Office Six Calbro House Tuam Road Galway Tel: 091 756229 Web: WWW - Asthmacare.ie

Office Six
Calbro House
Tuam Road
Galway
Tel: 091 756229
Web: www.asthmacare.ie
“The Perfect man breathes as if he is not breathing”

Lao Tzu 500 BC
This training manual is provided with Asthma Care workshop and consultations. If you
need further help and tuition, please call us. This is our twelve month follow up support.
PLEASE NOTE
Do not alter any medication or treatment without prior consultation and

recommendation from a registered physician. This information should only be used in
conjunction with Asthma Care program as misinterpretation of information will
exacerbate condition.
DIABETICS -PLEASE NOTE

Reduction of breathing will result in a decrease of blood sugar level. All diabetics must
consult with their doctor or endocrinologist prior to undertaking any breathing
retraining. More frequent blood tests and symptoms of hyperglycaemia should be
conducted.
Copyright 2002 by Patrick McKeown

Do not reduce medication without approval from medical doctor www.asthmacare.ie
Table of contents
Asthma Care 1
Carbon Dioxide 2
Symptoms of hyperventilation 5
Why do we overbreathe 6
Breathing retraining 8
Using Buteyko Method to reverse hyperventilation 11
Breathing exercises 15
Exercise 1. Air shortage by relaxation 17
Exercise 2. Monitoring air flow 19
Exercise 3. Physical exercise and sports 20
Exercise 4. Breath holds 22
Exercise 5. For children and teenagers 22
Exercise 6. Overcoming an asthma attack 24
During sleep 26
Stop coughing attack 28
Blowing nose/ sneezing/ speaking 29
Breathing muscles 31
Abdominal breathing 33
Medication 35
Buteyko research results 38
Diet and asthma 40

Allergy 44

Do not reduce medication without approval from medical doctor www.asthmacare.ie
Asthma Care
It is unknown what causes asthma. Increased pollution, hygiene, PVC windows and
increased allergens are often quoted to be the probable causes. While numerous studies have
been undertaken to prove the link between these factors and asthma, there has been no
conclusive findings to date.
Professor Buteyko
In 1952, a Russian Physician Dr. Konstantin Buteyko discovered from his observations of
hundreds of sick patients that their breathing was very related to the extent of their illness. At
the time he suffered from malignant hypertension which is a fatal form of blood pressure. He
pondered that his deep breathing may be the cause of his illness. He put it to the test by
learning to breathe less and in a more shallower fashion. Soon his symptoms decreased and
disappeared. He tested his new knowledge on hundreds of patients including asthma sufferers
and found that they were over breathing. By teaching these people to breathe less, they too
were able to recover from their illness.
Buteyko breathing aims to reverse hyperventilation over the long term. It requires no
additional drugs and all patients must remain on their prescribed medication until authorised
by a medical doctor to change. The approach as taught by Asthma Care is according to the
original and correct Russian Buteyko Breathing Method. It does take longer to achieve
results with this approach than with the modified Westernised version of Buteyko. However,
results are permanent incorporating better breathing as a way of life.
Volume of Breathing
Normal breathing is breathing a volume of air between three to five litres per minute.
Breathing in excess of this volume is over breathing or “hidden hyperventilation” as termed
by Professor Buteyko. Hyperventilation means breathing too much air, hyper meaning too
much and ventilation meaning inhaled air. Hidden hyperventilation is often not obvious as
regular breathing may be interspersed with incorrect breathing, for example periodic sighing
or yawning. Scientific research conducted by Professor Buteyko over three decades and
scientific trials at the Mater Hospital in Brisbane 1995 demonstrated that people with
asthma breathe a volume of ten to twenty litres between attacks and over twenty litres
during an attack.
Volume of breathing is measured in litres. To understand this concept, picture a 2 litre bottle
of soft drink.
y Normal Breathing in a healthy person as advocated by the World Health Organisation and
medical doctrine is 3 to 5 litres per minute. This results in a healthy level of 5 to 6.5%
carbon dioxide in air sacs within lungs.
y Over Breathing is breathing a rate of 5 to 20 litres per minute. A person breathing this
volume of air may be functioning quite normal but their body is suffering from various
symptoms and illness will often develop over many years.
y Severe over breathing is breathing a volume of 20 to 30 litres per minute. This is

breathing at a maximum level as in an asthma attack, panic attack etc.
Do not reduce medication without approval from medical doctor www.asthmacare.ie 1
Carbon Dioxide
When human life first began, the level of carbon dioxide of the atmosphere was
approximately 20%. Over millions of years with an increasing amount of plant life, carbon
dioxide levels continued to reduce to the present day rate of .03%.
Carbon dioxide is not just a waste gas, the human body requires a concentration of carbon
dioxide which is substantially greater than what is contained in the atmosphere. One of the
functions of the alveoli which are air sacs within the lungs is to retain a concentration of
6.5% for normal bodily functioning. Interestingly, the womb contains a concentration of
approximately 7% carbon dioxide in order to sustain life.
1- nasal cavity
2 - pharynx (throat)
3 - alveoli (air sacs)
4 - bronchioles
5- lung
6 - diaphragm
7 - nostril
8 - larynx /voice box
9 - trachea
10 -bronchus
Fig 1-Organisation of the respiratory

system. The airways (trachea, bronchi, bronchioles and alveoli) supply oxygen to and remove part of carbon
dioxide from the body . Air enters through the nose or mouth, into the trachea, the bronchus, the bronchioles
and into the alveoli. The diaphragm (number 6) is the most important breathing muscle. It is a flat sheet of
muscle which separates the chest from the gut. We will look more at the diaphragm further on. Cilia which are
extremely fine hairs line the airway walls. By beating in an upwards motion they move mucus which traps
matter such as dust etc. upward to the pharynx where it is swallowed.
The volume of air that we breathe in, we breathe out. Inhaling a large volume of air results in
exhaling a large volume of air. Exhaling a large volume of air causes too much carbon
dioxide to be carried out from the alveoli within our lungs and into the atmosphere. This is
why the level of carbon dioxide in an over breathing person does not meet the required
amount of 6.5%.
Our respiratory centre which is located in our brain instructs us to breathe depending
primarily on our level of carbon dioxide, not oxygen. Breathing in excess of normal
requirements over a period of time (weeks, months, years) will result in the day to day levels
of carbon dioxide being low. Our respiratory centre becomes accustomed or fixed at this

lower level of carbon dioxide and determines it to be “correct”. Our respiratory centre will
therefore instruct us to overbreathe so as to maintain this low level of carbon dioxide even
though the remainder of our bodily organs and tissues are suffering. Habitual over breathing
occurs due to many factors of modern living and affluence. These include overeating,
oversleeping, processed food, eating too much protein (dairy and meat), the misconception
that deep breathing is big breathing, stress, increased temperature and other factors.
Professor Buteyko states that genetic predisposition determines who develops asthma and
who develops other diseases of civilisation such as high blood pressure, diabetes, Raynaud’s
syndrome and many others. Professor Buteyko believes that people with asthma have a
natural defence mechanism to prevent the further loss of carbon dioxide. When carbon
dioxide levels go too low, airways become narrow from inflammation, from constriction of
smooth muscle, and from increased mucus.
This “defence mechanism” reduces over breathing which helps increase the amount of carbon
dioxide retained in the body to more normal levels.
Professor Buteyko is of the belief that people with asthma are better off than the remainder of
the population who overbreathe, as they are equipped with an instant defence mechanism to
prevent the loss of carbon dioxide. (We shall discuss further on why carbon dioxide is so
important.) People who do not have this defence mechanism suffer from an accumulation of
disease such as diabetes, arthritis, hypertension, cardiovascular illness etc. It is worth noting
that prior to the 1900’s, people who had asthma often lived longer than the rest of the
population and that death from asthma was unknown.
Fig 2: Alveoli or air sacs are grape like

structures located at the end of respiratory
branches. They are hollow sacs where oxygen
passes through a very thin wall into the
network of blood capillaries to be carried to
organs and tissues. Carbon dioxide is carried
from organs and tissues to the alveoli where
part of it is expired. Note that the concentration
of carbon dioxide inside the alveoli should be
6.5%. The environment inside the air sacs is
moist and warm. It is important to breathe
through the nose so that the air we breathe in is
conditioned to meet this. There are a total of
300 million alveoli within our lungs.
Bad Breathing resulting from modern

living is the cause of breathing related diseases. Hyperventilation is not just a result of
asthma, hyperventilation is the cause of asthma.
"One needs to eat less, breathe less, sleep less and physically work harder to the sweat
of ones brow because this is good. This is a fundamental change, this is true
restructuring. This is what we need to do these days." Professor Konstantin Buteyko

Why Carbon Dioxide is necessary
As stated earlier, carbon dioxide is not just a waste gas but serves a number of very important
functions.
y Transportation of oxygen: Because oxygen by itself does not carry well in blood, 98% of
oxygen is carried by a Hemoglobin Molecule. The release of oxygen from Hemoglobin is
dependent on the quantity of Carbon Dioxide in our alveoli/arterial blood. If the level of
carbon dioxide is not at 6.5%, oxygen “sticks” to the hemoglobin and so it is not released
to organs especially the brain (which may receive 50% less oxygen) and tissues. This lack
of oxygen further stimulates breathing in an already overbreathing person and so
perpetuates the cycle.
y Blood is already 98% saturated with oxygen at breathing three to five litres of air per
minute. Additional breathing as in the case of a person with asthma does not lead to
greater amounts of oxygen being added to the blood. Instead due to above, we have less
oxygen reaching organs and tissues.
y Carbon Dioxide is a smooth muscle dilator of both bronchi and blood vessels. Lack of
carbon dioxide causes smooth muscle in blood vessels to constrict. This results in the
heart having to pump harder and faster resulting in increased beat and blood pressure.
Lack of carbon dioxide in bronchioles causes smooth muscle to constrict. People
genetically predisposed to develop asthma have narrowing of the airways.
y It is very important that our body stays within normal acid alkali (PH) balance. 1 to 7 is
the acid range of PH with 1 being more acid than 7. The alkaline range is 7 to 14 with 14
being more alkaline than 7. Neutral Ph is 7, being neither acid nor alkaline. The human
body requires a slightly alkaline PH of 7.4. Shifts from this will result in drastic
consequences. Taken from Guyton’s textbook of Medical Physiology, 8th Edition, page
331. “The lower limit at which a person can live more than a few hours is about 6.8 and
the upper limit approximately 8.0”. Carbon dioxide is acidic. When carbon dioxide leaves
the lungs the body becomes more alkaline leading to various metabolism imbalance
which changes immunity responses into allergic ones. Normal PH is very important for
proper bodily functioning.
y Professor Buteyko believes that inflammation and allergic hyper-responsiveness is caused

by an immune system which does not function correctly due to low carbon dioxide.
Pollen, dust mites, allergens, stress, and other asthma triggers are not the cause of asthma.
They are the trigger of an attack when our immune system is not functioning correctly. In
addition the production of cortisol which is our bodies natural steroid is impeded. It is
therefore necessary to supplement with synthetic steroid such as Becotide, Flixotide etc.
y When carbon dioxide is low, the production of mucus increases.
It is the combination of the above which gives rise to asthma symptoms of chest tightness,
coughing, excess mucus production, wheeze, shortness of breath, nasal problems, sleep
problems, lethargy. Buteyko cites asthma as the bodies defence to stop and reduce the
amount of carbon dioxide being lost. When carbon dioxide increases to normal, the defence
mechanism is no longer needed and airways dilate etc. resulting in no asthma symptoms.

Symptoms of hyperventilation
Hyper means too much

Ventilation means breathing
The following are the symptoms caused by hyperventilation. Hyperventilation “presents a

collection of bizarre and often apparently unrelated symptoms, which may affect any part of
the body, and any organ and any system”. Claude Lum
Respiratory System- symptoms of asthma
y Shortness of breath- you feel that you need to breathe out and at the same to breathe in.
This creates anxiety which will further increase our breathing.
y Excessive mucus- mucus is secreted by the goblet cells into the airways. Too much
mucus is secreted than what can be removed by the actions of cilia and immune cells.
y Long term blocked or runny nose- Our nose is part of the airways. Whatever is arising in
our nose also is arising in our lungs.
y Sneezing- the airways become extra sensitive and sense harmless particles to be invaders
which must be expelled.
y Coughing- Many asthmatics have a cough which is repetitive and difficult to control.
y Frequent yawning. When asthma symptoms are at their worst, sleep is interrupted with
asthma symptoms and difficult periods of breathing. The body and brain also are
experiencing a shortage of oxygen which contributes to tiredness. Overbreathing causes
sleep apnoea and snoring - both are common among people with asthma.
Symptoms may occur at any time depending on the individual, but are generally more
common after exercise and at night time or early morning.
Asthma attack is a vicious circle of hyperventilation, because as your airways narrow, spasm
and become blocked by mucus, you feel an increasing need to breathe deeply
Nervous System- Light-headed, poor concentration, numbness, sweating, dizziness, vertigo,

tingling of hands and feet, faintness, trembling.
Heart- Racing, pain in the chest region, skipped heart beats
Psychological- Degrees of anxiety, tension, depression, apprehension, stress
General- Mouth dryness, easily tired, bad dreams, nightmares, dry itchy skin, sweaty palms,
increased urination, diarrhoea, constipation, general weakness and chronic exhaustion
Why do we overbreathe?
It is important to realise that as babies we instictively knew how to breathe correctly using
the diaphragm and inhaling the correct volume of air. As we grew older, various influences
changed this correct breathing pattern to incorrect. It is helpful to know the factors which
caused this change.
1. Misconception of Deep Breathing

It is traditionally viewed that deep breathing is very beneficial for fitness and maintenance of
good health in the Western World. The most common instruction during exercise and while
stressed is "Take a deep breath". In the Eastern world, shallow breathing and control of
breath is very much enshrined in culture and philosophy. Deep breathing has been
misinterpreted in the Western world. The correct meaning of deep means breathing using the
diaphragm. This is the correct way to breathe. However, most people associate deep with big.
Tell people to take a deep breath and instead they will take a big breath often through their
mouth and using upper chest muscles. Big breathing is hyperventilating and causes a loss of
carbon dioxide.
Throughout this manual I refer to deep breathing meaning the way it is interpreted. Deep
meaning big breathing. Shallow breathing on the other hand means smaller breaths- breaths
of two seconds in, three seconds out. This would provide an average of twelve breaths per
minute which will give the correct volume and respiratory rate (amount of breaths) per
minute.
2. Stress
A stress is anything which causes a change to our internal system, something that keeps our
heart beat high or makes us tense. We have evolved over thousands of years and our
evolutionary traits have not kept apace with modern development. Our built in response to
stress is to physically fight it or run away from danger (e.g. wild animal). We have no inbuilt
mechanism for when we are confronted with traffic jams, financial pressures, business
pressure, and modern life in general. Instead of releasing our pent up frustration, we
voluntary cover up and hide our stress. We are sitting on the outside and running on the
inside. This can be very disruptive to our breathing resulting in hyperventilation and illness.
Often people develop late onset asthma after dealing with a stressful period in their life.
If you are faced with any stressful situation, monitor your breathing. Bring your attention
inside of your body and focus on your breathing as much as you can. This will greatly help
you to stay calm and to have a clear mind so that a solution may be found. Be careful not to
overbreathe as it will only increase stress levels.
3. Diet
Protein increases our breathing as our body must convert protein into amino acids before it is
absorbed and used. Dairy foods especially milk, beef, pork, chicken, lamb and other protein
foods when eaten regularly cause adverse asthma symptoms. It is beneficial to be observant
of your asthma following eating a meal especially one of high protein.
A diet of refined sugar, white bread, jams, coffee, confectionery, canned vegetables,
chocolate and other processed foods increases breathing as our bodies have to work harder to
expel toxins.

4. Temperature
Research has demonstrated that mild or cool environments assist in shallow breathing.
Having the bedroom window slightly open at night to allow circulation of air is helpful in
reducing over breathing.
Being in a hot, stuffy, unaired room will cause over breathing. Also, wearing too much
clothing will increase breathing as the body reverts back to panting to help regulate
temperature. (look at a dog pant in a hot room) This is especially applicable to children who
are often over clothed due to the good intentions of parents. Very cold weather also increases
breathing so it is important to wear headgear to reduce the possibility of attack.
5. Lack of physical exercise
Increasing affluence results in children spending more time indoors playing computer games
and watching television and less time outdoors. This results in less exercise. Regular exercise
for both children and adults increases the production of carbon dioxide from our metabolism.
Swimming is an excellent exercise for asthmatics as increased muscle movement combined

with restricted breathing greatly increases carbon dioxide levels within our alveoli. To be
healthy, it is necessary to exercise regularly and within our capabilities. Unfortunately in
Ireland, children are spending too much time indoors to their own detriment.
6. Over sleeping
Professor Buteyko's research demonstrates that lying down in a horizontal position for a long
time causes severe over breathing. Seven to eight hours sleep per night while breathing
through the nose is the correct way to sleep. As we fall asleep, breathing gets progressively
With sleeping on our back, there is no restriction to breathing and the lower jaw drops down
causing mouth breathing. This is a very bad position to sleep. The best position to reduce
breathing is to sleep on our left side in the fetal position or on our tummy. Night time is the
worst time for all asthmatics and most asthma attacks occur in the early morning between 3
am and 5 am. If you have symptoms going to bed, it is safer to remain awake or sleep in an
upright position.
7. Pollution
When air is not sufficient or is polluted, the body senses that we are not getting enough air
and therefore we breathe more to compensate. Pollution itself is not to blame for the rise of
asthma despite numerous studies and claims. Rates of asthma continue to be far less in very
polluted Asian cities such as Bangkok etc. The rate of asthma in former East Germany was
much lower than in West Germany prior to unification, despite the fact that pollution levels
were far higher in East Germany. Other countries such as New Zealand which have very low
pollution levels have the third highest incidence of asthma in the world. Ireland does not have
a pollution problem and yet our rate of asthma is the forth highest in the world.

Breathing Retraining
Patience, concentration and regular practice of breathing exercises are required to reverse a
lifetime of bad breathing and to condition your breathing to a more healthier level.
The three basic steps involved with breath retraining are;
a. Becoming more aware of bad breathing

b. Learning to breathe through your nose only
c. Using Buteyko method to reverse hyperventilation
y Become very aware of your breathing. Listen to and observe your breathing in different
situations and try to notice when you take deep breaths. This will be when you sigh,
yawn, before a cough, sneeze, under stress, after eating, in bed, when excited, talking,
laughing, walking, exercising and other activities. If you can hear yourself breathe or if
you can see the rise and fall of your chest while you are at rest, then you are over
breathing. Relax and reduce your breathing immediately. It helps to become aware of
your own bad breathing by listening to other people huffing and puffing in the shopping
mall, at the bus stop, at work etc.
y Learning to breathe through your nose. Breathing through your nose is the correct way
to breathe. Your nose, throat and sinus cavity are part of your airways. If you experience
a blockage in any of these areas, it is because your bodys defence mechanism has been
activated to stop the further loss of carbon dioxide. Your nose becomes blocked because
of over breathing. Initially when you first began to experience a slightly blocked nose,
you unconsciously switched from nose breathing to mouth breathing in order to take in
more air. This change to mouth breathing further increased the exhalation of carbon
dioxide resulting in your nose becoming fully blocked and your airways becoming
constricted etc. Learning to breathe through your nose is a very important step on the path
to correct breathing.
Fig 3: All exercises will have a diagram using the following format
Breathing through your nose serves a number of very important functions
The nose serves to condition cold dry outside air to a more acceptable condition before it is
brought to the lungs. Breathing through the mouth is not effective in conditioning inhaled air.
With breathing through the nose:
y Inhaled air is brought to the correct temperature before it enters the lungs
y Air is filtered which helps prevent pollen, dust, bacteria from entering our lungs
y Lungs require a warm moist environment. The nose humidifies inhaled air increasing
moisture content.
y Regulates volume. All mouth breathers overbreathe and thus suffer from symptoms of
hyperventilation. Our nose is a smaller channel to breathe through and therefore it helps
to reduce volume. (Please note it is possible to overbreathe through your nose but to a
lesser extent.)
At any time one nostril is on duty (open), one off duty (partially blocked).
Remember-
Breathe through your nose at all times
y When you are watching television or reading

y Doing a gentle exercise. Initially fitness levels will decrease but after a number of weeks
fitness levels will improve considerably
y Eating
y Speaking
y Sleeping
y AT ALL TIMES
Remember, never breathe through your mouth. Look at animals in the wild. Look at a lion,
Zebra, Polar bear, or any other wild animal, their natural instinct is to breathe only through
the nose. A domesticated dog or cat may breathe through their mouth as we have influenced
their breathing with incorrect diets etc. Humans are the only species who do not know how to
breathe correctly.
During the 19th century, it was observed that Indian mothers on reserves of North America
paid a lot of attention to their infants breathing. If at any time their baby opened their mouth
to breathe, mothers would gently press the lips together to ensure continued nasal breathing.
It was noted that the rate of sickness and illness among Indian people in comparison with
European settlers was very low.
How to unblock your nose;
y Sit down and adopt correct posture- back straight, bottom against back of chair.
y Normalise / calm your breathing. Take a small breath (two seconds) in through your nose
(if possible) and a small breath out (three seconds). If you are unable to take a breath in
through your nose, take a tiny breath in through the corner of your mouth.
y Pinch your nose and hold your breath
y Keep your mouth closed
y Gently move your head until you cannot hold your breath any longer
y When you need to breathe, breathe gently through your nose with your mouth closed.
Avoid taking a deep breath- calm your breathing as soon as possible. If you overbreathe or
take a deep breath, you will lose the additional carbon dioxide and your nose will become
blocked again. The aim is to trap in that additional carbon dioxide. After some time and with
regular practice of breathing exercises, your body will become accustomed to a higher level
of carbon dioxide and your nose will continue to remain unblocked.

y Continue to do this until you can breathe through your nose. This may take five or six
times. If you are having difficulty unblocking your nose while shaking your head, breathe
out as above and walk around while holding your breath.
y Your nose unblocks by doing this exercise due to carbon dioxide quickly increasing in
the blood.
y Even if you have a cold- make sure to breathe through your nose.
F
ig:4 Unblocking the nose. Breathe IN and OUT HOLD BREATH Small breath IN
Your nose is a very good indicator of your breathing rate

If your nose starts to block it means that you are beginning to hyperventilate.
If you are breathing too deeply through your nose it will become partially blocked. It will not
become fully blocked unless you switch to mouth breathing. There is a very logical reason
why this happens. As soon as our nose becomes partially blocked, the volume of air
inhaled/exhaled is decreased which causes the level of carbon dioxide to increase which will
dilate our nasal passages. If you continue to over breathe, your nose will become partially
blocked again which will again increase carbon dioxide which will open your nasal passages
and so on.
If you can hear yourself breathe through your nose (whistling) then you are breathing too
much. Breathing through the nose must be maintained especially at night. If your mouth is
dry and your nose is blocked upon awakening in the morning, then you are hyperventilating
during your sleep. Please refer to instructions for correct sleeping.
When you first switch from mouth to nasal breathing, it will feel a little strange as there will
be a slight air shortage. An air shortage is when your body feels the need to breathe
additional air. This is because by switching to nose breathing, the volume of air inhaled has
reduced. This is a good sign of progress and the feeling will reduce in a couple of days. Your
body may trick you into breathing more by yawning, sighing or the odd mouth breath. Try
not to increase your breathing at this point. When you feel the need to deep breathe for
example during a sigh, swallow immediately to suppress this feeling.
It takes just a few days for a habitual mouth breather to change breathing to permanent nose
breathing. Increased observation of breathing, reduced breathing and nose unblocking
exercises are important to make this change.

Nasal Inflammation and Congestion
If you have constant nasal congestion and inflammation, it is helpful to wash out your nose
daily with the following and practice breathing exercises to reduce nasal spray dependency.
Dissolve ½ teaspoon of sea salt and ½ teaspoon of bicarbonate (baking soda) in one pint of
boiled water and let it cool. A plastic syringe with a rubber bulb can be purchased from your
pharmacy. Fill the syringe and squeeze water into one nostril. Sniff water in until it reaches
the back of the throat. Spit and repeat with second nostril. This is a very effective natural
cleaning remedy.
Using Buteyko Method to reverse hyperventilation
In order to commence Buteyko Breathing Method, it is necessary to learn how to measure

your pulse and your control pause. Your control pause is your primary measurement tool and
a very important part of The Buteyko Method. It is an excellent measurement to monitor your
asthma condition and progress.
Pulse Rate
Everybody and especially people with asthma should be able to measure their pulse. The
pulse is to be taken before and after breathing exercise. When breathing exercises are
performed correctly with reduced volume of breathing, the pulse at the end of exercise will
be lower than at the start. Reduced breathing will relax smooth muscle of blood vessels
resulting in the heart having to pump less. The pulse rate varies throughout the day and
exercises, meals and other activity will influence it. The pulse is a good measure of the state
of your health.
Check for the pulse

The pulse is measured by counting the number of beats in one minute. When measuring
beats, make sure to measure your pulse and not count the number of seconds on your clock or
watch.
y The pulse can be found on the thumb side of the wrist. About one inch up from the wrist
crease and 1 cm inwards. Measure by placing two fingers of your free hand onto the
groove or channel in this area.
y If you have difficulty locating your pulse on your wrist then check for it at the carotid
artery in the neck. This is located at either side of the Adams apple.
Normal healthy individuals will have a pulse rate of between 60 and 80 beats per minute.
Very physically fit individuals will have a lower pulse rate then this. If your pulse rate is
consistently higher than 90 during substantial periods of rest, it is a sign that you are deficient
of steroids. If you observe an upward trend of the pulse over a number of hours while at rest,
it is a sign that your asthma is getting worse. Do your breathing exercises intensively to bring
down the pulse. If your pulse is moving towards 100 beats per minute while at rest then
consult your doctor.
Different foods especially chocolate or stimulants such as coffee dramatically increase the
pulse. If you have a food intolerance, your pulse may rise at least 10% following
consumption of that food especially when it is eaten on an empty stomach.
The Control Pause
The control pause and pulse are used together to monitor your asthma. The control pause is a
measure of the level of Carbon Dioxide in your alveoli. It is a very good indicator of your
progress and asthma condition. Because of this reason it is important to learn how to measure
it correctly. The control pause is not an exercise to increase the level of your carbon dioxide.
For this you need a stop watch or watch/clock with a second hand.
To measure control pause
1) Sit comfortably in an upright chair
2) Take a small breath in (2 seconds) and a small breath out (three seconds). Hold your nose
on the out breath (with empty lungs but not too empty). You must pinch your nose in order to
block the air flow.
3) Count how many seconds you can comfortably last before you need to breathe in again.
Hold your breath until you feel a slight desire to breathe in again.
4) Don't push yourself too hard. If you need to take a deep breath after measurement, you
have pushed yourself too hard.
5) Remember breathe out and then count seconds.
6) This is for measurement purposes only.

Common mistakes include:
y Holding the breath after an inhalation

y Trying to empty out the lungs completely, this will result in immediate discomfort
y Holding the breath for too long (note that this is not a measure of how long you can hold
your breath for, it is a measure of how many seconds you can hold your breath until your
first urges to breathe again.)
At the start, it is very likely that you will push yourself a little too hard. You will notice this
when you have to take a couple of breaths to regain your breath after counting the seconds. It
is important that you start your control pause from the same place as this will give
consistency of measurement. With practice, your control pause will become more consistent.
F
ig 5-control pause: normalise breathing, breathe in for two seconds, out for three seconds. Hold breath. Count
seconds until first urges to breathe in. Ensure that breathing is not deeper after completion

Control Pause Measures
The control pause as taken in the morning before breakfast gives the most accurate
measurement of your level of carbon dioxide. Do not eat for two hours before taking control
pause as eating will increase the pulse and reduce the control pause.
Most people with asthma will have a control pause of between ten and twenty seconds at the
start of learning Buteyko Breathing. This means that their respiratory centre instructs them to
breathe a volume of air for between five and six people.
If your control pause is less than ten seconds you have a

y Serious hyperventilation problem
y very severe asthma
12 to 13 seconds
y Breathing five times normal amount
y Chronic asthma
y Nocturnal asthma
Control pause of 20 seconds

y Breathing three times normal amount
y Main asthma symptoms will have disappeared
y Some nocturnal asthma
Control pause of thirty seconds

y Breathing 1 and half to two times normal amount
y May have symptoms after exposure to severe trigger
Control pause of 40 to 60 seconds

y Correct breathing. Your underlying asthma is being treated.
y Very rarely will have symptoms
Morning control pause of sixty seconds

y You have no health problems/ diseases of civilisation. For over forty years Professor
Buteyko and his associates were unable to find any person with a control pause of sixty
seconds who had a disease of civilisation.
You are hyperventilating if your pulse is climbing and control pause falling. If this is
happening relax and concentrate on reducing your breathing immediately.

Control Pause Table
This table was developed by Professor Buteyko after measuring thousands of persons breath
holding ability/control pause and matching this with their Carbon Dioxide levels. It is the
level of carbon dioxide that determines how long you can hold your breath for.
The figures are consistent and show the level of Carbon Dioxide based on the length of
control pause. A person with a low level of Carbon Dioxide is able to hold their breath for a
less amount of time than a person with a higher level.
CO2 in Control
alveoli % pause(sec)
Normal 6.5 60
Deep 1 6.0 50
2 5.5 40
3 5.0 30
4 4.5 20
5 4.0 10
6 3.5 5
7 Death
If your control pause is eight seconds, then you have a little less than 4% carbon dioxide in
your alveoli. If your control pause is 15 seconds, your carbon dioxide is between 4 and 4.5%.
Your aim is to increase this until your control pause is at least 40 seconds and your carbon
dioxide is 5.5%.
With continuous practice of exercises, your respiratory centre will become accustomed to a
higher concentration of carbon dioxide. You will remember that it is the level of carbon
dioxide which determines our need to breathe. A low control pause means our respiratory
centre has become fixed at a low level of carbon dioxide and therefore will instruct us to
breathe a large volume of air in order to maintain that level. When you commence breathing
exercises, you are breaking this pattern by deliberately reducing your volume of breathing.
Regular practice of exercises and increased observation of breathing will help your
respiratory centre to become fixed at a higher level of Carbon dioxide. Just as it took time for
your respiratory centre to become accustomed to a low level of carbon dioixide, it will also
take time for your respiratory centre to become accustomed to a new higher, more healthier
level.
It will take at least five weeks to reach a control pause of twenty seconds and six months in
order to reach a control pause of forty seconds.

Breathing Exercises
The purpose of all breathing exercises are to train your body to become accustomed to a
higher level of carbon dioxide. You will remember that our lungs require a concentration of
6.5% carbon dioxide. Most people with asthma have a concentration of between four and
four and a half percent.
Breathing exercises are a time which you set aside during the day to deliberately reduce your
breathing to trap in and retain a higher level of Carbon dioxide. Exercise blocks usually take
about half an hour and are practised before breakfast, during the day and at evening time.
Depending on severity, most people need to do at least two to three sets of a half an hour per
day. Exercises should be performed until reduced volume of breathing becomes your way of
life and until the control pause will reach at least forty. Reduced breathing has become your
way of life when you no longer consciously need to decrease your breathing. At this time, it
is an unconscious activity and is incorporated into every activity that you do.
Breathing exercises are very important in increasing the control pause to twenty seconds.
Physical activity is to be used in conjunction with breathing exercises to help increase control
pause from twenty to sixty seconds.
The purpose of exercises and increased observation of breathing is to substantially decrease

asthma attacks occurring in the future and to stop an attack upon first sign of symptoms such
as a blocked nose. Over the course of twelve months, the volume of breathing is brought to a
more normal leve
Fig 6: Breath retraining- reducing of volume of air to correct amount of three to five litres per minute. This is
corrected over a period of twelve months.
The first exercise involves relaxation of the respiratory muscles to create a little air shortage.
The second exercise adopts the same features of the first but introduces use of the finger to
monitor volume of air flow to and from the lungs. The third exercise teaches us the correct
way to breathe during exercise.
Remaining exercises are specific to different symptoms that people may have. For example
coughing, blowing nose and sneezing.
Exercises are to be done regularly and within ones capabilities. An important feature of all
exercises is to maintain an air shortage. An air shortage is when you feel the need to take a
bigger or extra breath but you do not. The rule to remember with all exercises is that if there
is no air shortage, then you are not doing the exercises properly. On the other hand, if you
feel too much of an air shortage or suffocation, this will be too stressful and difficult to
maintain so breathing will increase. To get the feeling of an air shortage. Breathe out and
pinch your nose. Hold your breath for a few seconds after you feel the urge to breathe in.
The following diagram illustrates a little air shortage.
Fig 7: Maintaining a little air shortage. Note that breath is not any deeper on completion of exercise than at the
start of exercise.
Exercise one and two are to be practiced half an hour two to three times per day combined
with relaxation and observation of breathing for the remainder of the day and night. Do not
mechanically reduce your breathing for the remaining day and night as this causes stress and
is too difficult to incorporate into your daily life. Relaxation with decreased breathing is good
and should be incorporated all the time. For the first couple of months, it is necessary to go to
a quiet place where you will have no distrations.
You will not make very much progress if all your exercises are practiced while reading a
book, watching TV or driving your car as your concentration will be divided between doing
the exercises and the other activity. This is why it is necessary to set the time aside to
practice while having no distractions, otherwise you may get poor results. After the first
months, it is possible to relax and maintain an air shortage while performing any other
activity.
How should I breathe?
The correct way is breathing through your nose at all times with small breaths (two seconds
in, two/three seconds out) while using the diaphragm.
The reason why we have asthma is due to big breathing. Big breathing is breathing a volume
of air greater than six litres per minute. This is also known as hyperventilation. Deep
breathing has been misinterpreted to be big breathing. Ask someone to take a deep breath and
Deep breathing in the correct meaning is breathing using the entire lungs, it is breathing
down into the tummy. We are not bringing the air into our tummy. Instead our tummy moves
out with each inhalation and moves in with each exhalation because the action of our
diaphragm.
Small breaths are also short breaths, breathing in for two seconds, out for three seconds. This
lenght of breath is correct, anything greater than this contributes to overbreathing. The first
intention of exercise is to learn how to breathe smaller breaths. The second part is to breathe
smaller breaths while using the diaphragm.
We know that we are not breathing correctly when

y we can hear our breathing and we can see a rise and fall of our chest with each breath.
y we can hear deep sighs regularly or we have sharp inhalations of air prior to talking.
We are breathing correctly when

y we cannot hear ourselves breathe and we cannot see the rise and fall of the chest
y we do not have sighs regularly and we do not have sharp inhalations of air prior to talking
y we will have some movement of our tummies with each breath but this will be very
slight.
How much progress can I expect?
Progress is dependent on the extent that you are able to reduce your breathing. The more you
can reduce your breathing and increase your control pause, the better your progress.
Generally, people make great progress over the first number of weeks. This is interspersed by
very good days and very bad days. Over time and with continuance of exercises, very good
days will increase in number and very bad days will decrease in number. Very bad days are
similar to your asthma before you commenced Asthma Care program. If you have a number
of bad days in a row, spend as much time as possible on reducing your breathing. Use the
small breath holding exercise (explained further) and perform this about 500 times per day.
At the start, a large amount of time needs to be invested, this pays off substantially as the
months go by.
After a number of months practise of exercises and with a control of pause of perhaps twenty
seconds, you my reach a plateau where there seems to be no improvement in your condition
and control pause regardless of the amount of time you spend at exercises. Continue to
practice your exercises. Sometimes the control pause can be quite stubborn.
If your control pause is very stubborn, reduce your consumption of food and start to perform
physical exercise. This will increase your control pause more quickly.
Reducing your breathing will lead to a reduction of asthma over time. The speed which this
occurs depends on your adherence to the lifestyle changes and attention to doing the
exercises. Dont’t be too concerned if you have reached a plateau, your progress will continue
to increase after you have passed this point.
Nearly all persons with asthma have a relapse of symptoms within the first six months. This
can be partly explained by a more relaxed attitude reulting in a decrease of attention to
breathing. When this occurs, recommence breathing exercises and become more attentive to
breathing. A second relapse is not common as most people will have instilled better breathing
from their first relapse.

Exercise 1 Air shortage by relaxing respiratory muscles
y Take comfortable correct posture. Become totally aware of breathing, feel the movement
of air in and out of your body. Feel the movement of air through your nostrils and to the
back of the throat. This has very therapuetic characteristics and is especially useful to
control your breathing during a stressful situation.
y The correct posture is very important to help reduce your breathing. Sit with back straight
with both feet on the ground. Imagine a thread suspended from the ceiling and attached to
the top of the back of your head holding you in an upright position. Observe that when
you sit with correct posture - your stomach will move more than your upper chest. The
stomach moves out with each inhalation (breathing in) and moves in with each exhalation
(breathing out) because of the action of the diaphragm which is our main breathing
muscle. When we need to breathe in, the diaphram moves slightly downwards (1cm to ten
cm) which causes the stomach to move out a little. It is a thin sheet of muscle located at
the base of our chest (thorax) and seperates the chest from the gut. It is shaped like the
dome of an umbrella. Breathing abdominally using the diaphragm is very important in
reducing hyperventilation and is the most energy efficient way to breathe. We will
discuss further how to change breathing from upper chest to using the diaphragm.
y When we sit slouched, our breathing increases and we tend to breathe more upper chest.
If shoulders are hunched up, we increase the volume of the thorax which will increase our
volume of breathing. It is very important to relax your mind first by focusing on your
breathing, then relax your shoulders by letting them fall to their natural position. Focus
on complete relaxation of your body and especially the respiratory muscles which include
the chest and stomach. Breathing will automatically decrease. To understand relaxation,
clench your fist slowly for five seconds and then relax. Feel the difference between
tension and relaxation. To understand tension and relaxation of respiratory muscle tighten
the muscles of the upper chest area slowly for ten seconds. Feel the tension of this, then
relax fully. Secondly draw in stomach for ten seconds. Feel the tension of this, then relax
fully. Feel this relaxation. When your respiratory muscles are relaxed, breathing will
decrease automatically. Focus on relaxation of the out breath. When you breathe in, relax
all muscles and let the air exhale naturally and without effort. Let the air “fall out of your
body effortlessly”. The elastic recoil of the diaphragm, lungs and lower chest wall will
result in a very natural and unforced exhalation. This is a very good exercise to do when
air becomes trapped in the lungs.
y To assist with relaxation, place your two hands on your lap with palms facing upwards.
Position your head looking directly in front of you. Do not have your head facing up or
facing down as this increases breathing. Close your eyes and let your eyes roll up into the
top of your head. Your eyelids may flicker as a result which will indicate that you are
doing this correctly. Have jaw relaxed and lips lightly together. Have your tongue lightly
touching the roof of your mouth and the back of your top row of teeth.
y When you reach a depth of relaxation your breathing will decrease automatically. You
will then feel a slight air shortage and this is good. Maintain this feeling of a little air
shortage. An air shortage is when you feel the need to breathe a little more but you don’t.
(To understand what an air shortage is- hold your breath for a number of seconds, this
need for air is an air shortage). A little air shortage is an air shortage within comfortable

levels which can be sustained over the long term. If you normally breathe a volume of
fifteen litres of air per minute, then a little air shortage would be breathing a volume of
thirteen litres of air. If you normally breathe a volume of ten litres of air per minute, then
a litle air shortage would be breathing a volume of eight litres of air.
y It is the depth of breathing which you are aiming to reduce. Depth of breathing in this
situation refers to the lenght of time of each breath. If it is a long breath then it is a deep
breath, if is a short breath then it is shallow breathing. Shallow breathing is the opposite
to deep breathing. Shallow breathing is small breaths. Deep breathing is big breaths.
Shallow breathing using the diaphragm is the correct way to breathe. Shallow breathing is
short breaths. Breathe in for two seconds and out for three. Do not be particularly
concerned with your respiratory rate (how many breaths per minute) This will increase
when the lenght of your breath becomes shorter and that is okay. Your aim is to reduce
the volume of air inhaled by doing shallow breathing or small breathing. You know if you
are breathing small and using the diaphragm correctly by the movements of your chest
and tummy. There should be no movement from your chest and a little movement from
your tummy.
y Adapt this at all times- when eating, speaking, in emergency crisis. Your breathing is
more important than anything else. So pay attention to your breathing at regular intervals
throughout the day. Over time, this becomes an unconcious activity and is then something
that you automatically do. If you don’t adopt this and continue to overbreathe, you will
continue to have unnecessary symptoms which will cause poor quality of life.
Recap of exercise one
Set time aside

Adopt correct posture- back straight
Tense respiratory muscles and relax
Place hands on lap facing upwards
Close eyes and roll eyes to top of head
Maintain a little air shortage with relaxation
Adapt this as a way of life (relaxation and resulting air shortage)

Exercise 2
y This exercise is an extension to the first exercise and is suited to children or people who
cannot create an air shortage from relaxation alone. This exercise is also to be performed
as part of special exercise practice time that is set aside. It is useful in monitoring the
exact amount of air you are breathing over a number of minutes.
y Perform all the steps of the first exercise. Instead of closing the eyes with palms on lap
facing upwards, concentrate on reducing the amount of air being inhaled onto your finger.
Place your finger above your mouth and below your nose. Feel the warm air being
exhaled onto your finger. The greater the amount of warm air you feel, the greater your
breathing is. Over the course of three to five minutes concentrate on reducing the amount
of warm air that you feel on your finger. Create a little air shortage through relaxation and
ensure that you do have an air shortage by monitoring air flow with your finger.
y When you reduce the depth of your breathing (the length of each breath), your breathing
rate may increase (number of breaths per minute). This is normal. Do not be concerned
with the number of breaths per minute. Your task is to reduce the depth of breathing
which will reduce volume of breathing. The in breath should be no greater than three
seconds and the out breath no greater than four seconds. Anything greater than this is
deep breathing. Little breaths or short breaths result in a reduction of the amount of air
reaching your lungs. This is due to dead space- part of our airways will always contain a
proportion (150 ml) of air which never reaches our lungs.
y The purpose of formal breathing exercise sessions are to help you adopt into your every
day living a smaller volume of air. You know that we are over breathing if we can hear
ourselves breathe, can see a noticeable rise and fall of the chest and tummy or can feel a
large amount of air on our finger. This rule is applied both during exercise and in every
day activity.
y The aim of this exercise is to have very little air blowing onto your finger.
Recap of exercise two
Set time aside

Relax respiratory muscles
Place finger under nose
Concentrate on reducing air flow onto finger
Small breaths
Observe breathing throughout the day
With breathing exercises as above, you will experience mucus travelling from the lower
airways to the throat where it can be swallowed to dissolve in the acid of your stomach. This
is a direct result of decrease of breathing and happens very shortly after exercise sessions.
This is a cleansing reaction and is a good sign that you are doing exercises correctly.

Exercise 3
It is well known that exercise within ones own capabilities is very essential for all asthmatics.
The more physically fit a person is, the more they will be able to cope with additional
demands such as running for a bus etc. All people with asthma who exercise regularly report
a significant improvement in symptoms as a result of exercise. Exercise does not mean
pushing oneself to the limit, instead it should be done at a comfortable level.
Exercise is very necessary to help increase the control pause from twenty to sixty seconds.
This is very important to remember as it is very difficult to increase the control pause above
twenty without physical activity.
People who adopt an exercise routine which is too difficult often give up completely a
number of weeks later as they are unable to sustain it. The best way to exercise is to do a
little amount of exercise each time but to do it regularly. This should be done according to
our own capabilities which will make it more enjoyable and sustainable into the long term.
With exercises, it is very important to have a control pause of at least twenty seconds. If
control pause is not twenty, then any exercise that is undertaken must be very gentle and non
competitive. Walking while breathing through the nose would be best. When the control
pause is less than twenty seconds, it is more difficult to control breathing as the level of
carbon dioxide is low.
80% of all asthmatics have exercise induced asthma. Exercised induced asthma occurs
shortly after commencing exercise or shortly after completion. When you commence
exercise, your breathing rate increases in anticipation of additional physical activity.
However, your muscles have not yet begun to produce additional carbon dioxide to counter
balance this increase in breathing. The increase of your breathing without a coresponding
increase in carbon dioxide production causes a loss of carbon dioxide which results in an
attack. To avoid an asthma attack shortly after commencing exercise, warm up very gradually
for about fifteen minutes. Gradual warm up results in the metabolism producing extra carbon
dioxide while at the same time we can maintain good control of breathing. Observe breathing
during warm up and maintain a little air shortage which will trap in some carbon dioxide.
Controlling breathing during the early stages of exercise will greatly reduce the possibility of
attack.
After completing exercises, the production of carbon dioxide has decreased to a very low
level but breathing may have remained the same as during exercise. This would result in the
loss of carbon dioxide which will cause an attack. It is very important to normalise breathing
immediately after completing exercise. Calm breathing with relaxation and make a conscious
effort to reduce panting. Suppress your breathing quickly. Make sure not to blow off all that
carbon dioxide through over breathing.
Exercise is very beneficial for people with asthma. Maintaing a little air shortage during
exercise will result in an improved control pause. When exercising breathe a little less air
than what you need to breathe. If for example you were playing a game of hurling, then do a
gentle and gradual warm up first. While waiting for play during the match, breathe very little.
When you need to run for the ball- do whatever you need to do. After you have passed the

ball, calm your breathing immediately. Calming of the breath can also be done with several
small breath holds of a few seconds each. Ensure that you do not breathe deeply during the
game and observe your breathing as much as possible.
Walking half an hour per day is the best exercise for people who do not regularly exercise.
While walking, reduce breathing. If at any time you feel the need to deep breathe while
walking or doing any exercise, then slow down and relax. The most important aspect is never
to breathe through the mouth. Instead stop, calm your breathing. Then when you feel ready to
walk again, you can start walking. If you have severe asthma and at a maximum can walk
twenty steps, then only walk fifteen steps and stop. Reduce your breathing. Never push
yourself beyond the point where you cannot regain control of your breathing. To do this
would be counter productive and dangerous.
Other important rules to follow regarding exercise:
Measure your control pause before you commence exercise. Then measure your control
pause after you have completed exercise and your breathing has calmed down. (for example
fifteen minutes later) Your control pause after exercise must be greater than it was before. If
it is not, then you are deep breathing during your exercise and so it is important to make sure
that you correct your breathing during future activity.
Try to breathe through your nose at all times. Initially your fitness level will be below your
normal level when you start breathing through your nose. However, top athletes have shown
that within eight weeks, fitness levels will improve substantially by maintaining nasal
breathing. Nasal breathing serves greatly to reduce exercise induced asthma.
It may be better not to become involved with competitive sports until you have mastered the
breathing exercises correctly and can breathe through your nose at greater levels of exercise.
Do not take your reliever medication prior to exercise solely out of habit. A tolerance builds
to the reliever medication resulting in more and more puffs needed over time to reduce
symptoms. Instead only take the reliever medication if you need it. Never take it if you do not
need it.
Exercise is very important to aid in the recovery of your breathing with Asthma Care. It is
important to perform exercise in order to increase the control pause from 20 to the desired
sixty seconds.
Buteyko Technique has been used very sucessfully with Leicester Rugby Team, Australian
Be careful doing exercise if your control pause is less than twenty seconds
Exercise is very important to increase control pause above twenty seconds
Do exercise regularly and within your capabilities
Warm up very gradually and take control of breathing
Warm down gradually and take control of breathing
Walking or lifting light dumbbells/weights is excellent
Reduce your breathing throughout exercise
Measure control pause before and after, control pause should be greater after exercise
Do not spend fourteen hours of your day sitting down like a lot of unhealthy people
Never mouth breathe, instead stop and relax, regain breathing and then start gently

Exercise 4 Breath Holds
The main focus is to reduce your breathing which will increase your level of carbon dioxide
to more normal levels. If for any reason you are unable to formally practice the exercises,
then do many breath holds at regular intervals during the day. This is not near as effective as
doing shallow breathing with relaxation of the respiratory muscles but will help to conserve
carbon dioxide and thus reduce symptoms. If doing this without other breathing exercises, it
is necessary to perform from 100 to 500 breath holds per day to receive benefits. As with
other exercises, breathe in (two seconds), breathe out (three seconds) then hold breath for
four to five seconds, then breathe in and maintain a little air shortage. Continue to breathe for
as long as you can with an air shortage.
Fig 8: small breath holds of four to five seconds each
Exercise 5 Especially for children and teenagers -mouse breathing and steps
Children sometimes find it difficult to understand the relationship between their depth of
breathing and asthma, so a slightly different approach is used. These two exercises are to be
performed alongside other recommendations of Asthma Care program.
Because children usually are not able to create an air shortage with exercise 1 as they have
more difficulty deeply relaxing, it is better for them to practice exercise 2 and to do “steps” to
increase carbon dioxide levels. Exercise 2 is called “mouse breathing” for children and is
breathing as little as possible by placing the finger under the nose. Mouse breathing is
breathing like a little mouse, making no sound from breathing and having very little
movement from chest and tummy. It is the way a mouse would breathe if it were trying to
hide from a big cat who is listening for the mouse. If the cat hears the mouse breathing, the
cat will eat the mouse.
The second exercise which children make great progress with is called steps. Steps is also
helpful as a measurement of progress if the child has difficulty in applying the control pause
correctly. Steps is combining muscle activity which will increase carbon dioxide, with
holding of the breath which will trap in carbon dioxide.
With steps, the child breathes in for two seconds, breathes out for three seconds and pinches
their nose. They walk as many steps as they can until they need to breathe in again. When
they breathe in, it must be only through their nose and their breathing must be calmed
immediately. Usually the first breath after completing steps will be bigger than normal. Make
sure your child reduces or suppresses the second and third breaths. They should breathe like a
little mouse when they stop their steps so that the big cat cannot hear them. Steps are
performed usually in sets of four and should be done three times per day. Count aloud each
step and record so that progress can be monitored. Compare each days steps with past days so
that progress can be evaluated. This can be used as a measurement tool if the child is unable

to do the control pause correctly. Encourage your child to increase their steps over time. The
goal is for children to be able to walk 100 steps without having to take a breath. Steps should
be done only walking and not running, however fast walking is fine.
While breathing throughout the day, be observant of your childs breathing. If at any time you
can hear your child breathing or see them breathing through their mouth, then remind them to
breathe very gently through their nose. Ensure that your child does not let any air sneak in
through their mouth. Blame the air for “sneaking” into the childs mouth rather than blaming
the child.
Children will always folllow what their parents do, even with breathing. If father is walking
around the hosue with his mouth open puffing and panting and being unobservant of his
breathing then the child will do likewise. Oftentimes, it is the behaviour of the parents which
will slow down the progress of children. Correct breathing is a family affair and it is very
beneficial for all family members even if they do not have asthma.
Sometimes children may be able to start an asthma attack in order to get attention from their
parents. They unconsciously know that their tantrum or anger (causes deep breathing) will
lead to an attack. In this situation, an asthma attack is still serious regardless of how it started.
On the first signs of an attack (blocked nose, shortness of breath) have your child breathe like
a little mouse and to perform steps. The amount of steps should not be pushed too much (five
steps maximum) as a deep breath at the end will be bad for the attack. If the attack is not
under control within a few minutes, then take whatever medication is prescribed. If reliever
medication is not working correctly within five to ten minutes then seek medical attention
immediately.
Fig 9: steps- Note that deep breath on completion is calmed immediately
Recap on Exercise for children
Relaxation with correct posture (exercise two)

Place finger under nose
Breathe very silently like a little mouse
Do sets of three minutes according to record chart
Be observant of childs breathing all day
Ensure they do not breathe through their mouth
With steps - Count aloud and record steps

Goal is to reach 100
Breathe out and then do steps
Calm breathing immediately

Exercise 6 Overcoming an asthma attack
Generally an asthma attack which is a period of breathing difficulty does not occur without
advanced noticed. In most situations, the person will feel increasing tightness of the airways,
increased blocked nose, starting to wheeze etc. When one feels the first symptoms of an
attack, it is very helpful to do the following exercises. After the first minutes of an asthma
attack, it is very difficult to maintain control of breathing using exercises and medication or
medical attention is needed.
Do many small breath holds of 2-5 seconds each. Do not try to hold your breath for longer
than a couple of seconds because it would only increase breathing which will increase your
attack. After each breath hold, reduce breathing for a few minutes. Then do small breath
hold, then reduce breathing etc.
Reduce your breathing when you first observe oncoming symptoms. If you are observant
enough, your reduced breathing may be enough to increase the level of carbon dioxide and
your attack will pass. Do not have too much of an air shortage as this will cause a
pronounced increase of your breathing after you stop doing the exercises.
For most attacks there is a greater difficulty in breathing out than breathing in. Oftentimes,
one needs to breathe out while at the same time there is a need to breathe in. To help exhale
air which may otherwise become trapped in the air sacs, the following is an effective exercise
to practise.
y Breathe in gently and hold your breath for a half a second

y Concentrate on immediate relaxation of the chest, shoulders, stomach.
y Breathe out effortlessly. Do not force in any way. The elastic tendency of the diaphragm,
lungs and ribs will cause a movement of each back to their resting position which will
result in the exhalation of air.
y Breathe in as normal
y This is helpful to normalise breathing all the time
y Do this several times over the course of ten minutes or until attack has passed
Fig 10: Small Breath holding during an attack, note difficulty of controlling breathing during an attack,
Important to become very relaxed and gently reduce breathing
Often times people realise the benefits from Buteyko Breathing when they use shallow
breathing and relaxation to reduce their oncoming symptoms and attack. This is direct
evidence of the benefits which will further motivate people to increase their control pause
and thereby reduce the occurrence of attack in the future.

VERY IMPORTANT- TAKE MEDICATION
Breathing exercises will only alleviate asthma when applied during the early stages of
attack/wheezing. If an asthma attack has been occurring for more than five minutes- it
will be a lot more difficult to control using breathing exercises especially if your normal
CP is less than twenty. AFTER FIVE MINUTES OF AN ATTACK TAKE YOUR
MEDICATION (IF YOU ARE HAVING A SEVERE ATTACK- TAKE
MEDICATION IMMEDIATELY). IF YOU ARE NOT RESPONDING TO
MEDICATION WITHIN TEN MINUTES, SEEK MEDICAL ATTENTION
IMMEDIATELY.
VERY IMPORTANT- ASTHMA CARE TECHNIQUES ARE TO BE USED IN

CONJUNCTION WITH NORMAL DAY TO DAY TREATMENT. MAKE SURE TO
CONTINUE PREVENTATIVE MEDICATION, TAKE RELIEVERS WHEN
NECESSARY.
Recap on Exercise during attack
During early stages- first five minutes

Hold breath for two to three seconds each time
Do several breath holds until attack has passed
Breathe in for half a second

Relax chest and tummy
Let air flow out naturally
Do not mechanically exhale
Do this several times over the first ten minutes

During Sleep
Sleep is the most difficult time for asthmatics as risk of attack is greatest. Professor Buteyko
believes that the natural position for humans is in an upright position. When we lie down, our
breathing increases automatically. This increase in breathing to an already over breathing
person will lead to a removal of carbon dioxide which will cause an attack. Most attacks
occur between the hours of three and five am. Incidentally four pm in the evening is the best
time on average for asthmatics. For this reason over sleeping is not good. At most, people
should sleep from seven to eight hours per night and no more. Correct breathing will increase
your energy level and reduce fatique so additional sleep will not be necessary.
The difficulty with being asleep is that we have very little control of our breathing during the
depths of sleep. Correctly practicing breathing exercises and reducing breathing during the
day will help reduce overbreathing at night. In addition, there are a number of measures to
take which are necessary to reduce the risk from over breathing at night.
Firstly, be aware of your asthma symptoms prior to going to bed. If you are wheezy or have
noticeable symptoms before going to bed, then you will wake up during the middle of the
night with an attack. If you have symptoms, it is better to remain awake or to sleep sitting
upright. Ensure that you take your steroid medication prior to sleeping. Always do your
breathing exercises to reduce your symptoms before going to bed.
Secondly, sleeping on the back is the worst position to sleep as the lower jaw drops down to
cause mouth breathing. While sleeping on the back, there is very little restriction to
breathing and so we will breathe more deeply. Note that snoring which is also caused by
overbreathing is worse while sleeping on the back. Oftentimes when a person is switched to
sleeping on their side their snoring will cease. When you sleep on your tummy, the weight of
your body on your chest and tummy will restrict over breathing. Professor Buteyko found
after years of research that people who sleep on their left side in the fetal position breathe
less deeply. The reason for this is unclear but it may be because the heart is postitioned more
to the left side. It is also best to sleep on a hard mattress which restricts frontal movement of
the body from breathing and which is also good for sleeping posture.
It is most important to breathe only through the nose while sleeping. Mouth breathing will
cause a disruptive sleep resulting in waking up in the middle of the night with an attack or
feeling very tired and drained in the morning.
To measure whether you are over breathing during the middle of the night measure your
control pause before you go to bed and then firstly when you awake in the morning. If your
control pause is less upon wakening than before you went to bed it means you have been
deep breathing during your sleep.
In order to prevent deep breathing which may cause an attack during sleep, there are a
number of recomendations. At the Buteyko centre of Moscow, Luidmilla Buteyko advocates
sleeping in an upright position and setting an alarm clock to wake every two hours especially
if symptoms are not good. Waking every couple of hours will prevent falling into a deep
sleep with uncontrollable breathing. Upon waking every two hours, measure your control
pause and do shallow breathing exercises. Only fall back to sleep when your breathing is
more under control.

The second alternative is to have someone watch over you as you sleep for the first couple of
nights and until you become more used to breathing through your nose. The role of this
person is to gently close your mouth when you begin to mouth breathe or to wake you if your
breathing becomes too deep. This may not be very practical and so there is a third alternative.
Although this next option on first hearing it will sound unnatural and strange, It is very
effective for maintaining nose breathing during sleep. I have been using this method on an off
for a number of years now and find it very beneficial if I am having difficulty breathing
through my nose at night. This involves placing a paper tape over the mouth in order to
prevent breathing through the mouth. The best tape to use is one inch 3M micropore tape
placed in a horizontal position covering the mouth. Before placing, remove as much of the
glue on the reverse of the tape by sticking the tape to your hand and pealing it off a number
of times. Do this until there is just enough glue to keep the tape in place. Before placing the
tape on your mouth, make two tabs by folding part of the tape at either end. This will make
pealing the tape off in the morning easier.
Make sure your mouth is completely closed before placing the tape. If your mouth is partially
open, then you will be able to breathe through the tape during the night.
If your nose is partially blocked before going to bed, then first clear your nose doing the nose
unblocking exercise. While wearing the tape, your nose will never completely block. The
reason for this is due to the role of carbon dioxide in dilating the nasal passages. If you are
breathing deeply during the night while wearing the tape, then your nose will partially block.
This is the bodies defence mechanism to prevent over breathing. When the nose becomes
partially blocked, the level of carbon dioxide in the body will increase which will unblock the
nose. If you continue to overbreathe, your nose will become partially blocked again which
will increase the level of carbon dioixde thus causing the nose to unblock and so on.
Remember, your nose only completely blocks when you switch to mouth breathing.
The tape is not to be used on a child less than five years old, the child must be able to remove
the tape during the night if they feel they need to. If during the night you are having difficulty
breathing while using the tape, then do shallow breathing exercises. Try not to remove the
tape as you will begin to mouth breathe during your sleep which will only make your
symptoms worse. In order to reduce a possible panic feeling which some people may have, it
is beneficial to put the tape on half an hour before going to bed. This is enough time to
become used to the tape.
The tape is an option only, which has been used by thousands of people in Australia, New
Zealand and the UK. If you feel that the tape is not for you, then here is another alternative to
try and prevent mouth breathing during the night. This involves wrapping a scarf from the
top of the head and then bringing it around and under the chin. The purpose of the scarf is to
hold the mouth closed to prevent mouth breathing. Tie it to ensure that the lower jaw is
unable to drop down during the night.
You will know whether you mouth breathe if you wake up during the night breathing through
your mouth or if your mouth is dry in the morning. Your mouth should be wet when you
wake up in the morning. If you have a tendency to mouth breath during the night, it is
important to consider the above to prevent over breathing. Not only will you get a better
nights sleep and feel more refreshed in the morning, your asthma will also improve

substantially as well. All people who mouth breathe have a higher level of gum disease and
teeth cavity.
The final recommendation is not to eat for a number of hours before going to bed. Eating a
meal or drinking a protein drink such as milk or hot choclate etc will result in increasing
breathing. You will then have the double factor of increased breathing due to lying in a
horizontal position and the increased breathing due to eating or drinking. It would be a
guarantee of a poor nights sleep.
Exercise to stop Coughing attack
Coughing is one of the symptoms of asthma and some people are more prone to bouts of
coughing than others. The problem is not with a once off cough, but an episode of coughs
which are difficult to stop. Coughing attacks can occur at any time but tend to be more
frequent at night time or early morning. It is important to reduce coughing as frequent
coughing puts an overstrain on the heart.
Coughing is a reflex used to move mucus or other substance from the airways. Excess mucus
is caused by overbreathing which will trigger the cough. Before the cough, the person takes a
deep breath and coughs resulting in a forced expiration. This forced expiration causes a loss
of carbon dioxide which will create more mucus. This additional mucus will result in another
cough. Now the cycle is in progress. The person will take another deep breath and will cough
with a forced expiration. This loss of carbon dioxide from the forced expiration will create
more mucus which will cause another cough and so on.
The main point of this exercises is to break the coughing attack or cycle by doing the
following.
y Try not to cough at all. Try to suppress your cough. This will feel ticklish but after a
while the urge will reduce. Swallowing will help reduce this feeling.
y Do not force mucus. Mucus is the bodys defence against a loss of carbon dioxide. Forcing
mucus to come up without addressing breathing will lead to the creation of more
mucus. Instead reduce your breathing and the mucus will come up naturally. It can
then be swallowed to dissolve harmlessly in the acid of the stomach.
y Cough only through your nose. Note that it is the forced expiration of air out through the
mouth that perpetuates the coughing cycle. Coughing through the nose reduces the
volume of air expired thus leading to a substantial reduction in the amount of carbon
dioxide lost.
y After coughing do a 1 to 3 second breath hold so that carbon dioxide levels can be
slightly replenished. 1 to 3 second breath hold is very comfortable and so will not
disrupt breathing patterns.
y Try to relax all muscles and perform breathing exercises as outlined above.
The main point to remember with coughing is that the deep breathing and forced exhalation
will only perpetuate the cycle. Being conscious of this will reduce the attack.

Blowing Nose
Oftentimes children may have a slight cold which will contribute to their asthma symptoms.
They will use a hankerchief very often to blow and clean their runny nose. Every time we
blow our nose, we lose carbon dioxide. Too much blowing of nose will result in too much a
loss of carbon dioxide. This will lead to an increase in the production of mucus. The child
will then blow their nose to clear mucus. Blowing of nose will result in a further loss of
carbon dioxide which will create more mucus. Like coughing the blowing of the nose can
cause a vicious cycle of mucus and nose clearing.
Follow the same rules with regard to coughing.
y Try not to blow nose and do so only when necessary

y Blow nose gently. Blowing of the nose forcibly will result in a greater loss of carbon
dixoide and can result in sinus and ear problems.
y After blowing nose do 3 second control pause
y Reduce breathing. For a child- do sets of steps
Sneezing
Like coughing and blowing of the nose, the same rules apply to sneezing.
y Try not to sneeze and do so only when necessary. Place your finger under your nose
when you feel the urge. Oftentimes this will be enough to prevent the oncoming sneeze.
y Sneeze gently if you can. Sneezing forcibly will result in a greater loss of carbon dixoide
and can result in sinus and ear problems.
y After sneezing do 3 second control pause
Speaking
Speaking for long period of time leads to asthma symptoms. Research has indicated that
talking for a period of time leads to a substantial reduction of carbon dioxide. People working
in professions where talking is necessary need to pay particular attention to the link between
talking and carbon dioxide loss. The following points are important to pay attention to when
talking.
y Do not breathe in through your mouth prior to talking. Initially this will be a little
difficult
as it is necessary to pay attention to what you are going to say while also observing your
breathing. However, it is very important to reduce your mouth breathing and so the effort will
be worthwhile. Practice talking in front of a mirror saying the alphabet etc.
y Shorten your sentences. Long winded sentences result in a large exhalation of carbon
Dioxide. Instead shorten your sentences and put mental pauses mid sentence
y Take small breaths through the nose mid sentence.

y Listen to other peoples bad breathing. Listen to other people on the phone and taking
huge
sharp inhalations prior to talking. This alone can be enough to maintain a low carbon
dioxide.
Fig 11: Holding of the breath and reduced breathing after coughing, sneezing and blowing nose. Note the large
exhalations which cause a loss of carbon dioxide. Breath holding and shallow breathing reverses this.
Breathing Exercises
Some medical persons involved with helping people with asthma will recommend breathing
exercises such as blowing air as hard as you can through a straw to move marbles or blowing
up balloons etc. Other exercises involve taking very deep breaths in through the nose and out
through the mouth. Please do not follow this advice.
If we forcibly blow all our air out in an exhalation, we take a deep inhalation of air prior to
doing exercise or after we have completed it. Blowing air may be from doing breathing
exercises, speaking, coughing, blowing nose, cooling down our food prior to eating or any
other reason. We know that blowing air from the body causes too much carbon dioxide to be
carried out with each breath. This loss of carbon dioxide will cause spasm of smooth muscle,
increased mucus and eventual asthma attack.
Physiotherapists have been trained to help people forcibly remove mucus with coughing
exercises or tapping of the back etc. Gentle tapping with reduced breathing would be okay.
However coughing exercises will only make asthma worse. Please note that the placebo
group in the trials at The Mater Hospital in Brisbane were taught by traditional
physiotherapy. They showed no improvement while the Buteyko group showed very
significant progress.
To help remove mucus, do not do any coughing or blowing exercises. Mucus is the bodies
defence to prevent the further loss of carbon dioxide. By forcibly removing the mucus, we
increase our breathing which increases the loss of carbon dioxide which will create more
mucus. Instead perform shallow breathing exercises as above and drink a glass of warm
water with a half teaspoon of sea salt dissolved in it. The mucus will then loosen up and will
be brushed upwards to the pharnx by cilia which are fine hairs lining our airways. The mucus
can then be harmlessly swallowed. By reducing our breathing, the body has no need to create
additional mucus as part of its defence mechanism. Mucus already created will be removed
naturally.

Breathing Muscles
The diaphragm, intercostal and accessory are the three main groups of muscles used for
breathing. Diaphragm breathing is the most effective in reducing hyperventilation. The
diaphragm is a strong, thin, flat sheet of muscle which separates the chest from the gut. It is
tailor made and shaped like the dome of an umbrella. When breathing in, the Medulla
Oblongata located in the brain sends a message to the diaphragm which then flattens down
creating a negative pressure in the thorax. This causes the lungs to draw in air to equalise this
negative pressure. The downward movement of the diaphragm on the abdominal contents
causes the stomach to expand a little as we breathe in.
To find out if you are breathing with your diaphragm. Hold one hand across your breastbone
and the other hand on your tummy. At rest there should be no upper chest movement and
only very small movement of the tummy. The tummy will expand as you breathe in and
contract as you breathe out.
If you breathe primarily with your upper chest, then it is necessary to practice breathing
abdominal.
Fig 12: This bell jar experiment illustrates the central role which the diaphragm performs during breathing. To
breathe in nerons within the brain stimulate the diaphragm to contract (move downwards 1 cm to 10 cm) which
enlarges the chest cavity or thorax. This causes a negative pressure as in the first diagram resulting in inhalation
until the pressure in the alveoli within the lungs equals atmospheric pressure. At the end of inspiration, the
nerves to the diaphragm ceases firing and so this muscle relaxes. This “compresses” the air within the alveoli
which causes an exhalation. It is the movement of the diaphragm from the relaxed position to the contracted
position which causes the tummy to move out and from the contracted position to the relaxed position which
causes the tummy to move in.

Strategy for abdominal breathing
y Sit up straight and adopt correct posture
y Lengthen the distance from your sternum (chest bone) to your navel
y Have both feet flat on the floor
y Relax shoulder and upper chest- very important
y Lips together and jaw relaxed, breathe in gently through your nose
y Place one hand on your chest and one hand on your tummy
y Suppress or reduce the amount of movement of your chest with your hand
y Instead feel with your other hand your tummy move out with each inhalation and feel
your tummy move in on each exhalation
y Imagine a loose elastic band around your waist stretching as you inhale and contracting
as you exhale
y When breathing out- let air exhale naturally- do not force air out- the elastic recoil of
your diaphragm and lower chest will help to breathe air out effortlessly and quietly
Do not wear very tight fitting belts or clothes which will restrict abdominal breathing. Your
posture influences whether you breathe abdominally or upper chest. If you are slouched- you
will tend to breathe deeper using your upper chest. If you sit up straight, you will breathe less
deeply and will use your diaphragm more. Focus on your stomach expanding with each
inhalation and contracting with each exhalation. These movements are noticeable but slight.
It is only if you are breathing a large volume of air that you will have considerable
movement, this would not be good.
y At first nose/abdominal breathing will feel strange if you have been predominantly chest
breathing
y You may feel an air hunger as abdominal breathing reduces hyperventilation, this is a
good sign of progress.
y Practice doing this for ten minutes each day along with your exercises until you have
reduced upper chest breathing considerably
Remember- Breathe in - tummy out

Breathe out - tummy in

IMPORTANT- Cleansing Reactions
Overbreathing causes various physiolological changes to the body. It is important to know

that reduction of breathing may lead to various cleansing reactions and symptoms. The
symptoms you may experience are fever, headache, diarrhoea, coloured urine, nausea,
sweating, vomiting, increase temperature, excess mucus from nasal cavity and airpipes,
excessive tiredness with increased yawning, mild depression, general flu like symptoms or
feeling off colour for a couple of days.
Some people may experience a recurrence of symptoms in reverse corresponding to reaching

levels of 4, 4.5, 5.5 and 6.5% of CO2 content in alveolar air or control pause of 10, 20, 40
and 60 seconds respectively.
When you experience a headache or other cleansing reaction, continue to reduce your
breathing as this will shorten the lenght of time of your symptoms. Know that the symptoms
are due to your overbreathing and that the control pause will increase after the symptoms
have passed. It is okay to take a headache tablet to reduce symptoms.
When you experience cleansing reactions, increase your water intake.
People who have been on a large course of steroids may experiencing smelling of the
tablets/medicine through the skin. Again, this will pass, concentrate on doing shallow
Not all people experience cleansing reactions and for most people it is a slight headache.
So do not be alarmed when you do feel off colour. Know that this is our body readjusting to a
healthier way of life and that the symptoms will go in a short time.
On a positive note, all people will experience signs of health improvement including fewer
asthma symptoms, increased calmness and concentration, better sleep and more energy.

Length of time to practice breathing exercises;
Mild Asthma
y Never had any critical life threatening attacks or hospitalised

y Never used oral steroids such as prednisone
y Experience symptoms less than three or four times a week
y Can gain relief from a single puff of an inhaler
Practice half an hour twice per day for two months at least
Moderate Asthma
y Mild continuous asthma

y Regularly use bronchodilator with usually a steroid preventive inhaler
Practice half an hour twice to three times per day for three months at least
Severe Asthma
y Multiple types of medication- reliever and preventer

y Need frequent hospital visits
Practice half an hour three times per day for three to twelve months.
Practice time may seem to be a burden but it is very necessary as you are reversing a lifetime
of bad breathing. This cannot happen overnight. This time is the most rewarding investment
you can do to improve your quality of life. Initially I found the exercises to be time
consuming- however the rewards have far outweighed the time involved many fold.
Goal of Breath retraining
The primary goal of breath retraining is to reduce the volume of air to more correct levels.
Increased observation of breathing and practice of exercises as above is necessary to achieve
this. After a number of months application of breathing exercises and with an increase of
control pause to forty seconds, the amount of time set aside to do exercises can be decreased.
By then, reduced breathing will have become your way of life as you will be incorporating
reduced breathing in your every day activities. Your breathing will be reduced during your
speaking, eating, walking, sleeping, reading, cycling and whatever activity you are doing.
Anytime you then notice your breathing increasing, you will know to reduce it. This will
become an unconscious activity.

Medication
Medication for the control of asthma is very necessary. The following information regarding
medication is based on regular questions I have received from concerned users. The first
point I would like to make is that it is very important to know and understand the difference
between different types of medication. Medication can be divided into two main groups
namely reliever medication (bronchodilator) and preventer (steroid).
Reliever medication is further divided into short acting and long acting. Short acting reliever
inhalers are to be taken only when needed. Commonly prescribed short acting reliever
medications are Ventolin, Salamol, and Bricanyl. Long acting reliever inhalers such as Oxis
and Serevent are to be taken at regular times. Reliever medication come in grey, green or
Blue inhalers.
Preventer medication is predominantly steroid based and must be taken all the time
according to doctors instructions. Preventer medication is in red, brown or orange inhalers.
Commonly used preventer medications are Flixotide, Becotide and Pulmicort.
Short-acting bronchodilators (reliever)
y Should be used on an "as needed" basis to overcome attacks

y Take one puff only each time. Buteyko recommends to take one puff and wait for the
medication to take effect. This happens within five minutes. If you still need to take
another puff, then do so. There is no point in taking two puffs of reliever medication
when you only need one. Steroids are different, use steroids according to prescription.
y Until recently a standard recommendation was to use two puffs four times a day. But
“asthmatics do rather less well than when they took their bronchodilator only when they
needed it”. Professor Brostoff Asthma the complete guide
y Over use of short acting reliever inhalers leads to scarring of the airways and
irreversible damage.
Shortfalls
y They do not cure asthma- they don’t address the cause

y They cause hyperventilation. They force airways open and cause overbreathing. They are
also adrenaline based which causes hyperventilation.
Long-acting bronchodilators (reliever)
y Keep airways open for several hours

y Taken once every 12 hours and are prescribed for use on a regular basis, two puffs at a
time
y Should NEVER be used for emergencies. Some people have died taking long-acting
relievers for symptomatic relief
People who undertake Buteyko Breathing are advised to replace their long acting inhaler with
a short acting one such as ventolin.

Side effects of Bronchodilators
Hyperventilation
Tremor in muscles (often felt as a shaking of the hands)
Restlessness Dizziness
Headaches
Palpitations
Gastrointestinal upset
“Research shows that short acting beta 2 relievers used regularly, make the airways more
sensitive to allergens and exercise” Professor Jonathan Brostoff- Asthma The Complete
Guide
“Short acting beta agonist

Professor Jonathan Brostoff - Asthma the Complete Guide
Steroids (preventer)
y Most effective anti-inflammatory drugs
y Inhaled steroids usually brown canisters
y Do not give immediate relief
y True worth only emerges with continuos use
y Reduce inflammation
y Do not cure the underlying disease
y Take daily whether asthma symptoms occur or not
y Common mistake is to stop taking preventer when have fewer symptoms
Asthma slowly worsens again, the need for relievers increases and this can result in a serious,
uncontrolled asthma attack.
y Never stop your preventive medication without consulting your doctor
Steroids are very necessary in the control of asthma. Although steroid inhalers do have side
effect, they are far safer in treating asthma than an over reliance on reliever inhaler. It is
known that countries which have adopted a policy of steroid use for the treatment of asthma
have a lower death rate than those which have not. Use of reliever medication has been
described as putting paint on rust. Symptoms are suppressed while the underlying condition
gets progressively worse. This results in greater difficulty maintaining control and risk of
serious attack. On Asthma Care website, there is an article entitled Are Asthma Drugs the
Cure that Kills? This is located by clicking the link media articles.
All patients to Asthma Care will experience a substantial reduction of symptoms within a
short time after commencing breath retraining. The need for short acting medication will
therefore greatly decrease. When you or your child has not needed their reliever medication
for five weeks, make a visit to your doctor to have an examination. When your doctor is
happy with your progress, your steroid dosage will be reduced a little.
After this time with a small reduction of steroid, you may have slight asthma symptoms.
Continue to practice your breathing exercises and when you do not need your reliever
medication again for a period of four weeks, visit your doctor to have your steroid intake
reduced a little for the second time. Only reduce your steroid intake in conjunction with
your doctor as insufficient preventer medication could result in a serious uncontrolled
attack.
Steroids Dose
Adults Children Over 5

A Low dose 100-400 mcg per day
A Moderate dose 500-800 mcg per day
A high dose more than 800 mcg
Children less than 5 Years of age

A Low dose less 200 mcg per day
A Moderate dose 250-400 mcg per day
A high dose more 500 mcg per day
Asthma facts
y Study conducted by the ISAAC concluded in 1998 that Ireland has the forth highest
prevalence of asthma in the world with 274,000 people (half of which are under sixteen
years of age) after United Kingdom, New Zealand and Australia.
“For asthma symptoms, the highest 12 month prevalence were from centres in the UK,
Australia, New Zealand and Republic of Ireland. The lowest prevalence were from centres in
several Eastern European Countries, Indonesia, Greece, Taiwan, Uzbekistan, India and
Ethiopia. 463,801 children in total were studied in centres from 56 countries.
Published in The Lancet Volume 351 Issue 9111 25 April 1998- World wide variation in
prevalence of symptoms of asthma.
y 70% of people have persistent asthma for which preventative medication is necessary.
y Boys have asthma more commonly than girls
y About half the children with mild asthma will improve and "grow out of" the condition
through their teenage years
y Adult or "late onset" asthma occurs, more frequently in women than in men
y Rate of asthma among children in Ireland

1983 4%
1992 11%
1995 15.2%
1998 18.3%
y Death Rate from Asthma in Ireland - This is due to poor awareness and control of
condition. Over reliance on reliever medication.
1980- 69 males 65 females


Research Results
Two trials have been conducted on Buteyko Breathing Therapy and Asthma in the western
world. Throughout the development of Buteyko Breathing Method, several trials were
conducted in Russia which substantiated the therapy lead to its incorporation in Russian
medical doctrine. Medical textbooks in Russia contain information regarding Professor
Buteyko’s discovery.
The first trial of the Western world was conducted in 1995 at the Mater Hospital in Brisbane,
Australia. This was overseen by some of Australia's medical asthma experts. Taken from an
initial 170 people, 39 asthmatics were selected as they met criteria regarding asthma
diagnosis. These were divided into two groups. One group was taught normal physiotherapy
and conventional management of asthma. This is called the placebo group.
The second group was taught Buteyko Breathing therapy. The trial was blind meaning that
neither group knew which therapy they were being taught. There was no mention of the word
Buteyko during Buteyko Breathing sessions.
Average intake of air per person between attack

y 15 litres of air per minute- three times the norm
Buteyko Breathing Group results

y After 6 weeks
Results after eight months
Reliever medication
y
y Placebo group had increased average use by 9%
Inhaled Steroid
y Buteyko decreased average use by 49%
y
Symptom Scores
y Buteyko group - 71% improvement
y Placebo group - 14% improvement
The volume of air inhaled was reduced from an average of fifteen litres to an average of nine
litres per minute for the Buteyko group. Those who reduced their inhaled volume of air the
most also reduced their medication the most (under medical supervision of Professor Charles
Mitchell). This proves the direct correlation of over breathing and asthma symptoms.

Following the trial, all persons who were part of the placebo group were then trained in
Buteyko Breathing Therapy. On average this group also showed the same improvement as
the first Buteyko group involved with the trial.
Second Trial in Western World
This trial was researched by Jill McGowan as part of her PhD. with The University of
Strathclyde. This involved 600 patients and was conducted from April 2001 until April 2002.
These results are preliminary, are subject to scientific scrutiny and are due to be published in
a scientific journal.
Reliever Medication
---------------------------
Buteyko Group - decreased by 98%, 6 months and remained same at 12 months
Placebo and Control groups - no significant change
Preventer Medication
---------------------------
Buteyko Group - decreased by 92%, 6 months and remained same at 12 months
Quality of Life
-------------------
Buteyko Group - increased by 100%, 6 months and remained same at 12 months
Will Asthma Care Work for Everybody?
No it will not.
The reason is because not all people have enough discipline to follow through and practice
their breathing exercises. The results from all trials show that the people who reduce their
breathing volume the most reduce their need for medication the most. Reduction of breathing
volume is by regular practice of breathing exercises, increased observation of breathing at all
times and relaxation of the respiratory muscles to create a little air shortage at all times.
If you are doing all the above and are not achieveing results then increase the amount of time
you are spending on practice exercises.
If this does not achieve results for you, then call Asthma Care at 091 756229 or send us an
email to info@asthmacare.ie. We will then arrange a follow up session for you so that results
can be achieved.
If you are a severe asthmatic, then you need to spend as much time as possible being aware
of your breathing and doing exercises. If you have emphysema, then you need to spend even
more time than a person with asthma doing these exercises. If you are bed ridden, then it is
good to spend all day observing breathing.
We will work with all persons until they can apply method correctly and have results.

Diet and Asthma.
Asthma Care program is 90% about retraining of breathing with 10% observation of diet. The
recommendations regarding diet are very helpful for better breathing, better control pause,
less asthma symptoms and better health.
Guidelines with regard to diet are as follows:
y Only eat when you feel hungry. When you feel hungry, your body is telling you that it is
time to eat. If you do not feel hungry, then you do not need to eat. If you eat when you are
not hungry, your body uses energy in order to process a food that it does not need. This
increases your breathing and is not good for your health.
y Limit high protein foods such as dairy foods, meat, fish, eggs
High protein foods increase our rate and volume of breathing thus causing mucus production.
Children with constantly blocked or runny noses often clear when they stop drinking cows
milk. Many allergies and breathing problems can be directly related to dairy consumption.
Studies indicate that proteins in cows Milk, eggs, peanuts, soy and wheat are the most
common food allergies. Milk is the most harmful of these foods and some studies indicate
that children who are not fed milk before the age of two have less allergies. It is interesting to
note that the world wide rate of asthma is highest in Anglo-Saxon countries of UK, Australia,
New Zealand, Ireland, USA and Canada. These are also the countries with the highest per
capita consumption of milk in the world.
Japanese who consume hardly any milk because of their genetic inability to digest lactose
after infancy have an asthma prevalence of 1/20 of ours.
Milk is not the only food to provide calcium. Good sources of calcium include kelp, turnip
greens, rhubarb, broccoli, lambs kidney, tofu, tinned salmon with bones, baked beans,
fortified oatmeal and other cereals, all leafy green vegetables and kale.
y Fresh food is best. The longer the time a food is harvested before it is eaten, the more
nutrition it loses. Some foods are harvested twelve months before they are consumed.
The amount of nutrition in these foods is substantially lower than if the food was
consumed straight after harvesting. For this reason, I would regard all breakfast cereals as
stale foods.
y Limit refined foods- e.g. white bread, jams, chocolate etc. or most foods that are mass
advertised.
Dr Price’s research of the Gaelic people living on the Hebrides in the 1930s noted that when
the traditional people changed from a diet of small sea foods and oatmeal to the modernised
diet of “angel food cake, white bread and many white flour commodities, marmalade, canned
vegetables, sweetened fruit juices, jams, and confections”, first generation children became
mouth breathers and peoples’ immunity from diseases of civisliation reduced dramatically.
The traditional diets were found to provide at least four times the minimum requirement of
nutrients. The modern diet did not meet the minimum requirement. For example, here is a
quote taken from Dr Price’s book Nutrition and Physical Degeneration

“Modern white flour has had approximately four fifths of the phosphorous and nearly all of
the vitamins removed by processing, in order to produce a flour that can be shipped without
becoming infested with insect life. Tests showed that White bread was unable to sustain
insect life, while half a slice of whole rye bread was totally consumed by bugs.”
y Limit sugar
y Limit Junk food
y Don’t smoke
y Limit foods that promote inflammation

Red meat encourage the mast cells to release leukotrienes, which are even more potent than
histamine. (leukotrienes, histamine are inflammatory chemicals)
y Limit Coffee and conventional tea. Coffee sharply increases breathing.

Coffee and tea will temporarily help you to breathe because it stimulates the adrenals in an
extreme situation. However in the long run, it will only succeed in further exhausting you.
Caffeine tends to open up the airways and will have this effect on most asthmatics. The
amounts needed to have any noticeable effect are a large number of coffees, but this will
produce some unpleasant side effects.
y Cooked food produces more ventilation than raw food
y Don’t eat a heavy meal last thing before going to bed- will deep breathe during the night
and will not have a good nights sleep
y Spice up your meals- garlic, ginger, curry etc.
y Sea Salt in cooking is good. A half a teaspoon of sea salt in warm water is a known anti
histamine. It also helps reduce palpitations and helps break up mucus trapped in airways.
You should get relief from symptoms after fifteen minutes.
y Eat five servings vegetables a day. Eat fruit but not too much citrus or bananas. Citrus is
y Drink water- mucus tends to be thicker when you are dehydrated.
Observe which foods make your asthma symptoms worse. All foods increase our breathing,
Is there any foods you crave for instance chocolate or crisps? If so it is likely that you an
intolerance to these foods and consume then due to the bodys release of endorphins to avoid
pain.

Foods to limit in quantity are:
Dairy and products containing dairy ingredients

Milk, Yoghurt, Cheese, Ice cream, cream soups, Chocolate.
High protein
Beef, pork, chicken, fish, eggs
Stimulants
Coffee, strong teas, alcohol, cocoa, soft fizzy drinks, drinking chocolate.
Antigens
Citrus fruits, raspberries, strawberries, wheat, nuts.
Vitamin supplementation
Vitamin and mineral supplementation is recommended because hypervetilation causes the

body to excrete some minerals such as magnesium, calcium and potassium in order to
maintain PH. It is therefore necessary to replenish these, as the loss of magnesium leads to
further hyperventilation.
Nowadays, the soil from which are food is harvested is overused and does not have time to
replenish vital minerals which we need. Pesticides, chemicals are all added in an effort to
increase production. We have to accept that the quality of our food is not as high as it was for
our ancestors. It is because of this reason that I supplement my diet.
Magnesium-
The best form of magnesium to purchase is liquid magnesium. It is more expensive and a
little difficult to find but is better absorbed by the body. Magnesium in chalk form is more
commonly found in any health store and is beneficial to take. People who have difficulty
breathing will find that magnesium is helpful within a couple of days of starting to take this
vitamin. Most people with asthma are deficient in magnesium. (in fact I have spoken with a
Kinesiologist in the UK who told me that over the thousands of asthmatics he tested, they
were all deficient in magnesium.) Speak with an authority at the health store prior to
purchasing magnesium.
y Magnesium is a natural bronchodilator (opens the airways)
y Some hospitals in USA prescribe intravenous magnesium to complement with other

medicine in the event of an attack.
y Magnesium helps stabilise
y Some studies conclude hyperventilation stops with magnesium supplement

Sources of magnesium include whole grains, nuts, avocado, beans and dark leafy vegetables.
Supplement magnesium according to recommended daily amounts as stated by
manufacturers.
Vitamin B5 or Pantothenic acid
y When B5 is deficient the adrenal glands become weak and compromised

y Allergies are often a sign of B5 deficiency
y Involved in the production of cortisone and other hormones produced by the adrenal
Good sources of B5 are liver, kidney, whole grain products, peanuts, eggs and watermelon
Water
y Your body is 70% water
y Eat high water content food- fruit and vegetables
y Water transports the nutrients
y Dehydration- histamine increase greatly (histamine is an inflammatory cell)
y Drink warm water regularly
y Alcohol or caffeine- are diuretics- promote loss of water- dehydration
You need to replenish the water you lose each day by drinking pure water. You lose water
through sweat and in the excretion of bodily waste.
With asthma the need for water increases as laboured breathing contributes to dehydration.
We breathe an average of 18,000 times per day. We all know that if we breathe for one or
two breaths directly onto a dry window, there will be a residue of moisture left on the
window. This is a loss of moisture from the body. Imagine the amount of moisture that we
lose in a 24 hour period.
Drink eight glasses of pure water not coca cola or any other soft drink throughout the day.
Drinking alcohol, coffee, tea, coca cola and other caffeine drinks promote water loss and
dehydration. These drinks are known as diuretics.
If you are very active and play a lot of sports, then your need for water increases.
At first sign of symptoms, drink warm water with a half a teaspoon of sea salt in combination
with breathing exercises to greatly reduce an attack.
High water consumption may cut cancer risk by essentially washing carcinogenic substances
out of the body before they have a chance to come into contact with vulnerable tissue. It is
worth noting that the healthiest and as a result longest living people in the world live on a
high water content diet.

Allergy
During Asthma Care workshop, very little time is devoted to allergies as this information can
be got from any self help manual on asthma or from The Asthma Society of Ireland (tel. 01
878 8511). The main point is that over breathing results in the immune system working under
par. When the control pause increases to forty and beyond, allergens will become far
less of a problem. Buteyko recognised asthma as having one cause namely over breathing.
Allergies are triggers to asthma attack, they are not the cause. Until your control pause
reaches forty, take usual measures for the avoidance of allergies because until then
allergens will continue to trigger your attack. Reduced breathing will reduce affects from
allergies and triggers.
y When you come in contact with an irritant or allergen for example a cloud of dust along
the street. Breathe out and hold your breath, take 10-15 steps without breathing. Try to
hold your breath until you pass the allergen. If there is a lot of allergen and it is not
possible to hold your breath, then breathe very shallowly.
The purpose of this is to raise your defence system and also to inhale far fewer allergic
particles. This should be done any time you observe pollutants. E.g. hold your breath when
someone sprays deodorant, when a bus passes on the street etc. etc.
As dust mites are very common allergens, steps to take are listed briefly.
House Dust Mites
y Use anti mite covers on mattresses and put tape on seams to reduce dust mite escaping.
y Wash bedclothes regularly at a temperature of 60 degree or higher
y Do not sleep in lower half of a bunk bed
y Soft toys harbour a lot of dust mites. Freeze toys for an hour each week prior to washing.
y Remove pot plants and fish tanks as they are sources of humidity
y Do not dry clothes on radiators
y When dusting use a damp cloth to prevent dust from rising
y If you are allergic to dust, do not work in a dusty environment. Always wear a dust mask.
y Use a dyson vacuum cleaner or one that retains air

y Have wooden floors in bedrooms and not carpet
y Curtains with light material instead of heavy curtains.
Dust mites, moulds, pollen and Cat dander are microscopic airborne particles. They are very
difficult to avoid all the time. Instead take whatever measures you can to reduce your
exposure to them and concentrate on increasing your control pause to forty. When your
control pause reaches forty, you will have no further questions on allergens.
Temperature Extremes.
Temperature extremes of both hot and cold increase breathing. The sport with the greatest
risk for people with asthma is cross country skiing. During cold winter days, it is advisable to
wear head gear. If entering cold water, enter very gradually. People who straight into jump
into cold water take a deep breath due to a reflex action. In this situation, it is best to
immerse gradually and so prevent the deep breath. When entering from indoors to outdoors
or from one temperature to another e.g. shower to cold room- breathe shallow. Do not pant.
Do not stay in rooms which are to hot and try not to over dress.


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Office Six

“The Perfect man breathes as if he is not breathing”

Do not alter any medication or treatment without prior consultation and

DIABETICS -PLEASE NOTE

Copyright 2002 by Patrick McKeown

Buteyko research results 38

Diet and asthma 40

Copyright 2002 by Patrick McKeown

y Severe over breathing is breathing a volume of 20 to 30 litres per minute. This is

3 - alveoli (air sacs)

8 - larynx /voice box

Fig 1-Organisation of the respiratory

Copyright 2002 by Patrick McKeown

Fig 2: Alveoli or air sacs are grape like

Bad Breathing resulting from modern

Copyright 2002 by Patrick McKeown

y Professor Buteyko believes that inflammation and allergic hyper-responsiveness is caused

y When carbon dioxide is low, the production of mucus increases.

Copyright 2002 by Patrick McKeown

Hyper means too much

The following are the symptoms caused by hyperventilation. Hyperventilation “presents a

Respiratory System- symptoms of asthma

Nervous System- Light-headed, poor concentration, numbness, sweating, dizziness, vertigo,

Heart- Racing, pain in the chest region, skipped heart beats

Psychological- Degrees of anxiety, tension, depression, apprehension, stress

1. Misconception of Deep Breathing

Copyright 2002 by Patrick McKeown

5. Lack of physical exercise

Swimming is an excellent exercise for asthmatics as increased muscle movement combined

Copyright 2002 by Patrick McKeown

The three basic steps involved with breath retraining are;

a. Becoming more aware of bad breathing

Breathing through your nose serves a number of very important functions

With breathing through the nose:

Breathe through your nose at all times

y When you are watching television or reading

How to unblock your nose;

Copyright 2002 by Patrick McKeown

Your nose is a very good indicator of your breathing rate

Copyright 2002 by Patrick McKeown

Using Buteyko Method to reverse hyperventilation

In order to commence Buteyko Breathing Method, it is necessary to learn how to measure

Check for the pulse

To measure control pause

1) Sit comfortably in an upright chair

5) Remember breathe out and then count seconds.

6) This is for measurement purposes only.

y Holding the breath after an inhalation

Copyright 2002 by Patrick McKeown

If your control pause is less than ten seconds you have a

Control pause of 20 seconds

Control pause of thirty seconds

Control pause of 40 to 60 seconds

Morning control pause of sixty seconds

Copyright 2002 by Patrick McKeown

Copyright 2002 by Patrick McKeown

The purpose of exercises and increased observation of breathing is to substantially decrease

How should I breathe?

We know that we are not breathing correctly when

We are breathing correctly when

How much progress can I expect?

Copyright 2002 by Patrick McKeown