (EIB) in sports with high breathing requirements, and it has been assumed that exercise-induced respiratory symptoms in these athletes is due to asthma or exercise-induced-asthma (EIA).

Symptoms however are misleading and this Expert Statement looks at these differential causes of exercise respiratory symptoms: Exercise-Induced Laryngeal Obstruction (EILO) and Dysfunctional Breathing.

Interventions are then discussed which include breathing pattern retraining and inspiratory muscle training and finally conclusions are made.

You can read the full Expert Statement here, Assessment and Management of Non-asthma Related Breathing Problems in Athletes.

Proper Breathing – POWERbreathe Can Help

Your primary breathing muscle is your diaphragm; a dome shaped thin sheet of muscle separating your rib cage from your abdomen.

When you inhale this dome shape flattens out as your diaphragm contracts, pushing down on the contents of your abdomen (your gut) and increasing the space in your chest cavity.

Because your gut has to go somewhere as your diaphragm descends, it forces it down and out and your tummy expands. Because of this, this natural, healthy and proper way of breathing is often referred to as abdominal breathing or diaphragmatic breathing.

If you do already have a good breathing technique it can often go awry when you start exercising as you demand more air and your breathing increases to compensate. This is when your breathing technique can change from good diaphragmatic breathing to reverse breathing i.e. pulling in your tummy as you breathe in and letting your tummy go as you breathe out.

Because your diaphragm is a muscle, you can train it like any other muscle to become stronger and helping you retain that good diaphragmatic breathing even when pushed to your limit. POWERbreathe targets your inspiratory muscles – not only your diaphragm but also your intercostal muscles, the tiny muscles in between your ribs, which are recruited during a slightly forced respiration.

You’ll notice when training with POWERbreathe that you have to work harder to breathe in. This is the effect of resistance training acting on your inspiratory muscles. When breathing out, POWERbreathe offers no resistance because when you exhale normally, your diaphragm and intercostals naturally relax and move back up, pushing the air from your lungs.

Effects of IMT on Resistance to Fatigue of Respiratory Muscles in Exercise

EliteVelo Kalas Sportswear Cycling Race Team by Richard Fox Photography

EliteVelo Kalas Sportswear Cycling Race Team using POWERbreathe Plus IMT (above)
PHOTO: Richard Fox Photography

STUDY:

Effects of Inspiratory Muscle Training on Resistance to Fatigue of Respiratory Muscles During Exhaustive Exercise
M. O. Segizbaeva, N. N. Timofeev, Zh. A. Donina, E. N. Kur’yanovich, N. P. Aleksandrova

This study, published in Body Metabolism and Exercise – Advances in Experimental Medicine and Biology (Volume 840, 2015, pp 35-43) concluded that IMT elicits resistance to the development of inspiratory muscles fatigue during high-intensity exercise.

PURPOSE:

To assess the effect of inspiratory muscle training (IMT) on resistance to fatigue of the diaphragm, parasternal, sternocleidomastoid and scalene muscles in healthy humans during exhaustive exercise.

The sternocleidomastoid muscle flexes the neck and helps with the oblique rotation of the head. Also, the muscle helps in forced inspiration while breathing, and it raises the sternum. As for forced inspiration, the muscle also works in concert with the scalene muscles in the neck. The scalene muscles are lateral vertebral muscles that begin at the first and second ribs and pass up into the sides of the neck. There are three of these muscles. (SOURCE: Healthline.com)

CONCLUSION:

“The study found that in healthy subjects, IMT results in significant increase in MIP (+18 %), a delay of inspiratory muscle fatigue during exhaustive exercise, and a significant improvement in maximal work performance. We conclude that the IMT elicits resistance to the development of inspiratory muscles fatigue during high-intensity exercise.”

Read Effects of Inspiratory Muscle Training on Resistance to Fatigue of Respiratory Muscles During Exhaustive Exercise

Check out more Inspiratory Muscle Training Research here >

Discover POWERbreathe used in Research here >

What causes exercise-induced asthma?

The reason why asthma symptoms may be brought on during exercise has not been completely established but it is thought that because breathing becomes heavy and we breathe faster when we exercise, the linings of our airways narrow and dry out. Also weather conditions and allergies, such as an allergy to pollen, can also trigger asthma-like symptoms when exercising.

Recognising exericse-induced asthma (EIA)

Diagnosis is often made after symptoms, such as wheezing and a tight chest, are experienced during exercise, but this can result in either over-diagnosis, where athletes report symptoms but DO NOT have narrowing of the airways, or under-diagnosis where athletes who’re asymptomatic (showing no symptoms) DO have narrowing of the airways which affects their performance.

The scenarios above are supported in studies where elite athletes have been screened and shown to have EIA, such as reported by British Olympic Teams in the 2012 Olympics where it found that 25% of Team GB suffers from exercise-induced asthma. And at the 1996 Olympic games 20% of athletes reported asthma upon exercising.

Why screen for EIA?

The main reason is because exercise-induced asthma may be detrimental to an athlete’s performance, as it’s already been shown to reduce exercise capacity and running speed in colder environments which will not only affect an athlete during training but also during competition.

Treatment of EIA

Both pharmacological and non pharmacological therapies are currently successfully used to treat EIA, and studies have also highlighted the benefits of adjunctive intervention. POWERbreathe Inspiratory Muscle Training can be used as an adjunctive intervention, not only for daily training, but also as a respiratory warm-up prior to exercise.

Read more about Respiratory Disorders in endurance athletes in our blog.

And here’s an interesting article that looks at Pollen and Exercise Induced Asthma >

Breathe deeply with POWERbreathe for more energy

Deep breathing reaches the deepest depths of your lungs, and by practicing POWERbreathe inspiratory muscle training you’ll be training your respiratory muscles to breathe deeply into your diaphragm, taking in as much air as possible, breathing more in per breath.

As you’re breathing in more air per breath, you’re receiving more oxygen into your body, giving you more energy.

Senior consultant at the National heart Institute, India, and Founder, SAANS Foundation in India, Partha Pratim Bose offers a good example of this,

“By deep breathing exercises you breathe more per breath. If you breathe more per breath you expand your lungs more, you receive more oxygen. You will feel more energetic and also save your breaths. For example, if you breathe 250 ml per breath and your requirement is 5 litres then you need 20 breaths per minute. If you breathe more breath say double i.e. 500ml then you will require only ten breaths. So by breathing deep you breathe less and you feel better and conserve energy.”

Thankfully you can train your breathing muscles to breathe deep, as your respiratory muscles respond in the same way as skeletal muscles do to a training stimuli as they undergo adaptations to their structure and function. POWERbreathe is one such training stimuli, using the principles of resistance training to strengthen the inspiratory muscles. Its pressure loaded inspiratory valve offers the resistance on the inhale, while an unloaded expiratory valve allows for normal, passive exhalation.

How POWERbreathe Works >

You can read about other benefits of deep conscious breathing in Bose’s article ‘Wellness: Breathe like a tortoise, live like a king’ and here in POWERbreathe Benefits.

Breathing – your magic bullet to improved sports performance

Breathing properly could just be your magic bullet to improved sports performance and sporting achievements.

In an article about The Dangers of Dysfunctional Breathing, international performance consultant Brandon Marcello, Ph.D., MS, CSCS says, “Having improper breathing form is no different from having improper squat form.”

The article goes on to say that ‘when it comes to physical activity, breathing ineffectively can alter your performance’. Therefore breathing effectively will also alter your performance, but for the better!

POWERbreathe inspiratory muscle training (IMT) exercises your breathing muscles, improving their strength and stamina, reducing fatigue which in turn enables you to train harder, for longer and with less effort which ultimately translates into improved performance.

POWERbreathe IMT has been scientifically proven to:

 

Metabolic reflection of respiratory muscles limiting athletic performance

 

We’re grateful to our friends Fit & Breathe Concept for bringing this article to our attention. It’s written by Germain Fernandez Monterrubio, Bachelor of Science in Physical Activity and Sport and can be found in its original language here: ‘El reflejo metabólico de la musculatura respiratoria como factor limitante del rendimiento deportivo’.

We’ve translated the original text as best we can (as follows), but if it is not entirely clear then you may also be interested in reading this research, published in The Journal (2007) of The Physiological Society, ‘Insights into the role of the respiratory muscle metaboreflex’.

Metabolic reflection of the respiratory muscles as a limiting factor in athletic performance

Numerous studies show ventilatory fatigue (the inability of the respiratory muscles to achieve preural given pressure) (Chicharro, 2010) is considered as a limiting factor in performance, especially in disciplines that require endurance (such as marathon, rowing, swimming , triathlon etc).

One of the limiting factors that future studies will focus on is that of determining the specific influence of Metabolic Reflection of Respiratory Musculature (RMMR) in different cases.

The RMMR initiates fatigue of the respiratory muscles, which through III and IV afferents reach the supraspinal level, triggering a sympathetic response by vasoconstriction of peripheral muscle locomotive, which intensifies the fatigue of active muscles and increases also perception of effort, contributing to the limitation of return linked to intense aerobic exercise. (Romer and Polkey, 2008).

In aerobic performance, the TOTAL energy demand is not a limiting factor (Santalla, 2009), the production of energy in the time given is the determinant of fatigue… the “metaboreflex”. Respiratory muscles induce a number of mechanisms by which respiratory muscle fatigue can affect exercise tolerance (Jack mackerel, 2010, Santalla 2010, Romer and Polkey, 2008), incurring a series of cardiorespiratory interactions:

Pulmonary level:

  • Fatigue contraction of the diaphragm and accessory muscles of respiration.
  • Increased reflexes activated metabolites.
  • Increased afferent discharge (track III and IV).

Muscular level:

  • Increased efferent sympathetic discharge.
  • Increased vasoconstriction members.
  • Decreased oxygen transport.
  • Increased locomotor muscle fatigue.
  • Increased perception of effort.

In an experiment carried out with cyclists (Fischer, 2013) participants were induced to metaboreflex with post-exercise muscle ischemia, indicating that the increase in heart rate and the partial withdrawal of cardiac parasympathetic tone, is mainly attributed to increased cardiac sympathetic activity, and only after exercise with large muscle masses.

We speak of respiratory muscles (and mechanical); of autonomic nervous, central nervous system and cardiovascular system regulation in humans. A review by Douglas R. Seals raised the premise that if the RMMR represented the “Robin Hood” of the body to the locomotor muscles (Seals, 2001), determining that this reflex can have as its main objective the delivery of oxygen to the respiratory muscles, guarantees the ability to maintain pulmonary ventilation, adequate regulation of the gases in the blood flow and the pH and general organ homeostasis. The reflection is considered the “vital organ” responsible for supporting lung function and perfusion of the respiratory muscles, especially during physiological states in which there is competition for cardiac output, as in the exercise to maximum and submaximal intensities. This overrides the locomotor muscles.

Usually this phenomenon is found in those training for a sport or competition in which there will normally be a struggle between the respiratory muscles and the locomotor muscles for blood flow. Determining this is not so simple, as it also depends on the intervention of the central nervous system, which impinge on some physiological and psychological responses, such as the perception of effort. Generalizing, we can say that to focus on metabolic compromise reflects both muscles (respiratory and locomotor) at maximal or submaximal, rather than related to aerobic capacity.

Author: Germain Fernandez Monterrubio, Bachelor of Science in Physical Activity and Sport.

www.fermentourbano.com

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REFERENCES

  • SEALS, DR. (2001). Robin Hood for the Lungs? A respiratory metaboreflex that “steals” blood flow from locomotor muscles. J Physiol. 537(Pt 1):2
  • FISHER, JP y otros (2013). Muscle metaboreflex and autonomic regulation of heart rate in humans. J Physiol. 591.15 pp 3777–3788 3777
  • ROMER, LM y POLKEY, MI (2008). Excercise-induced respiratory muscle fatigue: implications for performance. J App Physiol. 104 pp 3879 3888
  • SANTALLA, A (2010). Presentation High Performance Program. Physiological Basis of Sports Performance. SE
  • CHICHARRO LOPEZ, JL (2010). Presentation Respiratory muscle fatigue induced by exercise: implications for clinical and performance.
  • HAJ GHANBARI, B. et alt. (2012) Effects of respiratory muscle training on performance in athletes: a systematic review with meta-analyses. J. of Strength & Conditioning Research.

View list of published research that used POWERbreathe as the IMT intervention of choice in POWERbreathe in Research.

Find more published research on our Inspiratory Muscle Training Research blog.

If you found this interesting (and if you found the translation not entirely easy to follow), you’ll probably find ‘Insights into the role of the respiratory muscle metaboreflex’ useful too.

Petr Ton, Czech Ice Hockey Player uses POWERbreathe K3

Petr Ton is a Czech Ice Hockey forward, which means his position on the ice is primarily offensive, and as an ice hockey player he has to be fit for the high intensity intermittent skating, with recovery between shifts.

Petr plays for HC Sparta Praha (HC Sparta Prague) which is one of the most successful and famous clubs in Czech Ice Hockey history. It is a regular competitor at the highest levels of the Czech extraleague and is a playoff performer every year.

Petr’s high intensity burst of skating requires muscle strength, power and anaerobic endurance, and with the length of the game and the requirement for his breathing to recover quickly, a good, efficient aerobic system is demanded. This high level of aerobic fitness will help all ice hockey players skate for a long time at a moderate pace without getting too fatigued. And good anaerobic fitness means ice hockey players will be able to keep going at a higher intensity for longer before legs and body get tired and start to slow down.

Our friends and POWERbreathe distributor in the Czech Republic, truconneXion, provided Petr with the POWERbreathe K3 earlier this year in January, and shortly after using it religiously, Petr became convinced about the fitness benefits of inspiratory muscle training with POWERbreathe for ice hockey players. In fact Petr’s training Load values increased from 40/50 cmH2O up to 90 cmH2O after training with POWERbreathe, and his Flow (i.e. a measure of the maximum rate at which you can inhale air into your lungs) increased too from 7 L/s to 10 L/s.

Peter said: “I’m trying to train responsibly, and I have to train a lot otherwise I could not maintain this level of fitness… Proper breathing for ice hockey is particularly important, not only for the explosiveness and absolute speed, but also the ability to recover quickly. Respiratory muscles are also essential for the stability of the body when in contact with the opponent… That’s why I immediately took up training of the respiratory muscles, and especially the model with electronic management of the load which I consider extremely effective supplemental training.”

Thank you to truconneXion for sharing this news with us, and we’d like to wish Petr and his team all the best, and we look forward to hearing more from Petr about his progress with POWERbreathe.