Asthma, Breathing

What's Your Poison?

I have asthma. Sorry, past tense. I had asthma. For years as a kid I struggled with shortness of breath in certain conditions, such as cold, dry air, and exercise. My dad had always suffered from asthma, and carried a 'puffer' like the one in the picture above around with him at all times, puffing several times an hour. So eventually a GP diagnosed asthma, and I got puffers of my own. Not just a reliever like the Ventolin inhaler above, but also a preventative puffer in a very fetching cream and dark brown, full of juicy steroids to gradually reduce the twitchiness of my airways.

These all worked. They never got rid of the asthma, but they managed it well. But then out of the blue I developed heart arrhythmias. Also something my dad had. This ended up in surgery to correct aberrant pathways in the elctrical parts of my heart, which worked for about 5 years. Then I got another arrhythmia. This time the doctor said I'd need to be on life-long beta blockers. That was my 'enough is enough' moment. Time to think it through and research things myself.

The funny thing is, if you go to the doctor and tell them you have a heart arrhythmia, one of the first things they'll ask is if you're using something like Ventolin. And if you are, that you should avoid it. Ventolin and asthma relievers in general are heavily implicated in triggering arrhythmias. Is it just me that has a sort of epiphany here? Not "incompetent health science caused my arrhythmia with the asthma medication", although there is that. But more - these things seem to be intrinsically linked. The asthma and the arrhythmia seem to have some fundamental connection physiologically.

Not that the doctors ever seemed to think this. As I always drone on about, they like to treat you as a collection of independent, billable ailments. It's the model of the body and health they're taught, and it shoehorns beautifully into the greatest source of their wealth. But as somebody trained in science, my curiosity was piqued, and looking down the barrel of a life on toxic drugs was more than enough motivation.

It all came back to breathing. Most people, including doctors, don't understand the very basic, high school science behind breathing. I wouldn't mind betting that the majority of us think that breathing is what I call a 'suck and blow' process. (Settle, filthy minds.) To breathe in you suck in air, and to breathe out you blow out air. I can guarantee that if you breathe like this, you'll be an asthmatic inside 10 minutes. What we all know but probably never think about is that most of the time we're not aware of breathing at all. We're not sucking and blowing because we're not even aware that we're breathing - it's just happening all by itself.

How we're really built to breathe is much more interesting. It's a combination of air pressure and the elasticity of our breathing apparatus. We breathe in when the air pressure outside our bodies is greater than the air pressure inside our bodies, which of course causes air to flow from outside us into our lungs (i.e. the air is 'pushed in by the entire Earth's atmosphere outside, if you liike, rather than us 'sucking' it in. As the old science joke says, vacuums don't suck). Like how any vacuum works, sort of. Then our musculo-skeletal, elastic breathing mechanism rebounds as it is expanded by this incoming air, and expels it as we breathe out. A beautiful, delicate interplay between pressure and elasticity. Nothing for us to do at all, it all happens just by itself.

If you suck and blow to breathe, which will often happen at times of activity (like exercise, when I suffered my worst asthma), your airways become twitchy and close up to some extent. This now seems to me to be the result of the air being forced into and out of you at too great a rate, and even more by your fiddling with your breathing apapratus rather than letting it function as a self-regualting elastic system.

[This next bit is early days in terms of me linking it all to existing scientific principles.]

It's partially tied up with the venturi effect I suspect, which Wikipedia summarises pretty well here. As your wind 'pipes' become constricted, the pressure of air flow through those constricted areas drops and the air flows faster - this is the 'wheeze' you hear in asthmatics. They constrict in the first place because when you suck air in, that too-great volume of air has to be shut down to satisfy the 'equation of contiunuity' in fluids, which basically is the conservation of mass i.e. you can't magically add or subtract fluid from a closed system, so the system responds with changes to pipe diameter or fluid veolicty etc. as conditions change, to mainatin that equilibrium.

Asthma is just bad breathing. And the worse the breathlessness gets, the more you tend to react to it, which means even more fiddling, and it then gets even worse - and onwards down a potentially lethal spiral towards no breath at all.

I can test this myself at any time, if the weather (such as a storm) brings on breathlessness, I can immediately release it by simply not fighting the contraction I feel. That contraction is your system doing what it always does, trying to keep you alive - you're sucking in that air too fast, and it's shutting down your airways to prevent that massive inrush. Just as your nose will get blocked if you suck air through it, as the passages dry out and become inflamed - if you accept the blocked-ness, you start to breathe through your mouth (automatically), which then relieves the nasal passages, and they become unblocked again. At which point you automatically start breathing through your nose again. (You'll also notice that often in cold air when exercising, your nose produces more mucus - it becomes runny. This I'm sure is your system trying to compensate for that great rush of cold, dry air coming into your nose).

How this links to the heart is still not clear to me, but in many ways it doesn't need to be. Fixing the bad breathing - by letting my system breathe for me - has so far stopped the heart issues as well. The Chinese see arrhythmias as being about bad breathing, and as above the medical science knows that treatments for asthma can trigger arrhythmias, so the link has been discovered there as well, they just don't seem to have realised it. It's linked to the nervous system (autonomic and sympathetic and so on) as well, as voluntary and automatic physiological responses are regulated there, and also regulate things like your heart.

By the way, 'good breathing' at rest can mean as few as 4 or 5 breaths per minute. That's my regular experience now, whereas for the average Westerner the average is 10-16. There are all sorts of spin-off effects to breathing well, not least of which is feeling absolutely bloody amazing. I might talk about some of the others next time. The East has always placed breathing central to health, and there do seem to be very good reasons for this.