Breathe In, Breathe Out

As we age, breathing correctly may become a problem for some of us as the rib cage and surrounding muscles get stiffer, making deep breaths difficult to take. However there are breathing exercises that can help you improve your breathing, says Dr Nidhi Kumar.

Breathing deeply may become a problem with age

The cardiovascular and pulmonary systems in our body are inherently linked as they interface with all other body systems. The focus of this article is on improving and managing your cardio-pulmonary health. To do that, let’s first have a brief revision of the respiratory system. The respiratory system primarily comprises of rib cage, lungs, trachea (wind pipe), pharynx (throat), nose, etc. While you breathe, air enters and exits the lungs. As we inhale, the airways get filled with air, made up of stretchy tissues. These are small sacs called alveoli. Blood circulates around these sacs and an exchange of oxygen and carbon dioxide is carried out. As you grow older, there are several anatomical, physiological & immunological changes in all the systems in our body. Ageing leaves a significant effect of on the respiratory system too.

We are listing down some of these:

* Bones become thinner as one grows older, changing the shape of rib cage. The result is reduced expansion of chest during breathing limiting the respiratory volume. This further reduces the respiratory reserve required during acute illness such as heart failure, obstructive disorder, infection, etc.

* Alveoli lose their shape and become baggy.

* The muscles that support breathing are weakened with age and prevent complete inhalation and exhalation of air. Weakened chest muscles also hinder coughing, a natural way of removing phlegm from the lungs.

* The surroundings of lungs stiffen, leading to shrunken airways.

Hence, elderly person are at higher risk of shortness of breath and lung infections like bronchitis and pneumonia, abnormal breathing patterns like sleep apnoea (shortness of breath during sleep).

Remedy

Breathing exercises and ventilator training are fundamental interventions for the prevention or comprehensive management of acute/chronic cardio-pulmonary disorders. The effects of breathing exercises & ventilator training can:

• Improve or redistribute ventilation.
• Increase the effectiveness of cough mechanism and promote airway clearance.
• Prevent post-operative pulmonary complications.
• Improve strength, endurance and co-ordination of muscles of ventilation.
• Maintain or improve chest and thoracic spine mobility.
• Promote relaxation and relieve stress.
• Improve overall functional capacity for daily living, occupational and recreational activities.

The precautions

• Never allow forced expiration as the increased air turbulence may lead to bronchospasm (i.e. can precipitate an asthma episode). Expiration should always be relaxed & controlled.
• Do not take a very prolonged expiration as this causes gasping with next inspiration, leading to irregular &inefficient breathing pattern.
• The upper chest should be relatively quiet during initiating breathing.
• The deep breathing should be performed for only 4-5 times only to avoid hyperventilation.

Pulmonary training

1. Diaphragmatic Breathing: This method improves efficiency of ventilation, decreases the work of breathing and improves gas exchange and oxygenation. Here’s how to do it: Sit on the bed or recline 45 degrees. Keep the shoulders relaxed & upper chest quiet, allowing abdomen to rise. Now breathe in slowly and deeply through nose. Let all the air out using controlled respiration. For self-assessment-place your hands just below your chest. The hand should rise during inspiration and fall during expiration.
2. Pursed-Lip breathing: This method can help patients with COPD (Chronic obstructive pulmonary disorder) e.g., asthma, emphysema, etc. deal with episodes of dyspnoea (shortness of breath). It decreases the respiratory rate, increases the tidal volume and improves exercise tolerance. Procedure: Assume a comfortable position. Do not expire forcefully or contract abdominals for force. Inhale slowly & deeply. Then loosely purse the lips & exhale passively. Do not prolong the expiration.
3. Chest mobilisation exercises: The exercises that combine active movements of the trunk or extremities with deep breathing are included in this category. These are aimed to maintain or improve mobility of chest wall, trunk and shoulder girdles as they affect ventilation. Here’s how to do them:

• Sit with legs relaxed, hands clasped behind the head. Bend forward while exhaling & bring the elbows together. Move up while inhaling and open the elbows horizontally.
• Sitting in chair, each with both arms overhead during inspiration. Then bend forward at the hips & reach the floor during expiration. Back to straight spine and overhead arms while inspiration.

Perform all the exercises for two to three minutes each, twice daily.