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PREVENTING ASTHMA IN CHILDREN WITH USE OF BREATHING EXERCISES
Beyond simple muscle relaxation comes the question of breathing exercises, which are usually taught by a physiotherapist. One of the major factors in asthma is tightening airway muscles, and if these can be relaxed then the affect is highly beneficial. Unfortunately these muscles are not under direct voluntary control; however, by regulating the aspects of lung function that are controllable there is no doubt that the muscles in the airways will relax. These controllable aspects include the rate and depth of breathing combined with other muscle groups which move the chest.
Deliberate alteration in the frequency with which breaths are taken is one of the more obvious ways in which control can be exercised over breathing. In asthma the airways are narrowed, so it is obvious that more effort is required to force air in and out through a narrow tube than to blow gently and gradually through a wider one. It takes less effort to breathe slowly and deeply through narrowed airways than it does to breathe rapidly and shallowly. Some children with asthma find they adopt this pattern naturally but most – usually from panic – seem to breathe more quickly than is really necessary. This soon makes them distressed, so the important message is to inhale slowly followed by gentle breathing out.
There is no doubt that relaxation and slow breathing are proven scientifically to be beneficial. Controversy surrounds the various techniques which claim to move one part of the chest more than another. The muscles involved in breathing fall into three groups: the diaphragm, which is at the base of the lungs; the muscles between the ribs; and the muscles around the neck. It is the diaphragm which really holds the key to controlled breathing in children with asthma. This is a dome-shaped muscle situated beneath the lungs which is attached to the trunk all around its outer edge. When the muscle fibres in the diaphragm contract during breathing in, the whole dome of the diaphragm moves downwards towards the abdomen drawing the lungs with it. This, in effect, expands the lungs, allowing more air to be taken into them.
When a child has an asthma attack there is automatic tightening of the muscles of the upper abdomen, and this prevents the downward movement of the diaphragm. The description ‘diaphragmatic breathing’ is given to techniques whereby this movement of the diaphragm is synchronized with relaxation of the abdominal wall. However, this breathing is not really diaphragmatic but abdominal.
The technique is difficult to teach to young children and it did not play a significant part in Julie and Simon’s management. However, many parents reading this book will have older children who will be able to control their breathing very easily. It is well worth a visit to a local physiotherapist to be properly taught the technique. It can, however, be learnt at home by following these simple steps:
As you breathe in, as well as allowing your chest wall to expand, ensure that your stomach is filling out. This relaxes the stomach muscles and allows the diaphragm to move downwards.
On the breath out, concentrate on deflating your stomach with a slow gentle movement.
In other words you are working at using the stomach to breathe rather than the chest. Of course the chest will really be doing most of the work, but this is automatic, whereas using the stomach is not. Learning this method of breathing will ensure that the correct pattern is maintained when wheezing develops, and help the attack to be better controlled.
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