Enhancing your breathing capacity in the face of Covid-19

Posted by Fiona Gavine on the 04th May 2020

A brief guide to enhancing your breathing capacity in the face of COVID-19 by Sue Watson, Craniosacral Therapist

Data is showing that approx 15% of COVID-19 cases are severe enough to need hospital treatment for breathing difficulties, in the most severe cases requiring ventilation in an intensive care setting. That means there may be many of us who experience a whole range of symptoms that won’t require hospitalisation. COVID-19 affects the lungs quite differently showing a tendency to affect the whole lung, both sides, in a more uniform way than most other respiratory conditions. So what can you do to be as prepared as possible if you or a member of your household’s breathing is affected by the virus?

Ensuring you are utilising the maximum capacity of your lungs is a useful place to start as it’s always easier to draw upon experience from having practiced than learn something new when you may be panicking or becoming breathless.

Key to optimum breathing:

Long, Slow & Deep!

Why do I say optimum and not maximum?

A ‘deep breath’ doesn’t mean ‘maximum breath’ – it means getting the breath to the right place – deep down. Practicing when you are well can really help in times of need.

Where are my lungs?

They are probably bigger than you imagine and the largest area where oxygen enters your blood is in the base, or bottom, of your lungs and that’s why deep breaths are important. Shallow breaths take the air only to the upper airways where there is much less blood for oxygen exchange to take place.

How to breathe deep and with ease:

· Sit tall if possible

· Easy shoulders

· Breathe in and out through your nose

· Breathe deeply into the bases of your lungs – use your imagination to ‘send the breath’ toward your pelvis.

· Use the whole of your lungs – front, sides and back – *see illustration for a useful way to breath into your back.

· Longs, slow and deep (may be remember ‘LSD’)

· Between 8 and 12 breaths / minute is ideal at rest.

· Stay well hydrated – this is more important than you might imagine!

Once you have mastered the pattern of breathing in, it can be helpful to simply focus on the breath out as this is associated with calming the nervous system and so helping if you feel anxious or fearful about your breathing.

Why through my nose?

There are several reasons for breathing through your nose – ideally both the breath in and out.

The air is warmed and moistened before travelling into your lungs, this avoids dehydrating the lungs and keeps secretions moist.

Filters particles from the air, avoiding irritants from entering your lungs.

Nitrous oxide is produced in the sinuses behind your nose. Research suggests this may act as a first line of defence against viruses, bacteria and infection. Nitrous oxide also helps with the suppleness of the lungs for good expansion and is involved in the exchange of gases.

The added resistance of the air passing through the sinuses slows the breath taking on the nitrous oxide and helping regulate the speed of breathing. This resistance creates a back pressure, important in keeping your airways (tubes inside your lungs) open. If breathing through your nose is difficult and you need to use your mouth, then pursing your lips and blowing gently and slowly on your out breath can help provide the same backpressure.

Common problems when trying to catch your breath

Slumping forwards, slouched sitting – prevents air getting to the bases of your lungs

Fast and short shallow breaths – the air at the top of your lungs is not useful for the exchange of oxygen into your bloodstream – the most effective exchange takes place in the bottom – or ‘bases’ of your lungs.

Failing to empty the lungs of ‘dead’ air before trying to take another breath in – you can’t get more air in if you have air already in your lungs. Ensure a long breath out before you breath in.

Breathing through your mouth – You may feel more able to get more air in through your mouth – but there are important reasons to breathe through your nose (see below)

Taking lots of big breaths. It’s not uncommon to leave you dizzy or feeling like you can’t get enough air – this is referred to as ‘air hunger’ or a feeling of suffocation and so there may be a tendency to breathe deeper or faster. It may seem counter-intuitive, but it is not the case that the more oxygen you get in the better. This is to do with carbon dioxide – a natural waste product of breathing which is in high concentrations in your out breath. Carbon dioxide is essential for your brain to register the sensation of having a satisfying breath. The key here is to slow your breathing right down, ensure you breathe out fully and your breath in goes right to the base of your lungs. This takes trust that it will work and keeping calm will help further.

Pacing – attempting to go from A to B as quickly as you can so you can get a seat and regain control. However, moving slowly and keeping control by taking long, slow deep breaths will help you stay calm and reduce the demand for oxygen.

Panicking or getting anxious – easier said than done when feeling like you need air – but the calmer you are, the less oxygen you need. Anxiety and panic increase the demand for oxygen.

What can I do if I get short of breath myself?

Stay calm – you’ll need less oxygen!
Check your position – Find a position that takes the effort out of having to hold yourself up – get pillows for support if required, lean against a wall – see the pictures below.

Slow your breathing down – long breaths out – empty the lungs, the breath out will help calm you
In through your nose is you can
Out through your nose if you can – or gently blow through pursed lips
Aim to breath into the belly and back – use the full lung
Ensure you are well hydrated – take a drink if you need to.

What is a member of my household becomes short of breath?

Stay calm!

If you stay calm you can help keep your family member calm.

Trying to remember information can go from your mind when you become anxious, this is normal, so having someone with gentle reminders can be helpful – have this list handy!.

Ensure a calm tone of voice.
Remind him/her of the steps to take to ease the work of breathing
Position of comfort
Focus on breath out – the breath in will follow naturally
Breathe through the nose if you can – blow out gently if not
Offer a glass of water

It can be normal for someone to become agitated and maybe short tempered if they are frightened and/or struggling to breath. Staying calm can help. But also remember that being too persistent can be a source of irritation, so use your experience and judgement to provide enough assistance to be helpful but not annoying!

A final word from the lead of recent Physiotherapy Guidelines for working with COVID-19, Bernie Bissett:

“The sooner a patient with COVID-19 gets up and gets moving, the better their chances of recovery,”

She recommends that recovering patients at home avoid prolonged bed rest and try to remain upright during the day (sitting, standing or walking) to help the lungs remain open and clear.

This is advice on breathing technique and guidance on supporting someone else and is not a substitute for medical assistance. If your symptoms persist here are some useful links should you be concerned you need medical assistance and where to find it.

https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms-and-what-to-do/

https://www.nhs.uk/conditions/shortness-of-breath/

Sue watson is a qualified and very experienced Physiotherapist and offers Craniosacral Therapy from One Allan Park Wellbeing Clinic.