Breathing – Inlife Blog.

A Focus to Slow the Rate of Breath

I have recently been working with a patient who describes herself as a person who likes to just get in and get the job done. We have had a bit of a journey to find a tool that helps her to slow her rate and gain control not just physically but mentally when she gets breathless following exertion.

I have been using patterns of breathing, with oxygen saturation and heart rate monitoring, to influence the recovery rate of the individual during and post activity. There is much in the literature about resonance breathing to help you relax faster when stressed using the natural respiratory pause at the end of the extended exhalation. Shooting and marksman sports use this natural pause to steady themselves.

Adding a visual cue to this patterning such as used in the breath in a box technique can give a focus mentally and a rhythm to follow that can help slow the rate and help the person relax more easily. Everyone’s condition is different so it is important to find the rhythm that is comfortable for you and improves your self management in the moment of breathlessness. Daily practice will help you to improve.

Using the respiratory pause to slow your rate

Unblock with Humming

Did you know that humming is good for your health? Especially if its combined with nasal only breathing. (Refer Weitzberg and Lundberg “Humming Greatly Increases Nasal Nitric Oxide”). Naturally produced nitric oxide in the sinuses is the one of the keys in the regulation of inflammation and immune defence. Blocked noses also benefit. Recently had a patient who used a set of 4 humming exercises every day with her usual relaxed diaphragm breathing and she has found her usual drip and block has cleared. Wonderful result for anyone with asthma who dreads the seasonal changes and the accompanying nasal overload.

Try this exercise on for size: For 2-3 minutes inhale 4 counts, exhale 6 counts with a hum and hold nose for 4 then repeat. If its a bit hard then lower the numbers and build slowly.

Of course regular use helps greatly. If anyone has difficulty with shortness of breath, assessment and individual plans are recommended.

Inlifetherapy Telehealth Remote Treatment (now available)

As part of Inlifetherapy’s COVID-19 Response Plan in line with Department of Health and WHO guidelines, strategies for treatment provision will include the following: use of outdoor areas for treatment, social distancing , use of hand washing, cough etiquette, hand sanitiser and use of minimal contact treatment methods / assessment tools have been put in place for home visits. Phone calls will precipitate all home visits to check health status and that an area for treatment that allows social distancing is available. Every referral will be assessed on an individual basis as to what is the best form of contact to be observed.

Treatment at this stage of the escalation pathway will not be provided to confirmed cases in order to protect patients who are not symptomatic.

Privately funded patients who have access to internet connected devices such as a desktop, Ipad, tablet, or smart phone will be able to seek treatment remotely from home without visitation if this is what they prefer.

On the 28 March Medicare Chronic Disease Management (CDM) plans have been approved for bulk billed funding of video or phone telehealth services by Occupational Therapists.

From the 1st April DVA has approved video or phone telehealth services by Occupational Therapists for referred patients.

Instructions for video telehealth can be emailed to you prior to your online appointment. If needed, it might be handy to preempt any difficulties by having a tech savvy family member or friend sit with you when you download the app or attend your first appointment.

Therapy aids will be emailed or mailed for appointments as required.

I am looking forward to this next phase of technical adaptation as a way to further enhance the quality of your health care and continue to help you meet your goals.

World COPD Day

On this day World COPD Day 2019, https://goldcopd.org/world-copd-day/ bringing awareness of COPD, it’s important to remember some key self management strategies that you need in the community to prevent unnecessary admissions and stay at home independently:

COPD plans must be filled in by your allied health professional or GP to better understand how and when your medications are to be used and left where family/housemates are aware of your needs when you are too breathless to talk yourself.
Correct inhaler device and spacer use means the medication is effectively going into your lungs and not lining your mouth and causing side effects such as thrush. Asthma relievers if used more than 2 in 7 days is not under control, please seek help from your GP or your breath management health professional.
Breathing techniques that take the work out of breathing and reduce recovery times post activity keep you moving through the day for longer.
Exercise is an important way of preventing deconditioning. Less exercise/ activity can lead to more breathlessness.
Meaningful activity engagement whether it be household chores, hobbies or social engagement are important motivators that keep us moving.
Use oxygen as prescribed – exertional oxygen during activity, nocturnal oxygen while sleeping or continuous long term oxygen for at least 18hrs.
Bush fire smoke reduction – close doors and windows, air conditioning on recycle, rest and hydrate, avoid strenuous exercise, P2 respirator masks, emergency evacuation plan to reduce exposure.

Singing Improves Breathing Symptoms in COPD

I have just read an interesting article on a study conducted in Kent, UK, on a group of participants with Chronic Obstructive Pulmonary Disease (COPD) that had completed a 10 month community singing program learning breath control, relaxation and breathing exercises whilst singing weekly as a group – https://www.ncbi.nlm.nih.gov/pubmed/29160737 .

Any activity that you find meaningful can distract you from the odious task of purposefully exercising muscle groups for health management. We all find it difficult to motivate ourselves to continuously do the actions required to maintain muscular strength and mobility when we are unwell.

Here is an activity that brings relaxation , enjoyment, friendship, mental dexterity and challenge whilst improving respiratory symptoms. I can personally vouch for the mental dexterity part after being involved in a Sing From Scratch with Schubert’s Mass No.2 in G Major in Germanic Latin! The study reported that the majority found their symptoms improved over the 10 weeks as well as their mental and social well-being.

A timely reminder as many choirs around the world are presently involved in practicing and performing parts of Handel’s Messiah for Easter celebrations.

The Language of Breathing

The MacMillan Dictionary lists 10 different words to describe breathing or difficulty breathing (https://www.macmillandictionary.com/thesaurus-category/british/to-breathe-or-to-have-difficulty-breathing) . The simple function of taking air in through your nose or mouth and then letting it go again is often not an easy thing to describe or relate for a patient.

People often have difficulty identifying if they have the breathlessness described and seen by their GP or case nurse. Their wording and explanations may not align with my use of the word breathlessness and may be more meaningful to them if explained with the words gaspy, or puffy…

The language we use in terms of words is one thing but then to be able to describe such fleeting changes that we experience with breathlessness in our activities can also be equally challenging. The only way forward is to use standardised activity to assess and then repeat to capture the initial ability and then review for change post treatment.

The patient learns to notice and become more aware of their breathing state, how to express it and how to rate it. In order to seek effective and timely treatment this becomes an invaluable addition to their chronic disease management toolkit.

Hill over Everest

Everyone has new year resolutions, whether it be in the realms of fitness, budgets,or new behaviours. People I work with all tend to have one constant aim and that is to not lose what they have.

This could be activities, independence, to breath freely after exerting themselves, or to get back to work. In order to keep this they need to devote themselves to something that needs repeating , may not be enjoyable and may have some level of difficulty. I think we can all relate to this.

The way to navigate towards what we want is to set a goal.

How to set a goal?

It must be personal and meaningful – own it – My goal is…
It must be specific – detail – walk 30 min in the shopping centre, 3x per week
It must be measurable so you know when you’ve achieved it
It must be achievable – no point setting an Everest, choose a hill you can climb
It must be realistic – don’t look at Ferrari when Holden is a better fit for you
It must be timely – don’t overload yourself

Start with one goal and go from there.

Don’t forget when you reach that goal to reward yourself for a job well done!

The Christmas Rush

Christmas can be a time of of scheduled events, family and friend catch ups, gift and food shopping, racing round to see those lights. For me its a time of thankfulness, blessing and promises fulfilled and I like to make sure I have moments to stop, rest and enjoy the togetherness of family and friends.

Christmas is also a time of traditions and habits , things we do every year because we have always done so. I have spent my time this year assisting my clients in developing healthy breathing and activity habits and hope that they continue into the new year seeing the fruits of their labour.

I heard recently that we can be so caught up in being busy that we think that this alone is enough for justification of our time. Instead we need to stop and look to see if, and what, we have actually achieved, and if we cannot see something for our efforts then we need to re-calibrate and be more purposeful in our actions and not just busy.

I saw a video recently of Bill Gates talking about time and of a friend who had showed him his diary with spare days in it instead of every one filled with appointments. He had said to Bill, “I can buy anything I want but I can’t buy time”.

So this Christmas try to slow down and simply breathe…, noticing the breath in ….and out…, feel your muscles release and relax…. and give your time where it can be purposeful and make a positive difference.

Scouts Motto : Be Prepared

I have such wonderful conversations with my patients that often have lessons for both patient and therapist. The best patient centred relationship is one where we learn off each other.

We were discussing relievers and spacers and how research has proven the improved dispersal of the reliever when a spacer is used. My patient then went on to say that she has taken to travelling with her reliever and the hand held fan as a kind of mini pulmonary toolkit that gives her the confidence of knowing she is prepared for every circumstance.

It reminded me of a situation I was in last week whilst travelling in Tasmania.

Cradle Mountain, world heritage area of majestic beauty but also a place of extreme weather and unpredictability. I was climbing to the Mt Marion Lookout and found that half way up in the cold and floating rain I had trouble catching my breath.

Exercise induced asthma has little warning I find. As every good explorer should do I had a snack in my pocket and my bottle of water and was rugged up in beanie and coat against the cold.

However just shy of the top things got a little uncomfortable. That need to fill the lungs but not getting as much as I’d like coupled with the knowledge that I was literally in the middle of nowhere and my nearest reliever was , you guessed it, in the car park an hour and a half away.

There was no way I was going to turn around and miss getting to the top so I used what I had to get relief. I stopped and leaned forward, blowing out through pursed lips and took a rest break to get my breathing under control. After a few minutes rest and hydrating with my drinking water I started up again pacing myself this time, keeping up the pursed lips as I went.

I made it and with a little sprint to compete with my 13 yr old daughter I got there ahead of the family and promptly claimed the seat to lean forward and recover my breathing once more.

To say the least, my patient was wise in her preparation and a puffer in my pocket next time will be part of my good explorer ensemble.

Noses, odours and memories

A recent article that I was made aware of through social networking has found that breathing through the nose significantly increased memory recognition. Olfactory sensory neurons detect the pressure created by the airflow into the nose and send this on via the olfactory bulb and on to the hippocampus, an important centre for memory function in the brain. In lay terms what does this mean?

nose breathing enhances the encoding and retrieval of memories
core brain functions can be impacted by breathing patterns

What this is leading to clinically is in the hands of researchers but I for one like the fact that as I teach breath management that promotes nose intake over mouth I find it a wonderful thought that perhaps I am positively influencing the patients olfactory senses and strengthening memory pathways to the brain’s heart, the hippocampus.

In older age memory is something that is an important part of who we are as individuals so next time you are out smelling the roses take a moment longer to really breath in through your nose and strengthen those neural pathways that keep our happy memories alive.