7085203423_fbdac0354c_oby James Hubbard, MD, MPH 

What do asthma attacks and panic attacks have in common, besides the fact that they’re both more likely during a disaster?

They both cause you to hyperventilate (breathe faster), which in turn makes them worse.

There’s a breathing technique that can help stop the cycle. But it’s the opposite of what you probably think. It’s not deep breathing; it’s slow, shallow breathing. And practicing it can even help prevent attacks from coming on. But you have to learn to do it properly—preferably straight from a professional.

How Everyday Breathing Affects Attacks

Asthmatics and people prone to panic attacks (panic disorder) tend to breathe in some slightly different ways than others, which keeps their carbon dioxide at a slightly lower level.

In everyday living, you never think about needing to maintain the carbon dioxide level in your blood in a certain range. Your body just does it. If you’re perceived as having too much, you exhale a bit more to release it through your lungs. Too little and you breathe a bit slower. But the level your body decides you should live with can affect you in many ways, large and small, obvious and not so much.

Why people with asthma and panic disorder tend to breathe a little differently, I’m not sure anyone knows. But it appears to make them prone to attacks.

For people with panic disorder, when the carbon dioxide level in the blood gets to a certain low level (the exact threshold level is slightly different in different people), the smothering feeling, heart palpitations, tingling, dizziness, and other symptoms of a panic attack start to occur. Though these people tend to keep their carbon dioxide at a little lower level, it’s not low enough to cause symptoms. But then, before an attack—minutes before they have any clue an attack is about to occur—the breathing apparently changes a bit more, and the carbon dioxide gets even a bit lower. This results in the person being even closer to the threshold of when symptoms begin. So then, breathing just a tad faster can bring on the attack. This at least partly explains why some people have panic attacks without warning or with no clue of why it occurred.

People with asthma also run a carbon dioxide level that’s slightly lower than average all the time. And since the lower level tends to make lung airways restrict more, it just makes it that much easier for some irritation to constrict the lungs past that threshold of when an attack occurs.

Better Breathing During an Attack

It seems counterintuitive, then, that taking slow, deep breaths might not be the best solution during an attack. But some studies have shown that when taking a really deep breath, you can lose as much carbon dioxide as with shallow, faster breathing. You take in more air, so you blow more out, and more blowing out means more release of carbon dioxide per breath. Apparently this is true even if you exhale slowly.

And with asthma, a deep breath can also stretch the lining of the airways and trigger constriction, so less oxygen-containing air gets through.

So the new theory is taking slow, shallow (or at least not so deep) breaths is best.

Better Breathing for Preventing Attacks

Now make no mistake. For asthma, no amount of fancy breathing can take the place of sometimes lifesaving prescription medicines or supplemental oxygen. But it could decrease the amount of or frequency those treatments are needed.

Breathing techniques can also decrease the frequency of panic attacks.

In fact, one of the beauties of learning a slow, shallow breathing technique correctly is that by practicing it regularly, your day-to-day breathing will become more normal, as will your carbon dioxide levels. In turn, this will actually prevent some attacks from ever coming on. The key here, though, is learning the technique correctly. I mean, it’s certainly possible that you can breathe too shallowly to get optimal oxygen also.

How to Learn a Breathing Technique

According to a new small study, formal training in this breathing technique by a respiratory therapist seems to help a lot more than trying to learn the breathing on your own. Even better? Formal training with a carbon dioxide monitor.

Learning breathing techniques is not new. (See my previous post here). But being able to learn them while monitoring your real time CO2 level is. This monitoring gives you immediate feedback, which enables you to learn the technique quicker and more precisely. And it takes the guesswork out of getting your CO2 to an ideal level.

The monitor is called a capnometer. It’s similar to the more familiar pulse oximeter that measures your blood oxygen level. But unlike that device, a capnometer is still way too expensive for most people to keep around the house.

Besides, learning the breathing technique, called capnometry-assisted respiratory training (CART) or capnometry-assisted hypoventilation (CATCH), from a respiratory therapist who’s trained to teach it will give you the extra benefit of getting their feedback on things like posturing and abdominal breathing (using your diaphragm more). And if you were to have a low oxygen level for some other reason, they could make sure you weren’t doing anything to make that worse.

One drawback to CART and CATCH, according to the study, is it may be hard to find someone trained in capnometry in your area. If you can’t, I think the next best bet at this stage is to learn the techniques from a respiratory therapist without the capnometry machine. If that isn’t an option either, you can try learning on your own. Learn diaphragm breathing, breathe through your nose, and try to limit breathing to about nine times per minute when practicing. Yoga and singing are two disciplines that use diaphragm breathing. Commonly recommended techniques for asthma are Buteyko, Papworth and Pranayama yoga breathing.

I’d suggest practicing 15 minutes twice a day for four weeks—then less as you get used to doing it. Practicing should get you in the habit of doing this type of breathing more in your everyday life without even thinking about it.

However you do it, learning a proper breathing technique can decrease the frequency of panic and asthma attacks—sometimes substantially. And knowing what to do ahead of time for during an attack could decrease the severity of any that occur.

But before you learn a technique, check with your doctor or other health care provider and make sure your diagnosis is correct, that there are not underlying factors that need to be treated separately, and that you’re taking the steps that are best for you. You can also get your best referral to a respiratory therapist that way.

… But Deep Breaths Aren’t Always Bad

For those of us who don’t have asthma or a panic disorder—and in normal, nonattack situations for people who do have those disorders—I have no reason to believe taking deep breaths is bad. In fact, until I’m convinced otherwise, I think it’s healthy. Certainly when you have a broken rib, for example, it’s still important to take a deep breath every once in a while to try to prevent pneumonia.

Even for those who have asthma and anxiety, the trick is not to just breathe shallow but to breathe more efficiently, or more in a way that doesn’t aggravate your symptoms.

For more a more detailed review of how hyperventilation affects the risks for panic and asthma attacks, click here.

How about you? Have you ever learned any breathing techniques? Did they seem to help, hurt, or neither?


Photo: Flickr/ PorscheBrosseau, CC BY 2.0.