While advanced technological and infrastructural developments have made life easier for all of us, they have also had a disastrous impact on the environment, particularly on air quality. Air pollution has become one of the biggest problems of our time. Fine particulate matter polluting the air can easily penetrate your bloodstream and adversely impact your overall health, especially your lungs. According to the data collected by the World Health Organization (WHO), ambient air pollution was the cause of 4.2 million deaths in 2016 and is estimated to lead to about 16 percent of all lung cancer deaths.

So, how can you keep your lungs healthy while living in a polluted city? Here we’re revealing how a few lifestyle tips can keep lungs healthy.

Follow these 9 tips to keep lungs healthy and strengthen them to fight pollution:

1. Keep an eye on pollution forecast

There are many applications and websites that provide nearly accurate predictive outdoor air quality reports every day. With their colour-coded system, these apps help you comprehend just how much pollution you will expose yourself to when you step outside that day.

2. Stay indoors on bad AQI days

Spend as much time indoors as you can, particularly on days when the pollution forecast or the AQI (air quality index) shows an alarming number. In case you need to step out, wear a high-quality face mask at all times to avoid inhaling harmful particles in the air.

3. Don’t exercise outdoors

Whenever the pollution levels are high, avoid exercising outdoors. Walking, jogging or any other strenuous activities that might increase your breathing rate can lead to the inhalation of harmful particles present in the air.

4. Drink enough water

Drinking enough water can help in flushing toxins out of your body. It is advisable to drink at least 8 to 10 glasses of water every day to stay hydrated.

tips to keep lungs healthy
Don’t reduce your water intake. Image Courtesy: Shutterstock

5. Maintain a healthy diet

One of the best ways to resist harmful effects of air pollution is by building up your immunity against infections. For this, maintaining a healthy diet rich in vital nutrients like vitamins C and E is essential. Make sure that your diet is packed with the nutrients to keep up the health of your respiratory tract.

6. Quit smoking

You need to quit smoking now, especially if you live in a polluted city. Nothing is more damaging to your lungs than smoking cigarettes. The harmful chemicals in cigarettes compounded with the harmful particles in the air can be immensely damaging to your lungs.

7. Get an air purifier

The air inside your home can also be polluted, sometimes even more than the air outside. For this reason, it is a smart choice to invest in an air purifier. Make sure to keep your air purifier clean and replace its filter frequently.

8. Practice breathing exercises

Practicing breathing exercises every day can prove to be helpful in improving lung functions. Some of these exercises include belly breathing and pursed lip breathing.

tips to keep lungs healthy
Breathing properly in the morning can improve lung health. Image courtesy: Shutterstock

9. Go green!

Make sure you do everything you can towards reducing air pollution and improving air quality. To do your bit, you can consume less energy in your homes, use hand-powered equipment, and take a bike, walk, or carpool whenever possible.

Takeaway

With air pollution posing such a huge risk to your lung health as well as overall well-being, it is best to follow the above-mentioned measures, especially if you are living in a polluted city. If you experience any respiratory problems or symptoms of lung issues, consult with a doctor right away.

Air pollution, if not more, is as dangerous and harmful to the human body as has been smoking over the years. It’s time we realize it is harmful and take preventive measures to safeguard ourselves from this growing menace.

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Dyspnea, commonly known as shortness of breath, is one of the common problems faced during pregnancy. Shortness of breath can also be considered as an early symptoms of pregnancy. Generally, dyspnea doesn’t cause any harm to the mother and the growing baby. But still, in some severe complicated conditions, it can lead to difficulty in breathing.

Reasons of breathlessness during pregnancy

An increase in levels of progesterone is the main cause of increase in shortness of breath during the first trimester of pregnancy, explains Dr. Anjali Chaudhary (PT), senior executive physiotherapist, Cloudnine Group of Hospitals, Noida.

it is basically due to increased capacity of lungs. The body adjusts itself to the new hormonal changes. However, other medical conditions such as asthma, anemia and pulmonary embolism, too can contribute to the same. Suitable precautions should be taken for the treatment of asthma and other underlying conditions.

shortness of breath
Keep a check on breathing patterns. Image courtesy: Shutterstock

As the size of the baby grows, other organs get compressed and start changing their position. At around 31st week to 34th week, the growing size of the belly exerts pressure on the diaphragm (the main muscle for breathing). This increase in the size restricts the lungs to expand fully and take in air.

Towards the end of pregnancy, the foetus head settles into the pelvis and eventually exerts less pressure on the diaphragm muscle. Therefore, the shortness of breath eases during the last few days of pregnancy.

How to handle the shortness of breath during pregnancy

You can try various breathing techniques and tips to manage and cope up with the situation of dyspnea or shortness of breath. By following these simple tips you can ease down the breathlessness.

1. Maintain a good posture:

Posture during pregnancy is important. Slouching while sitting will affect your lungs as lungs will not get enough space for expansion while breathing in. This may result in less oxygen intake. Sitting on a chair with your chest slightly bent forward can help relaxing the body and in creating extra space for breathing.

Standing with your back well-supported by a wall and body slightly leaned forward can also help relieve shortness of breath.

2. Sleep in a relaxed position

Dyspnea often leads to inability to sleep at night, leading to waking up several times and creating disturbance in sleep. To avoid this, sleep on the back with head elevated using extra pillows and knees bent with pillows below the feet. The right sleeping posture during pregnancy helps in keeping the airway relaxed and making breathing better.

sleeping posture during pregnancy
The right sleeping posture during pregnancy is important. Image courtesy: Shutterstock

3. Pursed lip breathing:

A very easy and a simple breathing technique that makes each breath deeper by helping release trapped air in the lungs, can help to manage shortness of breath during pregnancy.

Follow the simple steps to perform pursed lip breathing:
* Sit with shoulders relaxed.
* Slowly take in air through nose and keep the mouth closed while inhaling.
* Gently exhale or blow out air with pursed lips as if about to blow a candle.
* Practice for 5-10 minutes for about three to four times a day.

4. Diaphragmatic breathing:

Diaphragmatic breathing is basically deep breathing exercise which is also known as abdominal breathing or belly breathing.

To do diaphragmatic breathing or belly/abdominal breathing, follow these steps:

* Sit on a chair or simply lie down comfortably with knees bent and upper body relaxed.
* Place one hand on the chest and other below the rib cage (over the abdomen/belly) so that you can feel your diaphragm movement while breathing in and breathing out.
* Breathe in slowly and steadily so that the abdomen rises fully while doing so, making the hand to rise. Make sure the hand on the chest stays still.
* Then slowly exhale through pursed lips but make sure the abdomen lowers down while doing so and the hand on the chest remains still.
* Start practicing this exercise for 5-10 minutes for about three to four times a day. Gradually increase the number of times and even place a book over the abdomen to increase the efforts.

deep breathing
Deep breathing is good for lungs. Image courtesy: Shutterstock

5. Deep breathing with arm raise:

Deep breathing exercise with raised arms raises the diaphragm to open up the lungs. This helps to increase the capacity of the lungs and results in more oxygen uptake. It is similar to deep breathing, but along with breathing, hand movement is added.

* Stand and take a deep breath while raising arms slowly over your head. Exhale as you lower your arms. Repeat several times a days or whenever you feel breathlessness.
* Seeking Medical Help for Shortness of Breath during Pregnancy

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Practicing belly breathing can help you hold your breath longer (and bring down your stress, too).

Image Credit:
damircudic/E+/GettyImages

Is it bad to only be able to hold your breath for 30 seconds? What about 45 seconds or a minute?

Lots of things can affect your ability to hang on to a big gulp of air, and it's normal for different people to be able to hold their breath for different lengths of time.

Here's what's typical, plus what you can do to boost your lung capacity and hold your breath for longer.

What's the Average Time to Hold Breath?

Different people can hold their breath for different amounts of time. "Most people can hold their breath for 30 to 90 seconds without any difficulty," says registered respiratory therapist Mandy De Vries, MS-RCL/Ed, director of education at the American Association for Respiratory Care (AARC).

However, that time can vary based on a number of factors.

What's the World Record for Holding Breath?

In March 2021, a Croatian man named Budimir Šobat held his breath for 24 minutes and 37.36 seconds, according to Guinness World Records, surpassing the previous world record by 34 seconds.

Factors That Affect How Long You Can Hold Your Breath

You may not be able to hold your breath for that long if you smoke or have an underlying medical condition. For example, people with chronic obstructive pulmonary disease (COPD) or asthma usually can't hold their breath as long.

Infections like COVID-19 can factor in too. Even mild cases can cause temporary shortness of breath, while more severe ones can lead to permanent lung scarring that may reduce your lung capacity, according to Johns Hopkins Medicine.

People who regularly engage in aerobic exercise, especially activities like swimming and running, tend to have greater lung volumes that makes it easier to hold their breath for longer, De Vries explains.

Taller people tend to have greater lung capacities compared to those who are shorter.

Carrying excess abdominal fat, on the other hand, can reduce your lung volume by compressing your chest wall, according to a February 2017 paper in ​Multidisciplinary Respiratory Medicine​.

Lung volume can even (temporarily) shrink during pregnancy, as a person's expanding uterus can put extra pressure on the lungs.

Finally, don't discount age. Starting at age 35, our lung volume and pulmonary function start to slowly decrease, per the ​Multidisciplinary Respiratory Medicine​ paper. So younger adults may be able to hold their breath longer than older adults.

The Benefits of Greater Lung Capacity

The lungs are responsible for taking in oxygen and removing carbon dioxide from the blood. So when your lung capacity is healthy, you'll experience healthier physical function and feel your best overall.

You may also be less prone to breathing issues. "People with greater lung capacity tend to have lower rates of respiratory problems, such as asthma and bronchitis," says De Vries.

Being able to take in more oxygen can improve your exercise performance, too, especially when it comes to endurance activities like running or swimming. So you'll be able to push yourself longer and harder and need less time to recover, De Vries says.

How to Increase Your Lung Capacity and Hold Your Breath Longer

Anyone can boost their lung capacity. How you go about doing it depends on your current fitness level and overall health.

Whether you're looking to take your workouts to the next level or just make everyday activities like walking or stair-climbing a little easier, here's what to do.

1. Prioritize Aerobic Exercise

Aerobic activities force your heart and lungs to work harder to supply your muscles with more oxygen. When done consistently, your cardiovascular system becomes more efficient at delivering oxygen to your muscles, so you're less likely to feel out of breath, according to the American Lung Association (ALA).

Exercises that involve deep breathing, like running or swimming, are the most effective for increasing lung capacity, De Vries says. "Interval training, which alternates periods of high-intensity activity with periods of rest, has been shown to be particularly beneficial," she adds. (This 20-minute HIIT workout will give you a big aerobic bang for your buck.)

That said, you don't have to go full throttle to reap the benefits of aerobic exercise. Even walking can make a difference, as long as you maintain a pace where you're moderately breathless (you should be able to talk but not sing).

Warning

Always make sure to check with your doctor before starting a new exercise program, especially if you're new to physical activity or have a long-term lung condition.

2. Practice Breath-Holding Training

Breath-holding training involves gradually increasing the amount of time you can hold your breath. "It has been shown to be an effective method for increasing lung capacity," De Vries says.

Best of all, it's easy to do — follow these steps:

  1. Sitting up straight, open your mouth and inhale as deeply as possible.
  2. Then close your lips and hold your breath for as long as you can, keeping track of the seconds with a watch or your phone.
  3. Repeat the process, gradually working to hold your breath for a few more seconds each time. (But stop if you feel dizzy or faint.)

3. Try Pursed Lip Breathing

Pursed lip breathing, which reduces the number of breaths you take to keep your airways open longer, is a common exercise used to help people with long-term lung conditions like COPD or emphysema improve lung capacity, per the ALA. (Other healthy habits can help you breathe easier with these conditions, too.)

To try it, inhale through your nose and exhale for twice as long through your mouth while keeping your lips pursed. (If you inhale to the count of two, for instance, you'd exhale to the count of four.) Repeat several times.

4. Take Deep Belly Breaths

Like pursed lip breathing, belly breathing can be used to increase your lung capacity, the ALA says. (It's a good stress-buster, too.) Here's how:

  1. Inhale through your nose while placing your hands on your stomach, so you can feel your belly rising and falling. Keep your neck and shoulders relaxed.
  2. Exhale through your mouth for two to three times as long as you inhaled. (If you inhale to the count of two, for instance, you'd exhale to the count of four to six.)
  3. Repeat several times.

5. See a Respiratory Therapist

If your breathing problems are making it harder to carry out everyday activities, talk with your doctor about seeing a respiratory therapist.

"They can provide treatments that can help improve airflow and lung function," De Vries says. "They can also teach you how to properly use inhaled medications and manage your condition."

That in turn can help you breathe easier and increase your activity level — and improve your overall quality of life.

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Because research on how to best treat long COVID is still emerging, many patients have worked with one another in online groups and collaborated with researchers to share what helps them most. Here are suggestions from such patients, as well as doctors like Abramoff at Penn Medicine and Bell at UT Southwestern Medical Center.

• Start with your primary healthcare provider. With long COVID now so common, there’s a good chance that your regular healthcare provider has at least some experience with it. They may also be able to rule out other health issues, provide referrals, and generally keep track of your progress.

There’s no one medication that will help everyone with long COVID, but doctors can try to address certain symptoms with prescription drugs. For example, steroids might be used for some people to tamp down inflammation, Bell says. Stimulants such as modafinil are sometimes used to treat fatigue. In small studies, doctors are testing whether antiviral treatments like Paxlovid, used to treat COVID-19, might inhibit the virus. But right now, “you have to do individualized treatments, not one size fits all,” Bell says.

Your regular healthcare provider may also be able to help by diagnosing long COVID in the first place. Some people might not realize that their symptoms are a result of a prior COVID-19 infection, says Smith, the Baltimore teacher. That prompted her to do outreach in high-risk communities, where COVID-19 hit hard and information about long COVID is less available.

• Look for a long-COVID clinic. If your symptoms are particularly severe, multifaceted, or long-lasting, consider looking for a clinic that focuses on the condition. Care at such clinics is often led by a physiatrist—a doctor who focuses on rehabilitation—who can help coordinate with other specialists you may need.

But be forewarned that such care can be hard to find. “There is absolutely a dearth of clinics or practitioners who have a good handle on how to evaluate and treat post-COVID,” Bell says. That can mean long waiting lists. If you do get an appointment, there’s no guarantee of relief, say patient experts such as Lowenstein. Still, some people are helped. Search for providers at Survivor Corps, which has a list organized by patient-led support groups.

• Consult with a specialist experienced in your symptoms. Some people with severe fatigue from long COVID have found that doctors who treat myalgic encephalomyelitis, aka chronic fatigue syndrome, can offer some help, Lowenstein says.

Similarly, those with dizziness or heart palpitations may work with a cardiologist experienced in treating a condition called postural orthostatic tachycardia syndrome, which causes a similar set of symptoms.

People with brain fog might benefit from testing by a neurologist or a neuropsychologist. “The idea is not just to determine what cognitive areas may be challenging but also to identify relative strengths,” says Steven Flanagan, MD, who specializes in brain injury rehabilitation at NYU Langone Health in New York City. That allows providers to “develop compensatory strategies for identified areas of weakness.”

An occupational therapist might also help with brain fog by using cognitive rehabilitation. For example, multitasking can be hard for people with brain fog, Bell says. Learning to stay focused on one task at a time can help people avoid being overwhelmed.

People who have lost smell and taste could try olfactory or smell training, which involves relearning scents over time through practice with strong-smelling items like coffee and perfumes. Check out the resources offered by AbScent, an organization for people with smell loss, or consult with an ear, nose, and throat specialist.

• Consider making dietary changes. Many people with long COVID have tried to address symptoms by changing their diet. Dansereau, the IT technician, for example, adopted a Mediterranean-style diet. “Once I got my diet under control, symptoms gradually subsided,” he says. The Mediterranean diet—high in vegetables, fish, and healthy fats—which is considered anti-inflammatory, is recommended for long-COVID patients by the British Dietetic Association.

Some people notice an improvement when they eat a low-histamine diet, limiting cheeses, fruits, seafood, and nuts, according to the American Academy of Physical Medicine and Rehabilitation. Others have tried eating frequent small meals to help stabilize energy levels, a common strategy for people with chronic fatigue syndrome.

Still, caution is warranted: No one dietary approach yet stands out as being especially effective, Flanagan says, though “adopting a good, well-balanced diet” may help.

And JD Davids, who co-founded the Network for Long COVID Justice, a consortium of patient-led long-COVID groups, says to be skeptical about advice involving expensive supplements or dramatic dietary changes. Discuss any significant changes you are considering with your physician or a dietitian.

• Stay active—but don’t overdo it. Some people with long COVID have found relief through carefully structured activity programs or physical therapy. Such programs should be individualized based on a person’s capacity for exertion, according to medical experts. This may involve a specialist like a cardiologist prescribing a specific amount of activity.

Guidance on treating long COVID emphasizes that patients should be careful not to push too hard. Working out too intensely may worsen symptoms, a problem so common it has a name: “post-exertional malaise.”

Angela Meriquez Vázquez, a COVID-19 long-hauler who is now the interim president of Body Politic, says that’s what happens to her. “I could go for a 3-mile run right now—I believe my body with enough adrenaline could do that,” she says. “But I would pay the consequences for a month.”

Experts recommend pacing yourself. “I encourage folks to remain physically and cognitively active but without going to the point of exhaustion . . . and building up slowly over time,” Flanagan says. For Dansereau, that meant “gradually each day trying to build activity just a little bit more.”

If you have trouble breathing, Abramoff, at Penn, recommends breathing exercises, such as pursed lip breathing, where you breathe in through your nose, then exhale through pursed lips for twice as long. Some patients may qualify for pulmonary rehabilitation, where you work with a respiratory therapist on techniques to help avoid feeling out of breath.

• Identify your triggers. Lowenstein, formerly at Body Politic, recommends tracking your fatigue, brain fog, and other symptoms, trying to see if you can identify a trigger, such as staring at a screen or sitting up for too long.

• Find support. Many people find it helpful to connect with others having a similar experience, says Davids, the long-COVID patient advocate. “There’s a whole world of people out there who aren’t providers who will help you figure out how to live,” he says.

Take care not to send yourself on a worry spiral by focusing just on con­cerning posts, Dansereau says. Look for success stories, and tips from people who say they are getting better.

• Get insurance to pay. One sign that long COVID is gaining medical legitimacy is that there is now a diagnostic code for it. That means healthcare providers can more easily bill insurers, and insurers may be more likely to cover it. Smith, in Baltimore, has fought to ensure that doctors link her symptoms to long COVID in her medical record—and that they know the code: ICD-10 code U09.9.

Even with that code, insurers may refuse to cover care if they don’t consider it “medically necessary” or if you exceed a certain number of appointments with physical or occupational therapists. If that happens, you can appeal with the insurer and, if that fails, request a third-party review.

One other potential problem: In response to the pandemic, Congress temporarily expanded subsidies to people with Affordable Care Act health insurance plans. But this is not permanent and could be rolled back, says Katherine Hempstead, PhD, a senior policy adviser at the health-focused Robert Wood Johnson Foundation. Making the subsidies permanent and expanding Medicaid “are the biggest opportunities we have to make sure everyone has access to treatment,” she says.

• Apply for disability benefits. Long COVID can qualify as a disability when it substantially limits major life activities, according to the Department of Health & Human Services. That means housing accommodations and other protections under the Americans with Disabilities Act may be accessible, and you may be eligible for employer leave.

Qualifying for disability income can be more challenging, in part because long COVID is so new and poorly understood. Someone must show they have been or will be unable to work for at least 12 months. Historically, most people applying for disability income are denied.

In a 2021 speech, President Biden acknowledged the urgent need for such services. “We’re bringing agencies together to make sure Americans with long COVID have access to the rights and resources that are due under the disability law,” he said, “so they can live their lives in dignity and get the support they need.”

To find more information and resources for people with long COVID, go to the federal government’s long COVID guide.

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Most people breathe without thinking as an involuntary action. However, a person will sometimes need to use extra muscles to inhale and exhale, which is accessory muscle breathing.

A person needs to be able to take enough oxygen into the lungs to maintain the health of their vital organs and tissues and stay alive.

People with certain medical conditions and young children with muscles that are not yet fully developed may find it difficult to take in enough air using only their primary breathing muscles.

In this case, they must rely on additional, or accessory, muscles to help them breathe.

This article discusses what accessory muscles are and when and why the body may use them.

Most people can breathe without thinking about it. This is an involuntary action.

However, individuals can also take deliberate breaths. For instance, during breathing practices, such as during yoga or childbirth. This makes breathing more of a voluntary action.

Learn more about lung function here.

Involuntary breathing requires airway resistance muscles, which include:

  • the skeletal muscles of the tongue
  • the hyoglossus, styloglossus and stylohyoid muscles
  • the glottis
  • the larynx
  • the pharynx
  • smooth bronchi muscles

Accessory muscles, such as the sternocleidomastoid and scalene muscles, help stabilize the rib cage. Other muscles include the:

  • abdominal muscles
  • upper trapezius
  • internal intercostals
  • subclavius
  • posterior inferior

The body uses different accessory breathing muscles for breathing in and breathing out.

Inspiration means breathing in or inhalation. The accessory muscles of inspiration lift the third, fourth, and fifth ribs to increase space for air in the lungs.

Accessory muscles of inspiration include:

  • the sternocleidomastoid
  • the upper trapexius
  • the serratus anterior
  • the latissimus dorsi
  • the iliocostalis thoracis
  • the subclavius

Expiration means breathing out or exhalation and is typically a passive process.

Accessory muscles of expiration include the:

  • internal intercostals
  • abdominal muscles
  • transversus
  • thoracis
  • subcostales
  • iliocostalis
  • quadratus lumborum
  • serratus anterior
  • serratus posterior inferior
  • latissimus dorsi

For a person in good health, the accessory muscles are not active during regular breathing.

However, they may use these muscles when taking a deliberately deep breath. For example, they can involve them when swimming underwater or forcefully expelling air to blow out birthday cake candles.

If someone has a condition that makes breathing more difficult, the body may automatically activate the accessory muscles during typical breathing. Different life stages may also influence accessory muscle breathing.

It is common to use the accessory muscle to help compensate for respiratory conditions leading to hypoxemia, a lower than typical level of oxygen in the blood, or hypercapnia, when the blood’s carbon dioxide level rises above typical levels.

A person can also use the muscle for systemic conditions that lead to metabolic acidosis, which is when there is excessive acid in their bodily fluids.

COPD is an umbrella condition that makes it more difficult to breathe. It may force the body to activate accessory muscles for expiration.

A 2019 study reported that the diaphragm and intercostal muscles are at a disadvantage in people with COPD because the lungs over-inflate and air becomes trapped.

This leaves the muscles unable to move enough air into and out of the lungs, leading to the use of accessory muscles.

When examining a person with shortness of breath during end-of-life care, doctors look for abnormalities in their breathing rate.

Research shows that these physical signs include the activation of accessory muscles. In some cases, a person’s typical breathing moments reverse. This means that when they inhale, their chest contracts, and when they exhale, their chest expands.

Additionally, the area between their ribs and neck can sink in when they try to breathe in.

A 2022 review discussed the unique condition of newborns in terms of respiratory muscle function.

The researchers explained that the diaphragm of a newborn is not as strong and more likely to fatigue compared with that of an older child or adult.

When this fatigue sets in, the newborn’s body recruits the accessory muscles to help them keep breathing.

A 2019 study explains that the breathing of young children under general anesthesia can deteriorate more dramatically than in adults. This is because they cannot control their breathing to the same extent.

Young children are also more prone to:

  • losing oxygen from their blood
  • airway obstruction
  • fatigue or collapse of the lung

Additionally, their intercostal muscles are not yet properly developed, so they are not as effective in their role as breathing accessory muscles.

If a person appears to be working harder than usual to breathe, it is important to contact a doctor as soon as possible. The doctor will aim to find and treat any underlying causes.

If a person with COPD is using their accessory muscles to help them breathe, their doctor may recommend a technique called pursed-lip breathing.

This breathing technique may help them breathe out more effectively and eventually reduce the reliance on their accessory muscles.

Accessory muscle breathing means using muscles other than those people typically use for breathing to take in and expel enough air.

The body uses certain muscles, including the diaphragm, for inhalation, whereas exhalation is more of a passive process.

Accessory muscle breathing may result from deliberate breathing practices or strenuous exercise. It may also be due to a health condition.

People should contact a doctor as soon as possible if a person appears to be working harder than usual to breathe.

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Coronavirus disease 2019 (COVID-19) has spread around the globe. The most common symptoms associated with this are usually respiratory, but different central nervous system manifestations have been reported. There are many cases of Guillain-Barre syndrome (GBS) post-COVID-19. However, only a few simultaneous afflictions of COVID-19 with GBS have been reported. Therefore, our study aims to investigate a case of GBS along with COVID-19 infection in India. A 22-year-old male with no medical history presented with fever along with global weakness and breathing difficulty. There was no history of travel. At the time of admission, he had developed quadriparesis and had muscular strength of 2/5 in bilateral lower limbs and 3/5 in bilateral upper limbs. When the patient developed breathing difficulty, he was transferred to the intensive care unit. The cerebrospinal fluid evaluation showed albumin-cytological dissociation, and a nerve conduction study was done. The patient was managed by neuro physiotherapy 34 days after COVID-19 exposure. After proper physiotherapy and rehabilitation, the patient was able to return to his college life.

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) primarily affects the respiratory system but has also been linked to several neurological symptoms, including headache, confusion, myalgia, dizziness, and loss of taste and smell [1]. Though the first reported case in Wuhan, China showed a para-infectious presentation, this has been characterized as a probable uncommon sequela of COVID-19 [2]. Acute inflammatory demyelinating polyradiculopathy, i.e., Guillain-Barré syndrome (GBS) is defined by symmetrical, increasing limb weakness, areflexia on examination, sensory complaints, and, in some cases, facial paralysis that develops over several days and weeks [3]. GBS is an uncommon, immune-mediated, post-infectious neuropathy that often causes progressive weakening. According to preliminary reports, GBS can be a rare consequence of COVID-19 [4,5]. Since then, the number of cases has been increasing day by day not only in India but also worldwide. There are several high-quality studies suggesting the correlation of GBS with COVID-19, and it is necessary to test for COVID-19 in a patient reporting GBS [6]. Here, we present a unique case of COVID-19 simultaneously with GBS. Because these conditions have overlapping clinical features, such as respiratory involvement and limb weakness, the diagnosis of one may be overlooked by the other. Proper diagnosis and early treatment are required for both.

Cardio-respiratory training and neurorehabilitation, including active-assisted training, and progressing to strengthening, have proved to be effective in previous studies [3]. The Hughes severity score of GBS patients provides a measure of disability [7], and this was used to tailor neurorehabilitation according to the patient’s initial assessment, together with physiotherapy and regular monitoring of the vitals. Within a month the patient was able to become functionally independent without any residual weakness. Early physiotherapy plays an important role in regaining functional independence in such patients.

Case Presentation

Patient information

A 22-year-old male was referred to our hospital from a primary health care center. His presenting symptom was a fever, for which he took paracetamol and antibiotics from the local hospital and got relief. Five days later, he again complained of a fever in the morning, and in the afternoon, he started complaining of sudden weakness in all four limbs, for which he went to a local hospital, where he was assessed and referred to our hospital. The next day he tested positive for COVID-19 (as a protocol before hospital admission) and was placed in isolation for seven days. He was provided with intravenous immunoglobulin but soon developed respiratory distress necessitating transfer to the ICU for oxygen support, which he received for a total of 10 days. He was initially treated with intravenous immunoglobulin and improved. After 15 days, he tested negative and was transferred to the medical ward four days later. The patient was then referred for physiotherapy 34 days after the initial COVID-19 symptom onset.

Clinical findings

The patient was of mesomorphic build, well-oriented, and had intact sensations in bilateral upper and lower extremities. Muscle power was reduced in the right upper and bilateral lower limbs suggestive of weakness with a grade of 4/5 on the Medical Research Council muscle scale in the shoulder and elbow, 3/5 in the wrist, a grade of 3/5 in the hips and knee muscles, and 2/5 over his ankle muscles. Lower limbs were involved more than upper limbs. Deep tendon reflexes were diminished in lower limbs but preserved in bilateral biceps, triceps, and supinators. Abdominal reflexes were absent, bowel and bladder function were affected, and the patient was catheterized. Plantar reflexes were absent on the right and flexor on the left. Breathing was normal with no secretions, but he had difficulty taking deep breaths and was using his accessory muscle (sternocleidomastoid), which was the main reason for early fatigue. Air entry was reduced in bilateral lower lobes. 

Clinical diagnosis

Both the comprehensive metabolic panel and complete blood count were within normal range. The patient's nasopharyngeal swab was sent for SARS-CoV-2 identification on the same day of admission in light of the current global pandemic and his history of fever. One day following hospitalization, a lumbar puncture was performed for cerebrospinal fluid (CSF) analysis. He had albumin-cytological dissociation in his CSF. The patient was identified as having a mild dual diagnosis of COVID-19 and GBS. He was diagnosed with a case of sensory-motor polyneuropathy with nerve conduction velocity findings, which showed that compound muscle action potential amplitude could not be elicited in the bilateral peroneal nerve and was reduced, with prolonged distal motor latency and conduction velocity within the normal limit in the bilateral median, ulnar, and tibial nerves. F-min latency could not be elicited in the bilateral median, ulnar, tibial, and peroneal nerves. Sensory nerve action potential amplitude could not be elicited in the bilateral sural and right ulnar nerve and was reduced in bilateral median nerves

Physiotherapy functional assessment

The functional independence measure score taken on the first day of physiotherapy evaluation was 68/126, and the Hughes severity scale score was 4/6 (confined to bed). By then it was evident that the patient was dependent on caregivers for his activities of daily living (ADL).

The timeline of events in the ICU and wards is shown in Table 1.

S. No. Date of Events Consultation Findings Suggestions
1. On admission (COVID-19 positive) Emergency Bilateral lower limb and upper limb weakness, blurring of vision, diplopia, and COVID-19 Inj. methylprednisolone: 1 mg IV OD; Inj. piptaz: 4 mg IV OD; Inj. Emeset: 4 mg IV; T. favipiravir: 1,800 mg for 1 day; T. Limcee: OD; T. Zincovit OD
2. 26/09/2021 Isolation NCV revealed sensory-motor polyneuropathy Neuromonitoring, watch for SPO2 and respiratory rate. T. favipiravir: 800 mg BD (2nd -7th day) T. Limcee OD T. Zincovit OD IV IG 25 mg (03/10/2020 to 08/10/2020) IV IG 5 mg (09/10/2020)
3. 03/10/2021 Medicine ICU Difficulty in breathing and maintaining saturation, weakness persisting On O2 via facemask for 7-10 days. methylprednisolone 1 g Inj. meropenem 1 g Inj. levofloxacin 500 mg BD Inj. pantoprazole OD
3. 14/10/2021 Medicine ward COVID-19 negative, bilateral lower limb, and upper limb weakness Tab pantoprazole IV NS Ophthalmology call-  no diplopia was found. Neuro physiotherapy call
4. 22/10/2021 Neuro physiotherapist Acute inflammatory demyelinating polyneuropathy -GBS without the involvement of cranial nerves The physiotherapy session started and continued till discharge i.e., 14/11/2020 with a proper home exercise program
5. 02/12/2021 Neuro physiotherapist Difficulty performing complex ADL and IADL Strengthening exercises, gait training, fine motor training

Physiotherapy interventions

After 34 days with symptoms of GBS due to COVID-19, the patient had the effects of de-conditioning due to prolonged bed rest. The chest was clear on assessment, but as the patient had a history of recent COVID-19 infection, chest physiotherapy (breathing exercises, thoracic expansion exercises, pursed-lip breathing along with proper positioning) was provided to increase the chest excursion and reduce the level of stress. For maintaining joint mobility and integrity, range of motion exercises along with a regular change in position were taught to the patient. The treatment protocol is presented in Table 2. This protocol was provided once daily to the patient, with 10 repetitions of each exercise and proper rest periods in between. Along with this treatment protocol, the patient was advised to perform active limb movement, breathing exercises, and stress ball exercises during the evening hours.

Problem identified Probable cause Goal Framed Physiotherapy Intervention
Decreased air entry into the lungs Weakness of the diaphragm and intercostal muscles Mr. X will be able to perform the mild strenuous activity without excursion within two weeks Diaphragmatic breathing (Figure 1C), thoracic expansion exercises, pursed lip breathing, and incentive spirometry
Decreased range of motion Prolonged bed rest Mr. X will be able to perform activities in full range without any difficulty within two weeks Active range of motion exercise involving bilateral upper and lower extremities and calf stretching
Weakness of extremity muscles Decreased nerve conduction Mr. X will be able to regain the reduced strength in his limbs within two weeks of intervention Plan for giving electrical stimulation to increase muscle performance
Inappropriate posture Bedridden for many days postoperatively Proper posture will be gained by the patient by the end of two weeks Chest binders and positioning
Decreased bed mobility Weakness and decreased pulmonary and muscular endurance The patient will gain good bed mobility and endurance within two weeks of intervention Rolling facilitation and transition training (supine-to-sit, pelvic bridging, and supine-to-long-sitting)
Decreased out-of-bed transitions Weakness in girdle muscles and decreased stability Mr. X will get trained in out-of-bed mobility in three weeks Transition training, supine-to-sit, and sit-to-stand
Impaired Proprioception Prolong bed rest Proprioception will be regained with proper training in three weeks Proprioceptive training and joint compression
Reduced muscle strength Weakness due to the disease and hospital stay Mr. X will regain the reduced muscle strength and be able to perform his ADLs by himself within three weeks Upper limb strength training with a water bottle (1/2 L initially, then progressed to 1 L). Lower limb strength training with weight cuff (½ kg initially, then progressed to 1 kg). Hip hikers strengthening along with quadriceps strengthening
Impaired sitting balance Prolong bed rest The patient will regain the sitting balance within three weeks of rehabilitation Proprioceptive neuromuscular facilitation can be taught – alternating isometrics and rhythmic stabilization. Perturbations in a safe manner, with a variety of surfaces
Impaired fine motor training  Distal weakness Mr. X will regain fine motor functions by the end of four weeks Rubber band exercises, stress ball exercises, handwriting practice
Impaired walking pattern Prolong hospital stay and cerebellar improvement Mr. X will be able to walk independently in a good walking pattern after 3-4 weeks of gait training Side leg raises, ankle dorsiflexion, toe raises, heel raises, seated marching, dynamic quadriceps (Figure 1B), knee-to-chest, single-leg stance, squatting, and gait training
Decreased ADL Decreased performance of muscles Mr. X will be able to resume college after 5-6 weeks of intervention Encourage the use of the extremities for ADL

Follow-up and outcome measures

Incentive spirometry measures increased from 900 cc to 1200 cc over 10 days. There was an improvement in overall hand function, proper grasp, and opposition. The Hughes severity score decreased from 4/6 to 0/6, indicating that normal function was achieved post-rehabilitation. Other outcome measures are given in Figure 1A. Figure 1B shows the patient performing resistance dynamic quadriceps exercises, and Figure 1C shows the patient performing breathing exercises.

Results

The Hughes severity scale normalized to 0/6 (normal) by the time of discharge. The patient was able to perform routine ADL and movement transitions (sit-to-stand, squatting, and stair climbing) that were previously difficult. Dorsiflexion and hip internal rotator power also improved post-rehabilitation. There was an improvement in the Berg balance scale and dynamic gait index which indicate improved static and dynamic balance of the patient. All of this led to the enhancement of the quality of life of the patient and early return back to his occupation.

Discussion

GBS is defined clinically by the loss of reflexes and an increase in CSF protein content that progresses rapidly. Small action potentials, prolonged distal motor latency, delayed F-waves, and conduction block are all observed neurophysiologically [3]. In this case report, we presented a patient who developed GBS simultaneously with a COVID-19 infection. GBS was confirmed with clinical features, nerve conduction velocity, and CSF analysis, and COVID-19 was confirmed with a nasopharyngeal swab. The first case of COVID-19-associated GBS during the COVID-19 pandemic was identified in Wuhan as a possible para-infectious illness, where the patient had COVID-19 symptoms seven days following the start of GBS symptoms [1]. There have also been numerous case reports in the past indicating a connection between GBS and COVID-19 infections [7,8]. Early diagnosis and rehabilitation are the keys to early recovery. Following a COVID-19 infection, rehabilitation has been shown to enhance patient health outcomes, with fewer complications in the ICU, faster recovery, less disability, easier early discharge, and a lower chance of readmission [9]. With proper medical management and rehabilitation, the path toward early functional independence can be achieved [10].

In this patient, the medical management for COVID-19 was started from the day of diagnosis along with intravenous immunoglobulin for GBS, and physiotherapy was started after the repeat COVID-19 test was negative [11]. Physiotherapy can be started with proper monitoring to prevent respiratory and other complications. Early rehabilitation has been shown to play a positive role in mitigating neurological manifestations of COVID-19 [12]. Cardio-respiratory rehabilitation, early mobilization, frequent posture changes, bed mobility, sit-to-stand exercises, ADL, neuromuscular electrical stimulation, progressive aerobic exercise, and education on energy conservation are all general rehabilitation considerations in the post-acute phase of COVID-19 infection [13]. Other studies have demonstrated an improvement in the Berg balance score and the functional independence of the patient in the setting of comprehensive rehabilitation [14]. The Hughes severity score improved with normalization of the score, indicating the effectiveness of the intervention provided [15].

Conclusions

Our study concludes that neuro physiotherapy rehabilitation yields positive outcomes and reduces the hospital stay of the patients, making them able to go back to their occupations. The study further demonstrates the importance of the planned physiotherapy protocol in the management of acute cases of GBS along with COVID-19. Amid the COVID-19 pandemic, patients exhibiting paresthesia, tingling feelings, and trouble walking should not be dismissed as simply viral-associated myalgia and arthralgia. Due to COVID-19, GBS should be taken into account as a possible uncommon but serious consequence.



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Breathing exercises may sound strange to you if you've never come across yoga and pranayama. However, they are useful if you're looking to maintain good mental and physical health.

Breathing is the essence of life. It's the act of taking in air rich with oxygen, enriching the cells to perform various activities, and expelling air rich in carbon dioxide, which is a by-product of cells metabolizing glucose to produce energy.

The exchange of oxygen and carbon dioxide can be messed up by bad breathing, which can lead to anxiety, panic attacks, fatigue, and other physical and emotional problems.

There are breathing exercises that can help relieve stress and anxiety through techniques that mimic the calming effects of meditation. Read on to know more.


Deep Yoga Breathing Exercises for Stress and Anxiety

Here's a look at six such workouts:

1) Belly Breathing

Twenty to thirty minutes of belly breathing can help reduce stress and anxiety. Find a place that's comfortable and quiet to sit or lie down. You can sit in a chair, sit cross-legged, or lie on your back with a small pillow under your head and another under your knees.

Here's how you do this exercise:

  • Put one hand on the top of your chest and the other below the ribcage on your belly.
  • Let your belly relax, and don't squeeze or clench your muscles to make it go in.
  • Slowly take in the air through your nose. The air should move into your nose and down, making your stomach rise and fall with your other hand (towards your spine).
  • Slowly breathe out through lips that are slightly closed. Note that the hand on your chest should stay still for the most part.
  • The number of times you do the sequence will depend on your health. Most people start by doing it three times and work up to doing it five to ten minutes one to four times a day.

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2) Box Square Breathing

Box breathing, which is also called 'four-square breathing', is easy to learn and do. If you've ever noticed that you breathe in and out to the beat of a song, you've already done this type of paced breathing.

Here's how you do this exercise:

  • Exhale for four counts. Hold the air out of your lungs for four counts.
  • Take a four-count breath in. Hold your breath for the count of four.
  • Exhale, and start the steps all over again.

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3) 4-7-8 Breathing

The 4-7-8 breathing exercise, which is also called the 'relaxing breath', calms the nervous system in a natural way. At first, it's best to sit down with your back straight, and do the exercise. Once you know how to do this breathing exercise better, you can do it while lying in bed.

Here's how you do this exercise:

  • Put the tip of your tongue on the ridge of the tissue behind your upper front teeth, and keep it there for the entire exercise.
  • Make a 'whoosh' sound as you let all your breath out through your mouth.
  • Close your mouth, and take four slow, quiet breaths through your nose.
  • Hold your breath till you hear the number 'seven'.
  • Make a whooshing sound with your mouth for eight counts as you let all the air out.

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4) Mindful Breathing

Mindfulness meditation is when you pay attention to your breathing and the present moment without letting your mind wander to the past or future.

Choose a calming focus, like 'om', 'peace', or 'breathe in calm, breathe out tension', which you can repeat silently as you inhale or exhale. Give up, and chill out.

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When you realize your thoughts have wandered, take a deep breath, and bring them back to the present.


5) Pursed-Lip Breathing

A simple way to make deep breaths slower and more deliberate is to breathe with your lips together. People with lung diseases like emphysema and chronic obstructive pulmonary disease who suffer from anxiety can benefit from this breathing (COPD).

Here's how you do this deep yoga breathing exercise:

  • Relax your neck and shoulders, and find a good place to sit.
  • Close your mouthm and take a slow, two-second breath in through your nose.
  • Exhale through your mouth for four seconds while making a kissing face with your lips.
  • When you breathe out, keep your breath slow and steady.
  • Do the exercise four to five times a day to get the right breathing pattern.

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6) Resonance Breathing

Resonance breathing, which is also called coherent breathing, can help you calm down and feel less anxious.

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Here's how you do this breathing exercise:

  • Close your eyes, and lie down.
  • Close your mouth, and take six slow, deep breaths through your nose. Don't get too much air in your lungs.
  • Allow your breath to leave your body slowly and gently without forcing it for six seconds.
  • Keep going for as long as ten minutes.
  • Spend a few more minutes being still and paying attention to how your body feels.

Takeaway

To make deep breathing work for you, pay attention to your body, and be aware of how anxiety affects your daily life. If you still feel very anxious after practicing deep breathing, you might want to talk to a mental health professional or a doctor to get an evaluation and suggestions for treatment.


What do you think of this story? Tell us in the comments below..



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Are you trying to cope with stress and anxiety? Take a deep breath – or several.

Pausing a few times each day to focus on your breathing can help you feel better, physically and psychologically, studies show.

Doctors regularly counsel patients with pulmonary disease to use breathing exercises that help keep airways open and lungs working efficiently. But now, as the number of people who suffer from stress and anxiety is rising, more are turning to controlled breathing to help them feel better.

What breathing exercises have in common is the goal of making airflow into the lungs more efficient and less difficult. When breathing is irregular, the air entering the lungs is more turbulent, which creates more resistance. When breathing is regular and efficient, air gets into the lungs in what’s called a laminar flow, which means the air coming in is constant and consistent.

The concept of turbulent and laminar air flow isn’t just found in health care. Engineers strive for more efficient laminar flow in everything from air conditioning systems to aircraft design. What works best for lungs also works for wings.

Types of Breathing Exercises 

Here are three simple breathing exercises you can try:

  1. Pursed Lip Breathing. This exercise is particularly helpful in improving air flow into your lungs by making it smoother and more efficient. It’s easy: Simply breathe in through your nose and slowly and gently exhale through pursed lips. Try to make the exhale last twice as long as the inhale. An easy way to remember this exercise: Smell the roses and blow out the candles. 
  2. Square Breathing. It’s called square or box breathing because it has four equal steps, all using a count of four: Breathe in four 4 seconds, hold the breath for 4 seconds, exhale for 4 seconds, then wait 4 more seconds before starting again. 
  3. Arm Swing Breathing. Breathe in through your mouth, put your arms back like you’re making wings and then exhale through your mouth while swinging your arms forward. 

Remember to stop what you’re doing if you ever start to feel dizzy or lightheaded while doing these exercises.

Benefits of Intentional Breathing

Exercises are designed to make your breathing more intentional, which offers both psychological and physiological benefits.

Psychologically, it calms your mind — particularly for people who are prone to anxiety and stress — and helps you focus. 

Physiologically, breathing exercises can help lower your blood pressure, clear out your lungs and even improve your quality of sleep.

Making Time for Breathing Exercises

You have a lot to remember during a busy day of your job, kids, errands and what seems like a hundred other obligations. 

The beauty of breathing exercises is they take so little time. You just have to be deliberate about taking a 1-minute break to duck into a quiet space and do your exercises. Even a bathroom break can be an ideal time to get in a little pursed-lip breathing.

Just that brief amount of time can help reset the day and change the way you’re feeling by signaling your body to calm itself.

Remember the Bigger Picture

Regular breathing exercises are helpful, but they’re just part of a much larger picture.

Good lung health also depends on aerobic conditions and strength training. There’s a clear correlation between flexibility, muscle tone and lung efficiency. 

The lungs love it when you move. They love being upright. There isn’t a lot of mysticism about lung health — it’s about moving.

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Empyema is the accumulation of pus in the pleural cavity which can be linked to lung abscesses, trauma, septicemia, or spinal osteomyelitis. It is usually caused by a lung infection that extends to the pleural space and causes pus to accumulate. Here, we present the case of a 70-year-old male who complained of dry cough for 15 days, breathlessness on walking for 20 days, right-sided chest and upper back pain, and high-grade fever for 15 days. On investigation, pleural empyema was diagnosed. He underwent a thoracoscopy to drain the fluid and an intercostal drainage tube was inserted. Along with medical management, physiotherapy was also required to help the patient to perform his daily activities with ease. A physiotherapy protocol was developed for the patient to improve his condition.

Introduction

Pleural empyema is a serious infection-related complication that rarely resolves without appropriate medical therapy and drainage procedures. Empyema is the accumulation of pus in the pleural cavity which can be linked to lung abscesses, trauma, septicemia, or spinal osteomyelitis. It is usually caused by a lung infection that extends to the pleural space and causes pus accumulation [1]. Clinical signs include persistent fever and pleural involvement. Tuberculosis is also one of the causes of pleural empyema usually in the elderly as immunity decreases with age and other degenerative processes in the body begin to occur [2]. On the other hand, empyema can also be a secondary cause of pleural effusion. Pleural effusion is an excessive accumulation of fluid in the pleural cavity. It can be secondary to pneumonia, tuberculosis, malignancy of the lungs, lung abscess, lymph node blockage, and many more diseases. Usually, patients have dyspnea, cyanosis if the effusion is large, pain, lethargy, and restricted thoracic movements [3]. The pleural layers come together and may become adherent leading to the organization of fibrin due to the presence of plasma proteins in the fluid. The presence of fibrous tissue leads to restricted lung mobility, eventually causing alteration in the breathing pattern of the patient [4]. Patients require multidisciplinary treatment. Along with medications, physiotherapy also plays a crucial role in the treatment protocol for pleural effusion as well as in pleural empyema. The aim of physiotherapy is to avoid the formation of disabling adhesions between two pleura layers, regain full lung expansion, improve the ventilation of the lungs, improve the exercise tolerance capacity, and maintain joint mobility [3,4]. In this case, the patient was diagnosed with pleural empyema post-pleural effusion a few months ago and was undergoing treatment and rehabilitation for improvement in his condition. He was referred to the physiotherapy department where a proper well-planned treatment protocol was developed for the patient.

Case Presentation

A 72-year-old male, farmer by occupation, came to the hospital with complaints of dry cough, breathlessness on walking, right-sided chest pain and upper back pain for 15 days, and high-grade fever for 15 days. The pain progressed gradually. The patient also provided a history of low-grade fever for two days. After the development of these symptoms, he was taken to a private hospital near his residence where medications were prescribed. The patient was a chronic bidi smoker for 30 years, smoking three to four bidis per day. In the hospital, he underwent computed tomography (CT) scan of the thorax and was advised a thoracoscopy. During the procedure, 100 mL of thick pus was aspirated through thoracoscopy. Post-thoracoscopy, when the patient was stable, a clinical examination was done. He was in supine lying position, conscious, and well-oriented to time, place, and person with a mesomorphic build. During observation, a Foley catheter and an intercostal drainage tube (ICD) number 28 were present, and chest movements were decreased. On examination, pulse rate was 104 beats/minute, blood pressure was 130/88 mmHg, and oxygen saturation was 98%. His breathing pattern was abdomino-thoracic type with a respiratory rate of 23 breaths/minute. On palpation, the chest was asymmetrical, chest expansion was decreased, and the trachea had shifted to the left side. Stony dullnote and decreased vocal resonance over the right side were noted when percussed. The air entry was reduced on both sides, although more on the right. The patient was suspected for tubercular pleural empyema. Therefore, he underwent a high-resolution CT (HRCT) scan of the lungs on January 22, 2022. It revealed moderate right pleural effusion with loculations in places. Consolidation with sub-segmental compression atelectasis was seen in the underlying right lower and middle lobe region. Again, HRCT of the lung was done on January 27, 2022, which revealed, small air foci in the pleural collection, post-tapping status. Small patchy pneumonitis areas in both upper lobes were noted, suggestive of infectious etiology. The radiographical findings are shown in Figure 1. Later, 400 mL of pleural fluid was sent for cytopathological examination. It was reddish hemorrhagic fluid and suggested acute inflammatory leucocytic suppurative exudation like empyema. A high-dose contrast-enhanced computed tomography (CECT) scan of the thorax was done, which revealed a peripherally enhancing loculated large pleural collection noted on the right side causing the collapse of the right lung plus mediastinal shift and multiple enhancing lymph nodes, suggestive of empyema and right lung collapse. Other lab investigations were done; on complete blood count testing, the haemoglobin was reduced (10.9 g/dL). The kidney function test showed a reduced sodium level (128 mEq/L) and reduced creatinine level (0.6 mg/dL).

Therapeutic intervention

The objective of physiotherapy was to enable him to return to his everyday activities and health maintenance. The detailed physiotherapy rehabilitation protocol is presented in Table 1.

Goals Therapeutic interventions Treatment protocol
Patient education Educating the patient about exercises and its importance. Gaining cooperation and consent from the patient and his family The patient and the caregiver were educated about the importance of positioning, ambulation, and functional activities of daily living
To improve bed mobility Monitored for bed transitions and bedside sitting Patient was taught rolling and bedside sitting. Positioning helped prevent bed sores, facilitate drainage, and improve ventilation which increased oxygen uptake
To retrain breathing pattern and reduce dyspnea Controlled breathing exercises were taught, which included, pursed lip breathing and diaphragmatic breathing The patient was advised to perform these exercises 10 times two to three times a day which improved the breathing efficiency
To improve lung volume Thoracic expansion exercises, flexion of shoulder with deep inspiration, and expiration while extension Ten repetitions in one set twice a day were prescribed
Active range of motion exercises for the upper and lower limbs Range of motion exercises for all joints of the upper and lower limbs Daily 8-10 repetitions for each joint actively. This maintained the joint mobility
To improve lung volume and capacity Thoracic expansion exercises: shoulder in flexion with deep inspiration and extension with expiration. Incentive spirometer was used. Visual feedback through differently colored balls representing 600, 900, and 1200 cc Initially 10 repetitions in one set twice a day; later, 10 repetitions in two sets three to four times a day. Initially, the patient was told to perform spirometry two to three times a day; later, the patient was suggested to perform spirometry every two hours
Early mobilization Ambulation in the hallway Early mobilization helps in improving the functional residual capacity

Follow-up and outcome measures

Table 2 presents the detailed follow-up and outcome measures of the patient.

Outcomes First day of referral At the time of discharge Follow-up
Grades of dyspnea II I I
St. George’s Respiratory Questionnaire 76 58 55
Hospital Anxiety and Depression Scale 10 6 5

Discussion

Empyema is the collection of pus in the pleural cavity most commonly caused by pre-existing lung diseases such as bacterial pneumonia, tuberculosis, lung abscess, or bronchiectasis. Direct infection into the pleural space is the most common cause [5]. Clinical signs include continuing fever with signs of pleural involvement. The goals of the treatment are to eliminate the infection, obtain full lung expansion, and prevent the development of a rigid chest wall. Pleural aspiration, instillation of antibiotics, and physiotherapy are the daily treatment plan for patients [3]. Pleural effusion occurs when fluid settles in the pleural cavity. It can occur by transudation or exudation. It may be asymptomatic or associated with pleuritic pain [6]. Empyema can be a secondary cause of pleural effusion. When patients experience such conditions, a physiotherapist can assist in regaining mobility and function and improving their quality of life [7]. Chest physiotherapy has long been a standard aspect of treatment after a thoracoscopy [8] and includes patient education, early mobilization, splinted coughing or huffing, thoracic expansion exercises, using mechanical devices, and well-planned home exercise program during discharge [7,9]. We can conclude that flow-metric incentive spirometry, combined with breathing exercises and airway clearing techniques, can be effective in improving pulmonary function, forced vital capacity, and functional capacity. Chest physiotherapy has an essential role in both preventing and treating pulmonary problems.

Conclusions

It has been demonstrated that pulmonary rehabilitation improves patient ventilation and reduces dyspnea. It helps in the faster recovery of patients. In this case, after the rehabilitation, the patient was able to perform functional activities independently without feeling exhausted. The breathlessness was also reduced post-rehabilitation. Even though complete recovery was not achieved following rehabilitation, the patient’s lung vital capacity and exercise tolerance were significantly improved.



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When a person knows what is causing their shortness of breath and it is not a medical emergency, they may want to try easing it at home.

The following exercises can help ease breathlessness at home:

1. Deep breathing

Breathing in deeply through the abdomen can help someone manage their breathlessness. To try deep breathing at home, people can:

  1. Lie down and place the hands on the abdomen.
  2. Breathe in deeply through the nose, expanding the abdomen and letting the lungs fill with air.
  3. Hold the breath for a couple of seconds.
  4. Breathe out slowly through the mouth, emptying the lungs.

People can do this exercise several times per day or as often as they experience shortness of breath. It is best to keep breathing slowly, easily, and deeply rather than quickly.

People can also try other types of deep breathing exercise, such as diaphragmatic breathing.

That said, the quality of evidence behind deep breathing exercises for shortness of breath is limited, and research is ongoing.

There are also some risks associated with performing deep breathing exercises incorrectly. Indeed, research suggests that when a person performs them incorrectly, these exercises can be more harmful than helpful.

For example, in some people with severe chronic respiratory conditions, deep breathing exercises can lead to hyperinflation, which occurs when an increase in lung volume prevents efficient airflow in the body.

Other risks include reduced strength of the diaphragm and increased shortness of breath.

If possible, perform these exercises with the help of a trained medical professional to reduce potential risks.

2. Pursed lip breathing

Another breathing exercise that can help relieve shortness of breath is pursed lip breathing.

Pursed lip breathing helps reduce breathlessness by slowing the pace of a person’s breathing. This is particularly useful if shortness of breath is due to anxiety.

To try pursed lip breathing at home, people can:

  1. Sit upright in a chair with the shoulders relaxed.
  2. Press the lips together, keeping a small gap between them.
  3. Inhale through the nose for a couple of seconds.
  4. Gently exhale through the pursed lips for a count of four.
  5. Repeat this breathing pattern a few times.

People can try this exercise whenever they feel short of breath, and they can repeat it throughout the day until they feel better.

It is important to note that the quality and strength of the research into pursed lip breathing is very limited. Research into its effectiveness is ongoing.

3. Finding a comfortable and supported position

Finding a comfortable and supported position to stand or lie in can help someone relax and catch their breath. If shortness of breath is due to anxiety or overexertion, this remedy is particularly helpful.

The following positions can relieve pressure on a person’s airways and improve their breathing:

  • sitting forward in a chair, preferably using a table to support the head
  • leaning against a wall so that the back is supported
  • standing with the hands supported on a table, to take the weight off the feet
  • lying down with the head and knees supported by pillows

4. Using a fan

A study from 2010 reports that using a handheld fan to blow air across the nose and face could reduce the sensation of breathlessness.

Feeling the force of air while inhaling can make it feel as though more air is entering the body. Therefore, this remedy may be effective in reducing the sensation of breathlessness.

The use of a fan may not improve symptoms that occur due to an underlying medical condition, however.

In another study, the researchers did not find any clear benefit from using fan therapy, though it did appear to help some groups.

More work is necessary to determine who might benefit from this remedy.

5. Inhaling steam

Inhaling steam can help keep a person’s nasal passages clear, which can help them breathe more easily. Heat and moisture from steam may also break down mucus in the lungs, which might also reduce breathlessness.

To try steam inhalation at home, a person can:

  1. Fill a bowl with very hot water.
  2. Add a few drops of peppermint or eucalyptus essential oil.
  3. Position the face over the bowl, and place a towel over the head.
  4. Take deep breaths, inhaling the steam.

People should leave the water to cool slightly if it has just boiled. Otherwise, the steam could scald the skin on the face.

6. Drinking black coffee

Drinking black coffee may help ease breathlessness, as the caffeine in it can reduce tightness in the muscles in a person’s airway.

A review from 2010 reported that caffeine’s effects slightly improve the way the airway functions in people with asthma. This can be enough to make it easier for them to take in air.

However, it is important to remember that drinking too much coffee can increase a person’s heart rate. People should watch their caffeine intake when trying this remedy to make sure that they do not drink too much.

7. Eating fresh ginger

Eating fresh ginger, or adding some to hot water as a drink, may help reduce shortness of breath that occurs due to a respiratory infection.

One study suggests that ginger may be effective in fighting the respiratory syncytial virus, which is a common cause of respiratory infections.

Some people may experience shortness of breath suddenly and for just a short period of time. Others may experience it more regularly.

Shortness of breath that occurs regularly may have a common cause or be the result of a more serious underlying condition.

Shortness of breath that occurs suddenly might mean that the person needs emergency treatment.

The sections below will explore the different causes of shortness of breath in more detail.

Common causes

Shortness of breath that happens occasionally can be due to:

  • overweight or obesity
  • smoking
  • exposure to allergens or pollutants in the air
  • extreme temperatures
  • strenuous exercise
  • anxiety

Underlying conditions

Regular shortness of breath may be due to a more serious condition that affects the heart or lungs.

The heart and lungs help carry oxygen around the body and get rid of carbon dioxide. Because of this, conditions that affect how they function can also affect a person’s breathing.

Underlying conditions that affect the heart and lungs and can cause shortness of breath include:

Acute causes

There are also some causes of acute, or sudden, shortness of breath that indicate a medical emergency. These include:

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Can Breathing Exercises Boost Your Energy Levels & Productivity At Work?

Deep breathing exercise can be performed anywhere and at any time of the day

Breathing exercises have been recognised for providing various benefits to our physical as well as mental health. Various different breathing techniques have different effects on our bodies and their functions. Sitting in front of a screen or working for long hours can significantly lower our energy levels. There are various ways through which you can boost your energy levels and productivity at work.

Can breathing exercises boost energy levels at work?

Breathing exercises have been proven to manage and boost energy levels and productivity. There are various factors that prove breathing exercises improve our energy levels. In this article, we discuss how and which exercises can help boost energy levels and productivity at work.

How can breathing exercises help?

When we practice breathing exercises, there are various functions of our bodies that are facilitated and improved by it. These functions boost our energy levels. A gradual and healthy way to boost energy also makes us more productive at work.

Here are simple ways through which breathing exercises improve our energy levels and productivity at work:

1. Increase focus

Breathing exercises help calm the mind down and help increase focus. Better focus improves productivity at work.

2. Improves digestion

Poor digestion can significantly lower our energy level and focus. Breathing exercises help improve digestion which later boosts energy.

3. Reduces stress

Stress from work is one of the most common causes of low energy and productivity. Breathing techniques help reduce stress and boost happy hormones.

4. Reduces anxiety

Similar to stress, work might cause anxiety. Breathing exercises help calm us down and lower anxiety.

5. Improves sleep quality

Lack of good quality sleep may be another cause of low energy and lack of productivity at work. Breathing exercises lower blood pressure, calm the mind, boost hoary hormones, and various other factors that improve sleep quality.

6. Improves cognitive functions

Along with improved focus, breathing exercises have been proven to improve various other cognitive functions such as memory, learning, attention, thought, etc.

What exercises can help improve energy levels and boost productivity?

There are certain breathing exercises that focus on improving energy levels and also boost cognitive functions. Here are 3 breathing exercises that can help you boost your energy and productivity while you're at work:

1. Pursed-lip breathing

  • Sit with your legs folded, you can also perform this sitting at your work desk
  • Keep your back straight
  • Place your hands on your knees or however comfortable
  • Close your eyes and focus on your breathing
  • Slowly inhale with your mouth closed
  • Now, open your mouth and form a pout
  • At this point, your lips must appear as though you are giving a kiss
  • Now slowly exhale with your lips pursed
  • Repeat at least 3-4 times

2. Deep breathing

  • Sit with your legs folded, you can also perform this sitting at your work desk
  • Keep your back straight
  • Place your hands on your knees
  • Close your eyes and focus on your breathing
  • Slowly inhale for as long as you comfortably can
  • Now exhale
  • Repeat this 4-5 times
  • You can also perform this exercise lying down with hands on the side

3. Lion Breathing

  • This exercise can be performed sitting on the floor or on your desk chair
  • Keep your back straight
  • Inhale like you usually would
  • Now, open your mouth and pull your tongue out and exhale
  • When exhaling, you can make a ‘ha' sound
  • Repeat 5-10 times to boost energy

In conclusion, breathing exercises are extremely helpful if you often experience energy falls at work. Being productive at work the whole day can be tough and these techniques can help solve this issue.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

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Certain exercises can help the lungs work more efficiently. This can reduce shortness of breath when a person’s lung capacity is limited.

The lungs allow for the exchange of oxygen and carbon dioxide, which is essential for the body to function.

Age, smoking, pollution, and other factors can cause the lungs to work less efficiently. Certain health problems can restrict the lungs’ capacity, such as chronic obstructive pulmonary disease (COPD) and asthma.

A person may not be able to change how much oxygen their lungs can hold. However, breathing exercises can help reduce shortness of breath caused by limited lung function.

This article looks at three exercises that can help reduce shortness of breath in people with chronic lung conditions or respiratory infections.

Pursed lip breathing can help keep the airways open for longer, facilitating the flow of air into and out of the lungs.

To do pursed lip breathing:

  • Sit up straight — good posture can help promote lung movement.
  • Breathe in deeply through the nose in a slow, controlled fashion.
  • Purse the lips — they should be almost touching, as when making a “kissing” face.
  • Breathe out through pursed lips — ideally, the exhalation should be twice as long as the inhalation was.

Some people find it especially beneficial to focus on time, for example by breathing in for 5 seconds and breathing out for 10 seconds. It can help to keep a clock that shows the seconds nearby.

For people who are not very physically active and may not be exercising their breathing muscles frequently, pursed lip breathing may have particular benefits.

This exercise from the American Lung Association helps improve the rate at which the lungs expand and contract.

Belly breathing specifically focuses on strengthening the diaphragm muscle, which allows a person to take a deep breath.

To do the exercise:

  • Rest a hand or a lightweight object on the stomach.
  • Breathe in slowly through the nose, and note how far the stomach rises.
  • Breathe out through the mouth.
  • Breathe in through the nose, this time trying to get the stomach to rise higher than it did with the previous breath.
  • Exhale, and try to make each exhalation two or three times as long as each inhalation.
  • Periodically, roll the shoulders forward and backward and move the head from side to side to ensure that the exercise is not contributing to tension in the upper body.

To enhance lung function, practice belly breathing and pursed lip breathing for about 5–10 minutes every day.

If breathlessness or shortness of breath arise while exercising, interval training may be a better alternative to steady exercise.

Interval training involves alternating between short periods of more strenuous and less strenuous exercise. For example, a person could try walking at a very fast pace for 1 minute, then walking more slowly for 2 minutes, in a cycle.

Similarly, a person may perform a strength training activity for 1 minute, such as bicep curls or lunges, then walk at a gentle pace for 2–3 minutes.

Interval training gives the lungs time to recover before challenging them again.

Any time that exercise causes shortness of breath, it is a good idea to slow down for a few minutes. It can help to practice pursed lip breathing until the breathlessness subsides.

Exercises cannot reverse lung damage, but they can help a person use their lungs to their fullest capacity.

There are other ways to improve and preserve lung health, such as:

  • refraining from smoking
  • drinking plenty of water
  • staying physically active

If a person has symptoms of poor lung health, such as shortness of breath during daily activities, pain when breathing, or a cough that will not go away, they should contact a doctor.

The earlier a person receives treatment for any lung problems, the better the outcome is likely to be.

Just like aerobic exercises help improve the health of the heart, breathing exercises can make the lungs function more efficiently.

Pulmonologists — lung specialists — recommend breathing exercises for people with COPD and asthma because they help keep the lungs strong.

A person should do these exercises when they feel that their lungs are healthy, to build strength, and continue the techniques if they feel short of breath.

Deep breathing exercises may help increase lung capacity. For instance, the British Lung Foundation say that deep breathing can help clear mucus from the lungs after pneumonia, allowing more air to circulate.

To perform this exercise: Breathe deeply 5–10 times, then cough strongly a couple of times, and repeat.

Other exercises, such as pursed lip breathing, can help manage breathlessness during respiratory illness. According to the National Institute for Health and Care Excellence, this may help with breathlessness caused by COVID-19.

However, researchers have not yet looked into the effects of breathing exercises on lung capacity in people with COVID-19. There is currently no evidence that they are a safe or effective way to manage symptoms of this new condition.

Overall, it is a good idea to speak to a doctor before trying any new breathing exercise.

While breathing exercises may provide benefits to people with mild respiratory symptoms, people with severe symptoms may require oxygen therapy or the use of a mechanical ventilator.

Anyone who is worried about their respiratory symptoms should speak to a healthcare provider.

Lung exercises, such as pursed lip breathing and belly breathing, can help a person improve their lung function.

However, it is a good idea to check with a doctor before trying any new exercise, even a breathing exercise. This is especially true for people with underlying health issues, such as COPD.

The doctor may make recommendations to ensure that the person sees the best results.

Read this article in Spanish.

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If you have asthma, exercise can sometimes worsen your symptoms. The symptoms may include wheezing, coughing, and shortness of breath.

Typically, these symptoms begin within 3 minutes after starting physical activity, peaking within 10 to 15 minutes, then resolve within 60 minutes. Occasionally, these symptoms occur immediately upon stopping activity.

When this occurs, it’s called exercise-induced bronchoconstriction (EIB). The term “exercise-induced asthma” was used in the past to describe this phenomenon, but it’s considered outdated because exercise itself doesn’t cause someone to develop asthma.

On the other hand, you can have EIB without having asthma. But if you already have asthma, EIB can be a feature of it.

Understandably, you may be hesitant to start running. But with the proper precautions, it’s possible to run safely with asthma.

Running can even ease your asthma symptoms by strengthening your lungs and reducing inflammation. This can make it easier to enjoy daily activities and exercise in general.

Before starting a running routine, make sure your asthma is well controlled. Your doctor can help you manage your asthma before you hit the pavement.

For a safe and effective workout, follow these tips for running with asthma.

1. Talk with your doctor

Before starting a running routine, consult your doctor. They can provide safety tips and precautions based on the severity of your asthma.

Your doctor may also recommend more regular checkups as you develop a running routine.

2. Know your asthma action plan

Work with your doctor to create an asthma action plan.

This plan will include preventive measures to control your symptoms. For example, your doctor may have you use a daily inhaler for long-term management. This can soothe airway inflammation, which decreases your overall risk of flare-ups.

They might also have you use a rescue inhaler 15 minutes before running. A rescue inhaler contains medication that rapidly opens the airways. You can, of course, use your rescue inhaler as soon as symptoms arise while running.

Also, ask your doctor what to do if you’re running without an inhaler and have an asthma attack. They can show you the signs to watch out for in case you need emergency help.

Breathing exercises are unlikely to help in such a case — they’re more likely to help if dysfunctional breathing or vocal cord dysfunction is the contributor to breathlessness.

3. Pay attention to your body

While it’s easy to zone out while running, it’s important to stay in tune with your body.

Make sure that you’re familiar with the normal signs of exercising, such as:

  • flushed skin
  • faster, deeper breathing
  • sweating
  • feeling warm

You should also know the symptoms of an asthma attack, which aren’t normal during exercise. They may include:

  • coughing
  • wheezing (a high-pitched whistling sound that happens when you breathe)
  • shortness of breath
  • chest tightness
  • breathing that doesn’t slow down

4. Carry your rescue inhaler

Always take your rescue inhaler. This will help you prevent an asthma attack if you experience symptoms while running.

If you tend to forget your rescue inhaler, try posting a reminder near your door.

5. Check the weather

Look at the weather forecast before running outside. Avoid running in extremely cold or hot weather, which can induce asthma symptoms.

Exercising in cold, dry air may worsen EIB. Breathing through a loose-fitting scarf or mask may help reduce symptoms because these measures help to warm and humidify the inhaled air entering your airways.

Another option is to exercise indoors on very cold, dry days.

6. Avoid high pollen counts

Pollen allergies are commonly associated with asthma. If you have pollen allergies, consider checking your local pollen counts before heading out for a run.

If the pollen counts are high, you can opt to exercise indoors to prevent getting asthma symptoms. If you don’t have pollen allergies, it may be unnecessary to avoid exercising outside.

Besides the actual pollen counts, other factors, such as windy conditions or thunderstorms, can also worsen symptoms of your pollen allergies and asthma.

7. Reduce your exposure to air pollution

Air pollution is another common asthma trigger. To reduce your exposure, avoid running near busy, high-traffic roads.

8. Run in the morning

There are many reasons why running outside early in the day can help prevent symptoms of asthma. The levels of certain pollutants are lower in the morning.

It’s also possible that EIB symptoms are milder in the morning. This is partly related to the higher level of endogenous corticosteroids in our body in the morning. These hormones lower inflammation and thus allergic reactions.

However, running in the morning may not be the best option for everyone who has asthma. Generally, the air is cooler or colder in the morning, especially in the winter or on colder days in the fall and spring. Running in the morning when the air is colder may trigger EIB symptoms.

During the warmer months, the level of grass pollen tends to be highest in the early morning and early evening. This is another reason running in the early morning may not be a good idea if you have a grass pollen allergy.

If you’re allergic to tree and weed pollens, then avoid running outdoors at midday and in the afternoon, when their counts are highest.

9. Understand your limits

Start at a low intensity to warm up your body for about 10 minutes, then increase your speed over time. As your body gets used to running, you can begin to run faster with asthma.

Take frequent breaks. Long-distance running can trigger an asthma attack, as it requires prolonged breathing.

Run shorter distances and stop when necessary. This will make it easier to run more regularly, which can help increase your lung capacity over time.

When you’re winding down, reduce your pace for about 10 minutes to cool down your body.

Warming up and cooling down is especially important if you’re entering or leaving an air-conditioned or heated room, as drastic temperature changes can trigger symptoms.

10. Cover your mouth and nose

EIB often gets worse when the air is cold and dry air. If it’s cold outside, wrap your mouth and nose with a scarf. This will help you breathe in warmer air.

11. Take extra precautions

Run with a friend whenever possible. Let them know what they should do if you experience asthma symptoms.

Always bring your phone, and avoid running in remote areas. This ensures that another person can get help if you need medical assistance.

When done with a doctor’s guidance, running may help control your asthma symptoms. It has the following benefits:

Improve your lung function

Poor lung function is a hallmark of asthma. However, in a 2018 study, researchers determined that physical activity could improve lung function in people with asthma.

It can also slow down the decline of lung function, which normally happens with age.

Increase your oxygen uptake

Regular aerobic exercises, such as jogging, improve the oxygen uptake of your lungs and the health of your heart and lungs in general, according to a 2020 review of studies.

The search also found that such exercises can help reduce asthma symptoms and improve your quality of life.

Decrease airway inflammation

According to a 2015 study, aerobic exercise can help reduce inflammation in the airways. This could ease the symptoms of asthma, which are caused by airway inflammation.

To improve breathing during physical activity, try the following breathing exercises for asthma. You can also do these exercises before or after running to further manage your symptoms.

They work by opening your airways and normalizing your breathing.

These breathing techniques will only work in the case of breathlessness while exercising if the exercise-induced symptoms are partly due to vocal cord dysfunction or dysfunctional breathing. These contributing factors can worsen the symptoms of breathlessness from asthma.

It’s important to know that the following breathing techniques won’t specifically help reduce your symptoms if you have pure bronchoconstriction.

Some breathing techniques, such as Buteyko breathing, may help reduce perceived asthma symptoms over time, but may not necessarily be helpful when exertion triggers acute bronchoconstriction.

Pursed lip breathing

If you’re short of breath, try pursed lip breathing. This technique helps oxygen enter your lungs and slows down breathing.

  1. Sit in a chair, back straight. Relax your neck and shoulders. Pucker your lips, like you’re about to whistle.
  2. Inhale through your nose for two counts.
  3. Exhale through your mouth for four counts, lips pursed.
  4. Repeat until your breathing slows down.

Diaphragmatic breathing

Diaphragmatic breathing, or belly breathing, expands the airways and chest. It also moves oxygen into your lungs, making it easier to breathe.

  1. Sit in a chair or lie in bed. Relax your neck and shoulders. Put one hand on your chest and the other on your belly.
  2. Inhale slowly through your nose. Your belly should move outward against your hand. Your chest should stay still.
  3. Exhale slowly through puckered lips, two times longer than your inhale. Your belly should move inward, and your chest should stay still.

Buteyko breathing

Buteyko breathing is a method that’s used to slow down breathing. It teaches you to breathe through your nose instead of your mouth, which soothes your airways.

  1. Sit up straight. Take several small breaths, 3 to 5 seconds each.
  2. Breathe out through your nose.
  3. Pinch your nostrils shut with your thumb and index finger.
  4. Hold your breath for 3 to 5 seconds.
  5. Breathe normally for 10 seconds.
  6. Repeat until your symptoms subside.
  7. Use your rescue inhaler if your symptoms are severe or if they don’t go away after 10 minutes.

Before going on a run, follow these tips to stay safe and comfortable:

  • Take your rescue inhaler 15 minutes before running or as directed by your doctor.
  • Carry your phone and rescue inhaler in a running pouch.
  • Stay hydrated.
  • If you’re running in cold weather, wear a scarf around your mouth and nose to prevent cold-induced asthma.
  • Check the pollen and air pollution levels.
  • If you’re running alone, let a friend know where you’ll be running.
  • Carry a medical tag or card, if you have one.
  • Plan your route so you can avoid busy, polluted roads.

Extreme temperatures can worsen your asthma symptoms. This includes hot, humid weather and cold, dry weather.

Therefore, it’s best to run outside when the weather is mild and pleasant.

Talk with a doctor if you:

  • want to start a running routine
  • feel your asthma isn’t well controlled
  • have developed new symptoms
  • have questions about your asthma action plan
  • continue having symptoms after using an inhaler

You should also see a doctor if you think you have asthma but haven’t received a diagnosis.

It’s possible to run safely with asthma. Start by working with your doctor to control your symptoms. They can provide an asthma action plan, along with a rescue inhaler.

When it’s time to run, carry your inhaler and avoid extreme weather. Take frequent breaks and practice breathing exercises. With time and patience, you’ll be able to enjoy a regular running routine.

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Background: Most of the acute exacerbations of chronic obstructive pulmonary disease (COPD) are due to infections, mostly due to bacteria and viruses. There is a need to study the outcome of microbe-induced airway inflammation.

Materials and methods: It is an observational follow-up study from the pulmonary medicine department of Kalinga Institute of Medical Sciences with the participation of the Regional Medical Research Center, Bhubaneswar, from October 2018 to February 2022. Patients who were admitted with acute exacerbation of COPD and treated as per GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2021 guidelines were included in the study. Those patients in the severe category, who had clinically recovered, had undergone pulmonary physiotherapy, were on prescribed medications and home oxygen therapy after discharge, were followed up every three months by telephone calls. Any exacerbation, clinical stability, or mortality information was recorded.

Results: Out of 197 cases, the majority were elderly, males, smokers, and belonged to urban areas; in total, 102 (51.8%) microbes were isolated as etiological agents of infective exacerbation in which 19.79% were viruses and 23.35% were bacteria, while coinfection was found in 8.62% cases. Among the viruses, rhinovirus, influenza virus, and respiratory syncytial virus were the major isolates. Among the bacteria, mostly gram-negative organisms such as Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were isolated. Readmission was more among patients with coinfection.

Conclusion: Acute exacerbation of COPD was mostly seen in males in the age group of 61-80 years. Rhinovirus and influenza A virus were the two most common viral isolates, and among the bacterial isolates, Acinetobacter baumannii and Klebsiella pneumoniae were predominantly detected. Poor clinical outcomes were noticed more among the coinfection group.

Introduction

Worldwide, COPD is one of the major causes of illness and the sixth highest cause of death. According to research on the Global Burden of Diseases in 2017, it contributed to 50% of all chronic respiratory diseases. It is currently the third leading cause of death worldwide, accounting for nearly 3.23 million deaths, with nearly 80% of deaths occurring in the middle- and low-income countries, and is expected to rise from the 12th leading cause of disability-adjusted life-years (DALYs) in 1990 to the fifth leading cause in 2020 [1,2].

Acute exacerbations of COPD are significant events in the course of illness because they have a negative influence on health status, hospitalization rate, and disease progression. It is believed that respiratory infections are an important risk factor for COPD exacerbations, with viruses accounting for 22%-64% [3]. The increased exposure to viruses in winter has been correlated to an increase in the frequency of exacerbations in winter in some areas of the world [4]. Co-infections have also been linked to an increase in the severity of COPD exacerbations. The simultaneous discovery of bacteria and viruses in patients with acute exacerbation of COPD is responsible for the worsening lung function, prolonged hospital stay, and risk of recurrence of a similar event [5,6].

This study analyses the prevalence and pattern of viral and bacterial infections in patients presenting with acute exacerbation of COPD, correlates the type of infection with the severity of exacerbation among the patients, and finds out the long-term outcome of the severe follow-up cases after discharge in terms of readmission, clinical stability, or death.

Materials & Methods

The study was conducted from October 2018 to February 2022 among the patients admitted to critical care, Respiratory and General Medicine unit of Kalinga Institute of Medical Sciences, Bhubaneswar, in collaboration with Regional Medical Research Centre (ICMR), Bhubaneswar.

The sample size was calculated by using the formula: 

n = Z2 P(1−P)/d2

where n is the sample size; Z is the statistic corresponding to a 95% level of confidence, which is equal to 1.96; P is the expected prevalence (proportion of COPD patients with infectious etiology = 78.3% in a study conducted by Jahan et al.) [7]; d is the absolute precision (it has been taken as 6%). The sample size was found to be 179; adding a 10% non-response rate, the final sample size was 179 + 18 = 197.

Admitted cases underwent clinical assessment and other routine investigations. Empirical treatment was given as per standard treatment guidelines. The nasopharyngeal swab was taken and transported in a viral transport medium within 24 hours to the Regional Medical Research Centre (RMRC) for the detection of respiratory viruses. Samples were tested by real-time reverse transcription-polymerase chain reaction (RT-PCR). The test was done using recommended commercial kit (FTD, UK) following the manufacturer’s instructions on Applied Biosystems-7500 (ABI-7500) equipment (ABI, USA). After thorough rinsing of the oral cavity, respiratory secretions were sent in a sterile container to our institute laboratory for bacterial culture and sensitivity study by VITEK 2 compact instrument (bioMérieux, France).

Apart from the procedural guidelines, depending on the severity of the cases, patients were treated with microbe-targeted antibiotics, oxygen support, either parenteral or oral, nebulized corticosteroid, and bronchodilator and were classified as mild, moderate, and severe as per the GOLD guidelines. The severe cases underwent pulmonary physiotherapy (diaphragm strengthening, pursed-lip breathing, lower limb muscle training, and chest percussion) session one week after clinical stability.

The patients were contacted over telephonic/telemedicine services every three months (due to the COVID pandemic, physical follow-up was not done) to ensure that they were continuing to perform the exercises at home and consuming medications, and any clarifications sought were addressed. Outcome data were collected with respect to clinical stability, worsening of clinical symptoms requiring admission, or mortality at the end of one year of follow-up.

This is an observational follow-up study conducted in the pulmonary medicine department of the Kalinga Institute of Medical Sciences. Ethical clearance was obtained from Institutional Ethics Committee (vide letter no.: KIIT/KIMS/113). All patients (including those on ventilation) with acute exacerbation of COPD (based on acute onset of cough, increased sputum with or without purulence, and breathing difficulty) admitted to the pulmonary medicine department were included in the study. Patients with pulmonary tuberculosis (TB), bronchiectasis, bronchial asthma, pneumonia, and acute lung injury (based on history and evaluation) and patients unwilling to give consent were excluded from the study.

Statistical analysis

Descriptive statistics were done after the collection of data. Frequency distributions of categorical variables (occupation, gender, place of residence, smoking status, type of pathogens found, clinical features, comorbidities, and follow-up data) were calculated. For continuous data (age, total leukocyte count [TLC], and duration of hospital stays), mean and standard deviations were calculated. These were presented in tables using SPSS version 20.0 (IBM Corp., Armonk, NY) and Microsoft Excel 2007 (Microsoft Corporation, New Mexico, USA).

Type of infection, isolated organisms, and clinical outcomes after one year were identified. Chi-square and p-values were calculated to measure the associations between the type of infection and isolated organisms, type of infection, and readmission after one year.

Results

A total of 197 subjects were included in the study, out of which 138 (70.06%) were males and 59 (29.94%) were females. The maximum number of subjects (130 [65.9%]) were within the age group of 61-80 years. The total number of patients more than 80 years of age was 25 (12.69%). The mean age of the patients was 69.24 ± 11.08 years (Table 1).

Age group (years) Male Female Total
40-60 25 17 42
61-80 92 38 130
>80 21 4 25
Total 138 59 197

The total number of patients who had a smoking history was 126 (63.95%). Most of the study subjects were farmers (37.06%), and the least belonged to the category of laborer (2.54%). Out of the total subjects, only 83 (42.13%) patients were from rural areas (Table 2).

Variables Frequency Percentage (%)
Smoking history
Smoker 126 63.96
Non-smoker 71 36.04
Occupation
Teacher 16 8.12
Businessmen 21 10.66
Laborer 5 2.54
Farmer 73 37.06
Housewife 47 23.86
Unemployed 35 17.77
Area of residence
Urban 114 57.87
Rural 83 42.13

Out of 197 patients,102 (51.78%) had been isolated with bacteria or viruses, or both. Isolated viral infection was seen in 39 (19.79%) cases, while 46 (23.35%) had only bacterial exacerbations. In another 17 (8.62%) cases, both bacteria and viruses were detected. No etiology for exacerbation could be detected in 95 (48.2%) cases (Table 3).

Infection detected No. of cases Percentage (%)
Virus only 39 19.79
Bacteria only 46 23.35
Coinfection with both 17 8.62
No pathogen found 95 48.24
Total no. of patients 197 100

Out of 56 cases, in three cases of viral exacerbations, more than one virus (i.e., two) was detected, and in one case of viral exacerbation, more than one virus (i.e., three) was detected. A total of 62 viruses were isolated. Rhinovirus and Flu-A (H3N2) were isolated most frequently (30.35% and 25%, respectively) followed by respiratory syncytial virus (RSV) and parainfluenza virus 3 (PIV-3) (10.71% each; Table 4).

List of viruses No. of cases with viral infection (N = 56) % of patients with the isolated virus
Rhinovirus 17 30.35
Flu-A (H3N2) 14 25.0
RSV-B 6 10.71
Flu-B 4 7.14
PIV-3 6 10.71
Flu-A/PDM 09 4 7.14
HMPV 3 5.35
Adenovirus 2 3.57
RSV-A 2 3.57
COVID-19 4 7.14

A total of 63 bacteria were isolated in which gram-negative bacilli were most common, which include Acinetobacter baumanniiKlebsiella pneumoniae, and Pseudomonas aeruginosa. Among the gram positives, Staphylococcus aureus was the most common.

Rhinovirus was most commonly associated with bacterial coinfection in four cases (2.03%) followed by Flu-A and COVID-19. Acinetobacter baumannii was associated with a viral infection in most cases (five cases; 2.53%). This was followed by the detection of Pseudomonas aeruginosa and Klebsiella pneumoniae in two cases each (Table 5).

List of bacteria No. of cases with bacterial infection (N = 63) % of total bacteria isolated
Acinetobacter baumannii 14 22.22
Klebsiella pneumoniae 14 22.22
Pseudomonas aeruginosa 12 19.05
Staphylococcus aureus 5 7.94
Escherichia coli 8 12.70
Enterobacter cloacae complex 5 7.94
Serratia marcescens 2 3.17
Enterococcus faecium 1 1.59
Streptococcus pneumoniae 1 1.59
Staphylococcus haemolyticus 1 1.59
Sphingomonas paucimobilis 1 1.59

Breathlessness and cough were the most frequent complaints at the time of presentation. In cases with isolated viral exacerbation, 38 out of 39 cases (97.4%) had a shortness of breath, while 34 out of 39 (87.2%) cases had a cough. Fever was present in 14 out of 39 (32%) cases. However, sore throat was reported only in patients with isolated viral exacerbation, and chest pain was reported in patients with isolated bacterial exacerbations. Hypertension was the most common comorbidity reported in both bacterial and viral infections. Diabetes mellitus was mostly seen in patients who had a coinfection (Table 6).

Clinical feature Type of infection
Isolated viral Isolated bacterial Coinfection
Fever 14 19 6
Cough 34 36 13
Expectoration 9 10 4
Breathlessness 38 43 17
Chest pain 0 2 0
Sore throat 9 0 0
Altered sensorium 2 0 0
Comorbidities
Hypertension 11 16 4
Diabetes mellitus 5 5 6
Parkinson’s disease 0 2 0
Coronary artery disease 0 4 0
Cerebrovascular accident 1 2 0
Chronic kidney disease 1 1 0
Cushing syndrome 1 0 0
Chronic liver disease 1 0 0
Carcinoma larynx 0 1 0
Alzheimer’s disease 0 1 0
Congenital heart disease 0 0 1

Among the 102 patients with infective exacerbations, patients with viral exacerbation had relatively lower mean TLC, while patients with exacerbation due to coinfection had the highest mean TLC. However, the results were not significant (p = 0.641). Among the patients with infective exacerbations, those with viral exacerbation had the least mean duration of hospital stay (7.33 ± 4.8 days), while patients with bacterial exacerbation spent the highest number of days in the hospital (10.082 ± 5.89 days). The 17 patients with coinfection had a mean duration of hospitalization of 6.8 ± 5.03 days. The results were not statistically significant (p = 0.071). Ten (26%) patients with viral exacerbation, 24 (52%) with bacterial exacerbation, and nine (53%) patients with a coinfection required respiratory support and hence needed admission to ICU. Severity was most commonly noticed in coinfection cases (p = 0.020). Two deaths were reported in viral infections, four in bacterial exacerbation, and three in coinfections (Table 7).

Parameters Mean Value P-value
  Isolated viral infection (n = 39) Isolated bacterial infection (n = 46) Coinfection (n = 17)
Mean age (years ± SD) 68.36 ± 3.45 71.8 ± 11.73 73 ± 8.33 0.084NS
Total leukocyte count (cells/mm3) 11.139 ± 4.8 12.49 ± 5.435 12.66 ± 7.3 0.641NS
Mean duration of hospital stay (in days) 7.33 ± 4.8 10.052 ± 5.89 6.8 ± 5.03 0.071NS
Type of cases
Mild 12 (31%) 0 (0%) 0 (0%) 0.041S
Moderate 17 (43%) 22 (48%) 8 (47%) 0.062NS
Severe 10 (26%) 24 (52%) 9 (53%) 0.020S
No. of deaths among the severe cases 2 4 3 NA

The number of patients who had a severe disease was 43 (Table 7). Out of them, nine died. The rest 34 cases were advised pulmonary rehabilitation, oxygen therapy, inhaler-based medication as self-management home-based delivery, and were on telehealth monitoring. Five cases were lost to follow-up. In the rest 29 cases, information was documented after follow-up for one year that consisted of six viral infection, 17 bacterial infection, and six coinfection cases (Table 8).

Condition of the patients after one year of follow-up Viral infection (6 cases) Bacterial infections (17 cases) Coinfections (6 cases) P-value
Clinically stable 6 (100%) 16 (94%) 2 (33%) 0.034s
Exacerbation (admission) 0 1 (6%) 4 (67%)

All viral infection cases were clinically stable and did not require admission. Out of 17 bacterial infection cases, 16 (94%) were clinically stable and only one (6%) required hospital admission due to exacerbation. But in the six coinfection cases, two (33%) were clinically stable and the rest four (67%) cases required hospital admission, and the data was found to be statistically significant (p = 0.034). This shows most of the coinfection cases required rehospitalization during the period of follow-up (Table 8).

Discussion

Acute exacerbation of COPD results in deterioration of pulmonary function, morbidity, and death. In our study, the mean age of the patients was 69.24 ± 11.08 years with a majority of the patients belonging to the age group of 61-80 years (Table 1). In a recent study conducted at the All India Institute of Medical Sciences (AIIMS), Bhubaneswar, the mean age was 65.49 ± 10.40 years [7]. As per another Indian study by Mood et al., the mean age of patients was 66.8 ± 11.4 years and the maximum prevalence was observed in the age group 70-79 years [8]. In another study that involved both European and American subjects, the proportion of females was 36.7% among Europeans and 33.3% among Americans, which is in accordance with our findings [9]. A study by Hajare et al. reported a male-to-female ratio of 2.3:1 [10]. The preponderance of males being affected can be attributed to the fact that males are more involved in outdoor activities and hence are more exposed to environmental pollutants [8]. Smoking is a risk factor for COPD and also its exacerbation as it decreases mucociliary clearance, which is amply proved in our study where smoking as a risk factor was noticed among 64% of patients [11]. In our study, the two main occupations that had increased the prevalence of COPD were farmers and housewives (Table 2). In a study published in 2016, occupations that were at COPD risk were seafarers, coalmine operatives, and cleaners [12]. In a study in Bangladesh, occupational exposures in farmers, hazardous exposures in tanners, and cotton dust exposures in garments were among the most prominent risk factors for the development of COPD [13]. In our study, the urban population comprised the majority (57.8%, Table 2), which correlates well with a study done in India where the prevalence of COPD was more in the urban areas. But there has been a significant increase in the prevalence in rural areas where it was reported to be 8.8% in a study done in India, whereas in our study, the prevalence is around 22% [14]. The disparity in the urban-rural divide is reversed in the United States, where the prevalence of COPD in rural communities is nearly double that in urban areas [15].

The complex interactions between environment, host, and microbes are responsible for exacerbations in COPD and increased morbidity and mortality [16]. As per studies, the major cause of acute exacerbations is infections [7]. In our study, infection was detected in 51.7% of cases (Table 3). In an Indian study, around 78.3% of cases had a respiratory infection [7]. Our study illustrates that only bacterial infection was found in 23.35% of cases; only viral etiology was found in 19.79% of cases, and bacterial and viral coinfection was found in 8.62% of cases. Other studies have reported bacterial infection in around 42%-49% of cases, viral infections in around 20%-64% of cases, and bacterial-viral coinfection in 27% of cases [7,17,18]. There has been an increased report of respiratory viruses as a causative agent in the acute exacerbation of COPD. With the application of molecular techniques in patients’ samples, viruses have been implicated in around 47%-66% of cases [11]. A total of 56 viruses were isolated (Tables 3, 4). The most common viruses isolated were rhinovirus, followed by Flu-A and RSV-B. Human rhinovirus (HRV) has been reported as a common viral isolate in various studies [18]. The study by Koul et al. also reported rhinovirus and influenza virus as the most common virus causing acute exacerbation of COPD [19]. The high rate of isolation of influenza virus may be attributed to the transmission of the influenza virus in the community and the need to have immunization [20]. In our study, more than one virus was isolated in three cases. Similar results have been found in a recent study in India [7]. The most common bacterial isolates in our study are Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa making up around 21.9% (for both Acinetobacter and Klebsiella) and 18.8%, respectively. Among the gram-positive bacteria, Staphylococcus aureus (7.8%), Enterococcus faecium (1.6%), and Streptococcus pneumoniae (1.6%) were the most common isolates. In the study by Jahan et al., the most common bacteria isolated were Pseudomonas aeruginosa (28%), followed by Acinetobacter baumannii and Klebsiella pneumoniae in seven cases each (21%) [7]. In another study, the most common bacterial isolates were P. aeruginosa (30.7%) followed by K. pneumoniae (20.3%) and S. pneumoniae (8.6%) [8].

It is to be noted that most of the studies implicate Pseudomonas aeruginosa as the most common bacteria causing exacerbation, whereas Acinetobacter baumannii and Klebsiella pneumoniae are the most common bacteria causing exacerbations as per (Table 5) of our study [21]. The predominance of Acinetobacter spp. in our study is a novel finding, and further studies are needed to know if this is the emerging trend in acute exacerbation of COPD as MDR (multidrug-resistant). Acinetobacter baumannii is implicated in the etiology of various other infections [22]. Jahan et al. reported coinfection with virus and bacteria in 24.9% of cases of acute exacerbations of COPD [7]. In our study, coinfection was detected in 9.63% of cases (Table 3). However, this may not represent a natural course as many patients are chronically infected with multiple pathogenic bacteria before a viral pathogen is detected. Conversely, viruses have been shown to be frequently followed by secondary bacterial infection. Most of the coinfections were seen to be associated with rhinovirus and influenza A virus, whereas it was mostly associated with both influenza A and influenza B in another study by Jahan et al. [7]. In another study, the viruses implicated alone or as coinfections are picornaviruses (especially rhinovirus), influenza virus, and respiratory syncytial virus [23]. Comorbidities were associated with eight cases of viral exacerbation with hypertension being the most common (Table 6). Similar findings were also reported by Koul et al. where hypertension was seen in 60.52% of cases followed by heart ailments (14.16%) [19]. No significant correlation was observed between the various subgroups. Breathlessness and cough were the most common clinical presentation in cases of exacerbation in our study. Sore throat, however, was reported only in viral exacerbation and not in bacterial or coinfection (Table 6). The outcome of viral exacerbation has improved over time, owing to an increase in adult vaccination and early treatment. Among the etiological agents, in our study, we noticed poor outcomes among the coinfection group probably as a consequence of systemic inflammation (Table 7). As per a study in Japan, gram-negative bacilli were significantly associated with prolonged hospitalization [24].

The severe category of patients who were discharged was put on telemedicine advice on pulmonary physiotherapy, medications, and home oxygen. Among them, the coinfection group had exacerbation that needed admission, and the rest of the cases were clinically stable (Table 8). There are not many studies that correlate the long-term outcome of acute exacerbation of COPD with infective causes. As per a review by Wang et al., it is observed that in cases where there is coinfection with bacteria and virus, the lung function impairment is greater and the duration of hospitalization is also longer [25]. In another study published in Lung India, where the outcomes were followed up for readmission for two years, 12% mortality was observed; readmission was seen in 54% of cases, and two or more readmissions were seen in 45% of cases [26].

Thus, a proportion of patients appear to be more susceptible to exacerbation. Hence, prevention and mitigation should be the key goals. The application of technological advancement in communication during the COVID pandemic enabled us to overcome the challenge through tailored prescription and telemedicine intervention.

Conclusions

The clinical course of COPD is punctuated by exacerbation. These events are associated with accelerated loss of lung function, poor quality of life, increased health care costs, and mortality. Infection is the most important cause of exacerbation. Klebsiella pneumoniae and Acinetobacter baumannii among the bacterial isolates and rhino and influenza A viruses among the viral isolates were predominantly detected. During the telehealth follow-up, it was observed that those patients who had co-infections were more prone to readmission, whereas those who had isolated bacterial or viral etiology had better clinical stability. Pulmonary physiotherapy and appropriate medical measures for the mitigation of exacerbation can prevent further decline of disease progression.



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When was the last time you took a deep breath, expanding your chest, contracting your diaphragm, letting fresh air seep into the deepest part of your lungs? If you haven't, you should try it now. How does it make you feel? Cooler, more relaxed, calmer? 

Yoga practitioner Disha Sahay wouldn't be surprised. "Breathing right resets the body's internal temperature and helps in keeping the body cool. Practising the perfect yoga techniques to breathe right cools the body," says Sahay. The 36-year-old remembers how she would always be pulled up as a child for not breathing properly. "As a child, I would generally breathe through my mouth rather than my nose. My parents would keep ticking me off," she says. At 8, she failed to understand why she couldn't simply breathe through her mouth. "Now, as I practice yoga, I understand the difference between good breathing and bad breathing," she says.

Also read: Can you learn to breathe better?

Not everyone pays attention to breathing techniques. How complex can simply breathing in and out get, they counter. Well, the simple answer is that--believe it or not--there is a correct way of getting oxygen inside your lungs for the proper functioning of the system. And yes, while it is true that a busy day may not allow us to continuously focus on our breath, allowing a few minutes daily for it may not be a bad idea. Practising some simple breathing exercises regularly can help control anxiety, fear, and anger—all of which impact proper breathing—and to relax and calm our minds. Studies have shown that even half an hour of mindful breathing exercise can lead to changes in the amygdala—the emotional centre of our brain which gets affected by heart rate variability. Mindful breathing means focusing on breathing to its natural rhythm and flow.

"When we do deep and slow breathing, our heart rate variability reduces; these send a signal to the amygdala to calm and relax. Rapid breathing increases heart rate variability, which sends signals to the amygdala triggering feelings like anger, anxiety, and fear. This is the reason why breathing in a correct way is very important," says Dr Pujan Parikh, Consultant-Pulmonary Medicine, Sir HN Reliance Foundation Hospital, Mumbai. "When a person is calm and relaxed, breathing is slow and deep. Breathing becomes rapid and shallow during anger, anxiety, fear, and panic. In the same way, heart rate variability increases during anger, fear, and panic and reduces during a calm and relaxed state. Mindful breathing can reduce heart rate variability."

Sahay today understands that correct breathing is through the nose and involves the use of the belly. "I follow the 4-7-8 breathing technique based on pranayama breathing exercises," she says. Developed by Dr Andrew Weil, it is defined by the expert as a "natural tranquiliser for the nervous system." It involves sitting with the back straight and placing the tongue against the back of the top teeth. "You have to exhale completely through your mouth around your tongue. Close your lips and inhale through your nose for a count of four, hold your breath for a count of seven and exhale completely through your mouth for a count of eight," Sahay explains the technique.

When the physical activity of the body increases, such as while running or jogging, or when one's emotional levels are raised due to anxiety or anger, the body automatically resorts to drawing in oxygen through the mouth. While this is natural, it is only when one breathes through the nostrils and uses the diaphragm above the stomach muscles does breathing really benefits the body. "When breathing through the nose, the diaphragm contracts, the belly expands, and the lungs fill with air. The technique pulls down on the lungs, creating negative pressure in the chest. This results in the air flowing into the lungs," says Parikh, adding, "Pursed-lip breathing is the best way to maximise your oxygen intake."

The proper way of breathing helps when a person is suffering from a chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD). If one uses the nostrils and the diaphragm, one is assured of getting maximum oxygen into the lungs. This also aids in reducing shortness of breath. "Getting the maximum amount of oxygen into the body with minimum effort is important as oxygen generates 90 per cent of the body's energy. Only the remaining 10 per cent comes from what we intake in terms of food and liquids," says Pune-based pulmonologist Dr Pallavi G Limaye, adding, "Often bad breathing technique is a result of poor posture, stress, and other related factors. It leads to people breathing shallowly. In such cases, instead of the diaphragm contracting and making space for the lungs to expand, the upper rib cage moves more than it should. It ends up causing discomfort in the chest and back muscles and also weakens the muscles in the pelvic floor and lower back. Such breathing also disrupts the proper movement of the shoulders and spine."

Limaye says that as we age and experience more stress, we forget to practice mindful breathing. "No one takes breathing seriously because it's just there. But we have to practice the right way to breathe if we are to gain from it," she says. Studies have shown that controlled breathing can reduce levels of the stress hormone cortisol in saliva and alter the chemistry in the brain, affecting levels of another stress hormone, noradrenaline. "Breathing right could enhance focus and keep brains healthier for longer. The right way of breathing can help improve our sleep, digestion, and immune and respiratory functions. It can also bring down our blood pressure and anxiety," adds Limaye.

Also read: Breathing exercises for post-covid recovery

As Sahay gets ready to practice a round of 4-7-8 breathing, the question you need to ask yourself is: are you just breathing or breathing right?

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Breathing is an automatic process your body performs without you having to think about it until it becomes challenging. It’s not always easy to take a deep breath, especially if you suffer from conditions that compromise your respiratory system—like if you have asthma, for example, or in some cases, when you’re recovering from COVID. However, breathing exercises and even certain postures can help make it easier, like the deep breath stretch that’s trending on TikTok, which looks pretty much like the position most kids assumed watching TV back before handheld screens were a thing, lying on their belly, head propped up in hands.

In this position, “the upper back is in extension, which can open up the rib cage a bit and allow for more expansion (as opposed to being rounded forward),” says Leada Malek, PT, DPT, CSCS, board-certified sports physical therapist and strength and conditioning coach. The more your ribs can expand, the more room your lungs have to inflate as you breathe in, while being propped up on your forearms or elbows assists in this effort too by grounding the pose. “Fixing the elbows or hands allows for a stable shoulder and the muscles that attach to the rib cage can help expand it with better breathing too,” Dr. Malek says.

While this stretch seems to be popular, there are some drawbacks, according to Dr. Malek. “I see some limitations in it—ie. too much pressure from the ground onto the lower ribs, [for example]—but it's always nice to encourage people to move and breathe,” she says. “It’d be like breathing with a heavy weight on your chest, which makes it harder.”

As an alternative, “The easiest stretch to do for this would be a prone press up,” says Malek, which would be called cobra pose in yoga.

Watch this video to see how to do cobra pose (as well as the bigger version of the same backbend, up dog): 

You can also try these types of backbends while seated, Dr. Malek says, placing your hands or elbows on your knees instead of the floor. “This has been found to use muscles more effectively in people with asthma,” she says.

If lying on your stomach is uncomfortable, a second option is to backbend over a foam roller. For this deep breath stretch, you’ll lie down on your back on the floor with your knees bent and a foam roller across your shoulder blades so that you can open your chest and bend back over it. “This facilitates extension of the thoracic spine, where our ribs attach, and this will facilitate a more mobile ribcage,” says Dr. Malek. Do as needed or once a day.

Another good stretch to incorporate is pursed lip breathing. “Pursed-lip breathing helps provide relief for shortness of breath and helps people regain control over their breathing,” says Malek. Breathe through the nose and exhale through the mouth with your lips together like you’re trying to whistle. Make your exhales a slow, controlled flow, practicing daily for three minutes total to see the most benefits.

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Did you know that there are breathing exercises that might help you naturally lower your blood pressure? Breathing (especially through your nose) and practicing certain breathing exercises can be quite effective for those with high BP.

So, what precisely goes on when you breathe deeply, and why does it matter to your blood pressure?

Our noses are designed to operate as filters and provide the most oxygen to our bodies. Breathing through your nostrils decreases blood pressure because it allows you to take in more oxygen, promoting efficient blood flow and soothing your nervous system.

5 best breathing exercises to lower hypertension and stay fit

Breathing exercises are not as time-consuming as other exercises. It's really just a matter of scheduling a few minutes to focus on your breathing. Here are some suggestions to get you started:

  • Start with five minutes every day and gradually increase as the activity gets simpler and more comfortable.
  • Start with two minutes if five minutes seems too long.
  • Practicing several times a day is recommended.

Check out these five best breathing exercises that will help you lower your blood pressure:

1) Pursed lip breathing

By exerting purposeful effort in each breath, this is one of the easiest breathing exercises that can enable you to slow down your breathing rate. To properly master your breathing rhythm, consider using this breath four to five times a day when you first start.

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Here is how to do it:

  • Neck and shoulders must be relaxed.
  • Slowly inhale through your nose for two counts whilst closing your mouth.
  • As if you're going to whistle, scrunch or purse your lips.
  • For a count of four, slowly exhale by passing air through your pursed lips.

2) Lion’s breath

The invigorating yoga breathing technique of a lion's breath is claimed to ease stress in the chest and face, and is one of the most efficient breathing exercises.

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Here is how to do it:

  • Take a seat in a relaxed place. You can either cross your legs or simply sit on your heels.
  • With your fingers extended wide, press your hands against your knees.
  • Deeply inhale through your nose and widen your eyes.
  • Open your lips wide and push out your tongue, pulling the tip downwards toward your chin at the same moment.
  • Make a lengthy "ah" sound as you exhale out of your mouth, contracting the muscles at the very front of your throat.
  • You can look at the area between your brows or the tip of your nose by turning your head.
  • Repeat this breath two to three times.

3) Alternate nostril breathing

Breathing through alternate nostrils has been found to improve cardiovascular function and reduce heart rate, making it one of the best breathing exercises out there. It's better to do this exercise on an empty stomach. If you're sick or congested, stay away from the practice. Throughout practice, keep your breathing smooth and even.

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Here is how to do it:

  • Select a seated position that is comfortable for you.
  • Raise your right hand over your nose, squeezing your first and middle fingers into your palm while your other fingers remain extended.
  • Seal your right nostril with your right thumb after an exhale.
  • Breathe in via your left nostril, then cover it with your right pinky and ring fingers.
  • Exhale out of your right nostril after releasing your thumb.
  • Inhale and exhale via your right nostril.
  • Exhale via your left nostril, which has been opened by releasing your fingers.
  • This is the end of one round.
  • For a total of five minutes, repeat this breathing pattern.
  • Exhale slowly on the left side to end your session.

4) Resonant breathing

Another excellent breathing exercise, when you inhale at a rate of 5 complete breaths per minute, you're doing resonant respiration, also known as coherent breathing.

Resonant breathing is also known as coherent breathing (Image via Pexels/Marcus Aurelius)
Resonant breathing is also known as coherent breathing (Image via Pexels/Marcus Aurelius)

Here is how to do it:

  • Count to five as you inhale.
  • Count to five as you exhale.
  • For at minimum a few minutes, maintain this breathing rhythm.

5) Humming bee breath

A practice borrowed from yoga, the distinct sensation of this breathing exercise helps to establish instant peace and is particularly relaxing for your forehead. Humming bee breathing is used by some people to ease irritation, anxiety, and anger.

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Here is how to do it:

  • Choose a seated position that is comfortable for you.
  • Relax your face by closing your eyes.
  • Place your index and middle fingers on the tragus cartilage, which partially surrounds your ear canal.
  • As you breath, gently press your fingertips into the cartilage.
  • Close your mouth and make a loud buzzing sound.
  • Carry on for as long as you feel comfortable.

Key Takeaway

The majority of these deep breathing exercises are simple enough to try right away. Allow yourself to experiment with these different methods, which can be performed at any time of day.


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Q. Have you tried some of these breathing exercises?

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