RCPs have the opportunity to introduce the benefits of
yoga as respiratory patients consider the benefits of a more
healthy lifestyle including integrating natural techniques to
manage their conditions.
As respiratory therapists, we
know that breathing is an essential function and our daily
activities persistently revolve around the breath and
breathing. However, our focus on administering aerosolized
nebulizer treatments, ventilator management, emergency
procedures, and other tasks often distracts from the ability
to stop and consider the breath. The discipline of yoga,
however, has focused on the essential nature of the breath,
and refining breathing techniques.
We can better assist patients in their quest to assume a
more active role in their plan of care by learning about the
adjunctive therapies they may choose. “The increasing
popularity of complementary and alternative medicine (now used
by more than 40% of the public) reflects changing needs and
values in modern society in general. As the public’s use of
healing practices outside conventional medicine accelerates,
ignorance about these practices by physicians and scientists
risks broadening the communication gap between the public and
the profession that serves them.”1 For patients who
want to consider taking more responsibility for their health
and well-being, yoga stretches and breathing techniques offer
a natural and healthy choice.
The term “yoga” initially conjures an image of a
practitioner sitting on a pillow in a lotus pose or stretching
into an impossible arch. In fact, yoga is a generic term
applied to several disciplines with distinct goals. We will
consider yoga asanas (stretches) and pranayama (breathing
techniques) that may be of therapeutic benefit, specifically
for patients with asthma and chronic lung disease. According
to the American Yoga Association, yoga breathing exercises can
strengthen and relax the muscles of ventilation. Yoga
breathing and stretching postures are used to increase
respiratory stamina, relax the chest muscles, expand the
lungs, raise energy levels, and calm the body.
The yoga techniques we
will consider can be broken into two categories. The first is
pranayama, which includes breathing techniques that promote
diaphragmatic breathing and can create a profound sense of
relaxation. The second is asanas, which involve stretches that
provide a mild form of exercise to enhance flexibility,
circulation, and muscle tone.
Andrew Weil, MD, directs the
program on integrative medicine at the University of Arizona,
Tucson, and has become nationally known for his best-selling
books, including Spontaneous Healing and Natural Health,
Natural Medicine, which promote health and wellness. His
central thesis is that, given the chance, the body will heal
itself. Weil has devoted his career to exploring and
evaluating alternative therapies and presenting them as part
of his vision for preventive health that promotes individual
responsibility for health and fitness. He has recently
released a recorded narrative on compact disc called
Breathing: The Master Key to Self Healing. He describes a
scenario that will be familiar to most respiratory therapists:
“In the four years I spent at Harvard Medical School I learned
about the anatomy of the respiratory system, I learned about
disease of the respiratory tract, but I heard nothing about
breath as the connection between the conscious and unconscious
mind, or the doorway to control of the autonomic nervous
system, or breathing techniques for controlling anxiety and
regulating mental states.”2 His excellent narrative
on the first disc is devoted entirely to understanding the why
of breathing exercises. He reminds us that breathing is the
only autonomic function that can be consciously controlled and
suggests it is the key to bringing the sympathetic and
parasympathetic nervous system into harmony. “Breath is the
only function through which you influence the involuntary
nervous system. That is, you can establish rhythms of
breathing with your voluntary nerves and muscles that will
affect the involuntary nervous system.”2
The recording promotes “eight
techniques to revitalize your health,” beginning with the most
basic technique of “following your breath,” and exploring more
advanced techniques of pranayama including maneuvers that he
calls the “stimulating breath” and “relaxing breath.”
Weil concludes that “of all the techniques that I have
investigated for reducing stress and increasing relaxation, it
is breath work that I have found to be the most time
efficient, the most cost-efficient, and the one that most
promotes increased wellness and optimal health.” And that “the
results are long lasting, they get better over time, and of
course they are completely free of the toxicity that is
usually associated with pharmaceutical drugs.”2
One of many effective pranayama techniques is alternate
nostril breathing, which is using the thumb of the right hand
to block the right nostril. Patients exhale completely through
the left nostril, then inhale slowly. Then they remove the
thumb from the right nostril and block the left nostril with
the fourth and fifth fingers. Patients exhale completely
through the right nostril, then inhale slowly. They should
continue this pattern for about 5 minutes.
P.K. Vedanthan, MD, is an
allergy and asthma specialist who has maintained a thriving
practice in Fort Collins, Colo, since 1976. Although Vedanthan
had practiced yoga since childhood, he had never applied the
techniques to patient care. Intrigued by the success of H.R.
Nagendra, MD, in his clinical studies in India, Vedanthan
began making yoga instruction available to asthma patients.
“These were moderate to severe asthmatics who were on daily
medications, inhalers, and oral medications. We found that
they were able to reduce their medications, they felt a lot
better, and their breathing attacks were comparatively less,”
He subsequently began a series
of studies to attempt to document any clinical changes as a
result of practicing the techniques, which included pranayama,
asanas, and meditation. One controlled study showed that
people with lung disease who practiced yoga clearly felt
better and had improved quality of life scores compared to
patients who did not use the techniques.3 There
were no significant differences in pulmonary function test
results or oxygenation in the asthma group, however.
“The most significant things were nonpulmonary aspects,”
Vedanthan says. “What we now call quality of life, these
[scores] improved significantly. So they felt better, were
less anxious, were able to handle minor attacks much more
positively and were sleeping better. All those compared to the
non-yoga group improved a lot, which is significant. We
concluded that yoga can be a good adjunct to therapy—it
doesn’t replace medicines, but it’s a good thing for people
with asthma to practice yoga on a daily basis.
“In yoga literature, there is a certain kind of breathing
called chair breathing techniques,” Vedanthan explains. “These
are relaxation techniques, which they claim helps asthma
attacks. So we took a group of asthmatics and provoked [their
asthma with] an exercise challenge, attained a certain pulse
rate, and measured their lung functions [to] see what
happened. We found that six out of eight got to baseline
levels much quicker with the chair breathing techniques and
their asthma symptoms abated a lot faster without the use of
Vedanthan has also studied the
benefits of yoga for chronic obstructive pulmonary disease
(COPD) patients.4 “We took 11 patients ages 61 to
79. They were taught yoga breathing techniques by a teacher
and practiced at home with the help of an audio tape. They
were all on oxygen, from 1 to 3 lpm. Baseline oxygen values on
O2 were obtained, then O2 was
discontinued. Within a few minutes, the range of desaturation
was anywhere from 82% to 92%. Then we had them perform the
yoga techniques and O2 saturations started
rising at 10 minutes and 20 minutes to figures of 92% to 94%
without oxygen,” Vedanthan says. “Ten of the subjects felt a
lot better subjectively and felt relaxed overall. One subject
could not tolerate being off O2 but was
better subjectively after using yoga breathing techniques.
After the study was completed, they kept on coming back saying
they wanted to do it again. So we had them continue doing it.
Lung functions showed no change. So basically, what we thought
was true—these breathing techniques can improve oxygenation.
It probably would benefit patients with COPD and may be useful
in reducing the O2 needs in these patients by
improving their breathing technique. Most of them just panic
and don’t know how to breathe.
“Even if I don’t find objective measurements, they
subjectively feel better,” he continues. “That is a common
thing we find in all these groups. We thought it may be a good
part of pulmonary rehabilitation, and further studies are
Sapna Patel, a certified yoga instructor, works with some
of Vedanthan’s patients and specializes in yoga for geriatric
patients. She has observed that one of the most important
aspects of yoga for asthma and COPD patients is that “they
develop an increased capacity to relax and control their
breathing. They learn that they don’t have to let their
breathing control them and that they can take charge of their
breathing.” As with any technique, she emphasizes that yoga
requires regular practice in order to be effective.
Chair breathing is an
asana specifically recommended for patients with COPD and
asthma where the patient sits on a mat in front of a folding
chair, with legs stretched forward and resting their arms on
the seat. They tighten all the muscles of the body, then
progressively relax each part locally (progressive
relaxation). Moving the head backward and forward slowly, the
patient should repeat the exercise five times. Next patients
move their head backward while inhaling slowly and deeply,
then move their head forward and down while exhaling slowly
and completely. This step is repeated five times.
This exercise includes performing the previous maneuver
while chanting “Ah” in a low tone while moving the head
forward and down. This is repeated five times. Next, patients
perform the above maneuver but chant “MM” in a low tone while
moving the head forward and down. This is repeated five
If therapists place their hands on the rib cage of a person
performing this technique, they can actually feel the
percussive vibrations created when these exhalation maneuvers
are performed. Chair breathing is not a replacement for
bronchodilators, but can be used as a helpful coping technique
when managing an asthma episode.
The United States Yoga
Association, in cooperation with Kaiser Permanente and St
Lukes Hospital, San Francisco, has developed a program called
Yogasthma, which promotes a holistic approach to asthma
management. Program director Sandy Wong-Sanchez says that the
Internet component of the program was inspired by the need to
make asthma information available to children and families
outside the classroom. “The last thing you want to do is take
them out of class” to access asthma information, she notes.
Yogasthma outlines “Seven Steps to Asthma Control,” including
asthma education, pranayama, asanas, proper use of
medications, dietary recommendations, clean personal space
(including fresh air), and relaxation techniques. Its Web site
(www.usyoga.org) provides clear directions for learning yoga
techniques and addresses each of the topics in an effective
As the benefits of yoga practice become better documented,
the opportunity to integrate yoga techniques into standards of
practice becomes apparent. “All the major alternative medicine
systems approach illness first by trying to support and induce
the self-healing processes of the person. If recovery can
occur from this, the likelihood of adverse effects and the
need of high-impact, high-cost interventions are reduced. It
is this orientation toward self-healing and health promotion
(salutogenesis rather than pathogenesis) that makes
alternative medicine approaches to chronic disease especially
attractive.”1 As respiratory patients become
interested in considering the benefits of a more healthy
lifestyle and integrating natural techniques to manage their
conditions, RCPs have an opportunity to help them learn about
the potential benefits of yoga as an adjunctive therapy. They
may find that “the simplest and most powerful technique for
protecting your health is absolutely free—and literally right
under your nose.”2
John Wolfe, RRT, is a
respiratory care professional in Fort Collins, Colo, and
serves as the chairman for the Northern Council for the
American Lung Association of Colorado.
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Breathing: The Master Key to Self Healing. Compact disc.
Boulder, Colo: Sounds True; 1999.
3. Vedanthan PK,
Kesavalu L, Murthy K, et al. Clinical study of yoga techniques
in university students with asthma: a controlled study.
Allergy Asthma Proc. 1998;19:3-9.
4. Vedanthan PK. Yoga
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Program and Abstracts of the 94th International Conference of
the American Thoracic Society; April 23-28, 1998; San Diego.
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